An in vitro study of adherence of coagulase-negative staphylococci to bone chip columns

Coagulase-negative staphylococci (CNS) have become a dominant cause of bone infections and their adherence to the infected bones is a prerequisite for the initiation of these infections. In the present study we investigated and compared the adherence of CNS bacteria to human, chicken and rabbit bones. The study was performed using columns made of bone powder from the three different sources, and measurement of the extent of adhesion to bones of CNS bacteria as an in vitro model which is based on particles of matrix that are closely related to the natural matrix. The adhesion to rabbit bone was relatively high, while adhesion to both human and chicken bone columns was lower and almost identical. Pretreatment of the CNS bacteria with sodium periodate, beta-galactosidase or proteinase K significantly inhibited by 50-60% the adhesion to human bones. Pretreatment of CNS bacteria with subinhibitory concentrations of vancomycin or tunicamycin increased their adherence to human bones several-fold. When the bones were pretreated with vancomycin a considerable increase in the adhesion rate of the bacteria to human and chicken bones was seen. A smaller increase in adherence was observed after pretreatment of human bones with the antibiotic tunicamycin. Salicylic acid or benzalkonium chloride (BZC) also resulted in an increase in adhesion to these pretreated bones. From the results obtained it seems that pretreatment of the CNS bacteria with certain reagents exposes adhesins on the surface of the CNS bacteria. On the other hand, pretreatment of the bones with other reagents may enable a better exposure of receptors located on the bone cells and, as a consequence, may improve the adhesion of the CNS bacteria to the treated bones.

Multifocal osteomyelitis in a child: a rare manifestation of cat scratch disease: a case report and systematic review of the literature

We present a case of a 9-year-old immunocompetent girl who presented with pain in her left elbow and a painful swelling at her left clavicle. She had no lymphadenopathy or fever. Four hot spots were seen at her left clavicle, proximal and distal left humerus and lumbo-sacral spine on a bone scan. A magnetic resonance imaging showed an inflammatory process with bone destruction at her clavicle. Serological testing and polymerase chain reaction performed on a bone biopsy identified a Bartonella henselae infection. She was treated with rifampin and trimethoprim-sulphamethoxazole. After a relapse half a year later, the patient recovered fully. Multifocal osteomyelitis is a rare manifestation of cat scratch disease in children.

The diagnosis of osteomyelitis of the foot in diabetes: microbiological examination vs. magnetic resonance imaging and labelled leucocyte scanning

AIMS

Foot infections and their sequelae are among the most common and severe complications of diabetes mellitus. As diabetic patients with foot infections develop osteomyelitis and may progress to amputation, early diagnosis of osteomyelitis is critical.

METHODS

We compared the diagnostic values of labelled leucocyte scanning with Tc(99)m, magnetic resonance imaging (MRI) and microbiological examination of bone tissue specimens with histopathology, the definitive diagnostic procedure. Thirty-one diabetic patients with foot lesions were enrolled in the study and histopathological examination was performed in all. Patients had clinically suspected foot lesions of > or = grade 3 according to the classification of Wagner.

RESULTS

Bone specimens were obtained for histopathological examination. Microbiology had a sensitivity of 92% and specificity of 60%. Labelled leucocyte scanning had a sensitivity of 91%, specificity of 67%, and MRI a sensitivity of 78%, specificity of 60%.

CONCLUSIONS

Microbiological examination may be as useful as and less costly than other diagnostic procedures and is the only method which can guide the choice of antibiotic therapy.

The effects of combined gentamicin-hydroxyapatite coating for cementless joint prostheses on the reduction of infection rates in a rabbit infection prophylaxis model

Infections remain a critical issue in total joint arthroplasty. Addition of antibiotics to bone cement was shown to significantly improve antimicrobial prophylaxis in cemented joint arthroplasty. In cementless joint arthroplasty a comparable prophylaxis by local antibiotics has not been possible yet. The aim of the current study was to investigate the antimicrobial effect of two different gentamicin-hydroxyapatite (HA) coatings for cementless prostheses in a rabbit infection model. Staphylococcus aureus with a dose of 10(7) CFUs was inoculated into the intramedullary canal of the tibia of 30 rabbits followed by the implantation of standard steel HA K-wires (n=10), steel K-wires coated with a gentamicin-HA combination (n=10), and steel K-wires coated with a gentamicin-RGD-HA combination (n=10), respectively. The animals were sacrificed after 28 days and clinical, histological and microbiological assessment on the bone and on the removed K-wire itself by agar plating and DNA-pulsed field gel electrophoresis were carried out to detect infection. There was a statistically significant reduction of infection rates by both gentamicin-coating types (0 infections in both groups) compared to standard HA coating (7 infections in 8 animals; 2 animals were lost due to acute diarrhea) (p<0.001). An excellent correlation between agar plating testing results of the K-wires and of the bone samples was found. Detailed histology showed cortical lysis, abscess and sequester formation in the infected animals. Both gentamicin-coating types showed significant improvement of infection prophylaxis compared to standard HA coating and, therefore, this coating technology could help to improve infection prophylaxis in cementless total joint arthroplasty. In further studies biocompatibility of the coatings has to be assessed.

A prospective evaluation of the diagnostic value of sinus specimen cultures in chronic osteomyelitis

We prospectively compared organisms isolated from sinus and bone marrow specimens in 25 patients with chronic osteomyelitis at the King Orthopaedic Clinic, Ekpoma, Edo State, Nigeria between January 2001 and December 2003. Sinus and bone marrow specimens were taken from each patient at the time of surgery and sent for aerobic cultures. The mean age was 12 years, with a range of 6-40 years. Staphylococcus aureus was the commonest organism associated with chronic osteomyelitis. Organisms isolated from the sinus specimens were similar to those obtained from the bone marrow specimens. Sinus specimen culture is a good guide to selection of antibiotics in the preoperative treatment of chronic osteomyelitis.

Evaluating bacterial pathogen DNA preservation in museum osteological collections

Reports of bacterial pathogen DNA sequences obtained from archaeological bone specimens raise the possibility of greatly improving our understanding of the history of infectious diseases. However, the survival of pathogen DNA over long time periods is poorly characterized, and scepticism remains about the reliability of these data. In order to explore the survival of bacterial pathogen DNA in bone specimens, we analysed samples from 59 eighteenth and twentieth century individuals known to have been infected with either Mycobacterium tuberculosis or Treponema pallidum. No reproducible evidence of surviving pathogen DNA was obtained, despite the use of extraction and PCR-amplification methods determined to be highly sensitive. These data suggest that previous studies need to be interpreted with caution, and we propose that a much greater emphasis is placed on understanding how pathogen DNA survives in archaeological material, and how its presence can be properly verified and used.

Etiologic diagnosis of chronic osteomyelitis: a prospective study

BACKGROUND

Although bone specimens were established 25 years ago as the gold standard for etiologic diagnosis of chronic osteomyelitis, recent studies suggest that nonbone specimens are as accurate as bone to identify the causative agent. We examined concordance rates between cultures from nonbone and bone specimens in 100 patients.

METHODS

Prospective study conducted at Hospital Universitario San Vicente de Paul, a 750-bed university-based hospital located in Medellín, Colombia. We included patients with chronic osteomyelitis who had been free of antibiotic therapy for at least 48 hours, excluding those with diabetic foot and decubitus ulcers. At least 1 nonbone and 1 bone specimen were taken from each individual and subjected to complete microbiologic analysis.

RESULTS

Bone cultures allowed agent identification in 94% of cases, including anaerobic bacteria in 14%. Cultures of nonbone and bone specimens gave identical results in 30% of patients, with slightly better concordance in chronic osteomyelitis caused by Staphylococcus aureus (42%) than by all other bacterial species (22%). However, statistical concordance determined by the Cohen kappa statistic was less than 0 (-0.0092+/-0.0324), indicating that the observed concordance was no better than that expected by chance alone (P>.99).

CONCLUSIONS

Appropriate diagnosis and therapy of chronic osteomyelitis require microbiologic cultures of the infected bone. Nonbone specimens are not valid for this purpose.

[Tuberculous osteoarthritis of the foot in the diabetic: not unrecognize this diagnostic trap. About one case]

Osteoarticular tuberculosis is the fourth leading extrapulmonary localization of tuberculosis. The disease has a progressive course and is often diagnosed in the stage of bone destruction, causing an important diagnostic problem in diabetics with nervous osteoarthropathy. We report the case of a 23-year-old patient with multicomplicated diabetes type 1, treated for pulmonary tuberculosis who consulted after a trauma distended the left ankle. Bone biopsy was performed because of the diagnostic doubt between diabetes and infectious osteoarthropathy. Pathology reported active tuberculosis. Osteoarticular tuberculosis is still a severe disease because of the functional prognosis that requires early diagnosis, a difficult task in some conditions particularly in the diabetic where the disease may mimic nervous osteoarthropathy. Bone biopsy should be performed if there is a doubt.

Endogeneous sources of infection in transplant recipients

The mammal organisms carry on their surfaces and in their tissues cohorts of microorganisms of various nature. There is a balance of interests and profits between the host and microbial inhabitants. The bacteria and fungi behave like comensals, colonizers, dormants, however, under certain, mostly unknown, conditions may evoke reaction of the host. This process is damaging both for the host and microbes. Large surgical trauma and allograft itself, as well as, immunosuppression create favorable conditions for imbalance between inhabiting microorganism and the recipient. The host flora and that transplanted with the organ graft become activated. Active combating of the proliferating bacteria with antibiotics becomes necessary. Our knowledge of the bacterial flora of the so called "sterile" tissues remains rudimentary. There is still a great deal of prejudice on the sterility of deep tissues e.g. muscles, fat tissue, etc. This review cumulates pertinent literature data on the microorganisms-host interactions. Our own findings on colonization of arteries and adjacent tissues are discussed in the context of atherosclerosis and grafting.

Evolutionary innovation: a bone-eating marine symbiosis

Symbiotic associations between microbes and invertebrates have resulted in some of the most unusual physiological and morphological adaptations that have evolved in the animal world. We document a new symbiosis between marine polychaetes of the genus Osedax and members of the bacterial group Oceanospirillales, known for heterotrophic degradation of complex organic compounds. These organisms were discovered living on the carcass of a grey whale at 2891 m depth in Monterey Canyon, off the coast of California. The mouthless and gutless worms are unique in their morphological specializations used to obtain nutrition from decomposing mammalian bones. Adult worms possess elaborate posterior root-like extensions that invade whale bone and contain bacteriocytes that house intracellular symbionts. Stable isotopes and fatty acid analyses suggest that these unusual endosymbionts are likely responsible for the nutrition of this locally abundant and reproductively prolific deep-sea worm.

Musculoskeletal tissue banking in Western Australia: review of the first ten years

BACKGROUND

Musculoskeletal tissue allotransplantation has been used as a standard approach for reconstructive surgery. The present study has reviewed the banking of musculoskeletal tissue at the Perth Bone and Tissue Bank (PBTB) and provided evidence of quality assurance on musculoskeletal tissue allotransplantation.

METHODS

All donor tissues were processed in accordance with the Therapeutic Goods Administration's relevant codes of good manufacturing practices. Microbiological monitoring at each step of manufacture and postoperative surveying of the musculoskeletal allotransplantations were both conducted. The possible contribution of contaminants in allografts to postoperative infections was also assessed.

RESULTS

Of the 5276 donors obtained over the last 10 years, 1672 were rejected, giving an overall donor rejection rate of 32%. Milled femoral heads were the most frequently implanted allografts, followed by whole femoral heads. In the postoperative survey an infection rate of 4.9% was found (113/2321 recipients). The infectious agents were identified in 65 cases but for 60 of these there were no correlations with the positive culture test results for the allografts. The organism most commonly identified in postoperative infections was Staphylococcus species.

CONCLUSIONS

The present study shows evidence that musculoskeletal tissue allotransplantation is a safe procedure when accompanied by high standards of quality assurance.

Genotypic analysis of the earliest known prehistoric case of tuberculosis in Britain

The earliest known case of human tuberculosis in Britain dates to the middle period of the Iron Age, approximately 2,200 years before present. Bone lesions on the spine of a male skeleton excavated at Tarrant Hinton in Dorset, United Kingdom, show evidence of Pott's disease and are supported by molecular evidence of Mycobacterium tuberculosis complex DNA amplified by IS6110 PCR (19). In the present study, we used a further series of sensitive PCR methods to confirm the diagnosis of tuberculosis and to determine the genotype of the infecting strain. These tests demonstrated that this individual was infected with a strain of M. tuberculosis rather than Mycobacterium bovis. The strain had undergone the tuberculosis D1 deletion affecting the mmpS6 and mmpL6 genes and can therefore be identified as a member of the family of "modern" M. tuberculosis isolates. All evidence obtained was consistent with surviving mycobacterial DNA being highly fragmented in this case.

Effective use of optimized, high-dose (50 kGy) gamma irradiation for pathogen inactivation of human bone allografts

The safety of tissue allografts has come under increased scrutiny due to recent reports of allograft-associated bacterial and viral infections in tissue recipients. We report that 50 kGy of gamma irradiation, nearly three times the dose currently used, is an effective pathogen inactivation method when used under optimized conditions that minimize damage to the tissue. Cancellous bone dowels treated with a radioprotectant solution and 50 kGy of optimized irradiation had an ultimate compressive strength and modulus of elasticity equal to conventionally irradiated (18 kGy) and non-irradiated control bone grafts. We subjected bone dowels treated with this pathogen inactivation method to an in vitro cytotoxicity test using three different mammalian cell lines and concluded that the treated grafts were not cytotoxic. The log reduction of nine pathogens spiked into radioprotectant-treated bone irradiated to 50 kGy was also tested. We achieved 4.9 logs of inactivation of a model virus for HIV and hepatitis C and 5 logs inactivation of a model virus for human parvovirus B-19. Complete inactivation (6.0-9.2 logs) of seven clinically relevant microorganisms was demonstrated. The results show that a combination of radioprotectants and optimized, high-dose gamma irradiation is a viable method for producing safer cancellous bone grafts that have the mechanical strength of existing grafts.

Development of heating method by microwave for sterilization of bone allografts

The purpose of this study was to develop a disinfection method using a microwave apparatus to treat large bone allografts. Heating of a bone allograft is an effective method for the disinfection of bacteria or inactivation of viruses. However, the size of the bone we can treat is limited, and following the popular method of using a bathtub is a lengthy process. The experimental system described here was designed using a microwave oven, an optical-fiber thermometer, and a power regulator. Large and small specimens, a femoral head, and a metatarsal were harvested from a bovine femur. The influence of size and the electrical or thermal characteristics of the specimens were assessed regarding temperature distribution after microwave irradiation. The effects of humidity or hot-air supply were also assessed. The average temperature of the bovine femoral head became 80 degrees C throughout the 15 min of microwave irradiation, although the temperature in the metatarsal did not attain uniformity. Microwave irradiation with a hot-air supply realized a uniform distribution of temperature at 83.0 degrees +/- 0.4 degrees C in the metatarsal within 15 min. Use of microwave irradiation enables quick heating for disinfection of large allograft bones when a hot-air supply was used as well.

Comparative metagenomics of microbial communities

The species complexity of microbial communities and challenges in culturing representative isolates make it difficult to obtain assembled genomes. Here we characterize and compare the metabolic capabilities of terrestrial and marine microbial communities using largely unassembled sequence data obtained by shotgun sequencing DNA isolated from the various environments. Quantitative gene content analysis reveals habitat-specific fingerprints that reflect known characteristics of the sampled environments. The identification of environment-specific genes through a gene-centric comparative analysis presents new opportunities for interpreting and diagnosing environments.

Comparative evaluation of tigecycline and vancomycin, with and without rifampicin, in the treatment of methicillin-resistant Staphylococcus aureus experimental osteomyelitis in a rabbit model

OBJECTIVES

Staphylococcus aureus is the most common organism isolated in osteomyelitis. Methicillin-resistant S. aureus (MRSA) infections are particularly difficult to treat. We evaluated the efficacy of tigecycline and vancomycin with and without rifampicin in a rabbit model of MRSA osteomyelitis.

METHODS

A 28 day antibiotic therapy with a subcutaneous injection of tigecycline (14 mg/kg twice daily), with and without oral rifampicin (40 mg/kg twice daily); or subcutaneous administration of vancomycin (30 mg/kg twice daily), with and without oral rifampicin (40 mg/kg twice daily) were compared. Osteomyelitis was induced with an intramedullary injection of 10(6) colony-forming units of MRSA. Infected rabbits were randomly divided into six groups: tigecycline, tigecycline with oral rifampicin, vancomycin, vancomycin with oral rifampicin, and no treatment control and tigecycline bone penetration groups. Treatment began 2 weeks after infection. After 4 weeks of therapy, the rabbits were left untreated for 2 weeks. Rabbits were then euthanized, and the tibias were harvested. The bones were cultured, and bacterial counts of MRSA were performed.

RESULTS

Rabbits that received tigecycline and oral rifampicin therapy (n=14) showed a 100% infection clearance. Rabbits treated with tigecycline (n=10) showed a 90% clearance. Rabbits treated with vancomycin and oral rifampicin (n=10) also showed a 90% clearance. Rabbits treated with vancomycin (n=11) showed an 81.8% clearance. Untreated controls (n=15) demonstrated only a 26% clearance. For the tigecycline bone penetration group, the bone concentrations of tigecycline in the infected tibia were significantly higher than the non-infected ones.

CONCLUSIONS

Tigecycline may be an effective alternative to vancomycin in the treatment of MRSA osteomyelitis.

Co-infection of Mycobacterium tuberculosis and Mycobacterium leprae in human archaeological samples: a possible explanation for the historical decline of leprosy

Both leprosy and tuberculosis were prevalent in Europe during the first millennium but thereafter leprosy declined. It is not known why this occurred, but one suggestion is that cross-immunity protected tuberculosis patients from leprosy. To investigate any relationship between the two diseases, selected archaeological samples, dating from the Roman period to the thirteenth century, were examined for both Mycobacterium leprae and Mycobacterium tuberculosis DNA, using PCR. The work was carried out and verified in geographically separate and independent laboratories. Several specimens with palaeopathological signs of leprosy were found to contain DNA from both pathogens, indicating that these diseases coexisted in the past. We suggest that the immunological changes found in multi-bacillary leprosy, in association with the socio-economic impact on those suffering from the disease, led to increased mortality from tuberculosis and therefore to the historical decline in leprosy.

Metalloproteinase-7 contributes to joint destruction in Staphylococcus aureus induced arthritis

Septic arthritis induced by Staphylococcus aureus causes a rapid destruction of joint cartilage and periarticular bone. The mechanisms behind this phenomenon are not fully understood. Earlier studies have shown that cytokines and metalloproteinases are of importance in bone metabolism. Matrix metalloproteinase-7 (MMP-7) has pleiotropic function including facilitating migration of both macrophages and neutrophils. The aim of this study has been to investigate the significance of MMP-7 expression in septic arthritis. MMP-7 deficient mice and congeneic controls were intravenously inoculated with an arthritogenic dose of S. aureus LS-1. This study shows that MMP-7 deficient mice exposed to S. aureus developed significantly less severe arthritis both clinically and histologically. Despite this finding, bacterial growth in the deficient animals was significantly increased. In vitro responses to staphylococcal antigens and superantigens did not differ between MMP-7(+/+) and MMP-7(-/-) mice with respect to cytokine production and if anything increased the production of certain chemokines. In addition MMP-7(-/-) mice exhibited decreased numbers of peripheral blood mononuclear cells before and one day after bacterial inoculation, but increased numbers of peripheral granulocytes on day 1. In conclusion, MMP-7 contributes to the development of a destructive course of septic arthritis despite decreased bacterial load. In addition, expression of MMP-7 is of importance for the distribution of peripheral leukocytes.

Bone contamination and blood culture in tissue donors

INTRODUCTION

Swab cultures are the most usual method to detect graft contamination; nevertheless it has been confirmed his limited sensibility. We have studied the relationship between blood cultures, swab surface cultures and cultures of entirely samples of cancellous bone.

MATERIAL AND METHODS

We have evaluated 5 donors with positive blood culture, from 70 multiorganic donors during 2002. Blood samples were obtained prior the heart arrest. The bone procurement was done just after the organ recovery under aseptic conditions, and surface cultures were performed of each bone. After storage at -80 degrees C, cancellous samples were obtained by trephine and were completely cultured.

RESULTS

In one case, the same microorganism grown in blood culture, in 2 of 9 surface cultures, and in 15 of 26 samples of cancellous bone.

CONCLUSION

We conclude that to guarantee allograft's safety it is recommended to add donor's blood culture to the habitual surface swab culture if secondary sterilisation is not performed.

The usefulness of bone scannning for the diagnosis and evaluation of otogenic skull base osteomyelitis. A description of three cases

BACKGROUND

The aim of this report was to assess the usefulness of bone scanning in the diagnosis and evaluation of the skull base osteomyelitis.

MATERIAL AND METHODS

Bone scanning was performed in three male patients with otogenic skull base osteomyelitis, aged 65-84 years utilizing Tc99m-MDP and dual-head gamma camera.

RESULTS

In one case, bone scanning played a crucial role in establishing the diagnosis. In two cases, it provided confirmed MRI results. CT scanning was negative in two cases.

CONCLUSIONS

Bone scans may give valuable information for establishing the diagnosis and assessing the severity of this disease, and add complementary physiological information to radiological imaging.

Systemic blastomycosis with osseous involvement of the foot: case report

We report a patient who presented with three months of foot pain, lytic bone lesions in the foot, and a painless ipsilateral leg skin ulcer. Bone and skin biopsies revealed organisms compatible with Blastomyces. Systemic blastomycosis is rare, especially with bone involvement in the foot.

Mit Knochenkollektor bei dentaler Implantation gewonnenes Knochenmaterial

BACKGROUND

Simultaneous implantation and augmentation using autogenous bone collected during implant surgery is a well-established procedure in oral implantology. The aims of this study were (1) to identify any bacterial contamination of bone obtained with a bone collector, and (2) to verify the antimicrobial effect of rinsing the bone collector with a 0.1% chlorhexidine solution prior to augmentation.

MATERIAL AND METHODS

A total of 39 patients undergoing a simultaneous implantation and augmentation procedure were examined. All patients rinsed their mouths with a 0.1% chlorhexidine solution for 2 min prior to surgery. Bone was collected with the Osseous Coagulum Trap, while saliva was collected with a separate suction tip. Once bone collection was complete a microbiological swab was taken from the bone collector (sample 1); before the bone was taken from it 200 ml of a 0.1% chlorhexidine solution was aspirated into the collector, after which the bone was removed and the collector sieve was (sample 2) sent for microbiological analysis which included aerobic and anaerobic cultivation of microorganisms and their identification and semiquantitative assessment of microbial growth.

RESULTS

Before the collector was rinsed with chlorhexidine microbial contamination was found in 34 (82.7%) of the 39 samples, and 37 different microbial species were identified in cultures. When the collector had been rinsed with 200 ml 0.1% chlorhexidine a significantly lower rate of microbial contamination was found: 66.7% of the samples were sterile.

CONCLUSIONS

Despite separate suction techniques for bone dust and saliva and preoperative use of a chlorhexidine mouthwash, bacterial contamination of bone obtained from the mouth with a bone collector has to be anticipated. Not only the physiological bacteria of the oral flora, but also the microorganisms frequently associated with implant failure can be found. Rinsing the bone collector with 200 ml of a 0.1% chlorhexidine solution significantly reduces microbial contamination. The effects on bone vitality must be studied before routine rinsing with chlorhexidine can be recommended.

Multifocal skeletal tuberculosis in children: a retrospective study of 18 cases

Multifocal skeletal tuberculosis is an uncommonly reported entity, Unanimity on terminology is lacking in the literature. The article presents a series of 18 such patients encountered in our institution. All the patients were below 15 y of age. Male to female ratio was 13:5. Most of the cases presented with swellings, discharging sinuses and/or ulcers. Appendicular involvement was seen in 17 of these cases. All the cases were diagnosed histopathologically as tuberculosis. All the cases were treated with multi-drug anti-tubercular therapy with additional procedures such as incision and drainage or sinus tract curettage performed in 9 of the patients. All the lesions healed. Their clinical behaviour, result and outcome are analysed with available international literature.

Molecular identification of human tuberculosis in recent and historic bone tissue samples: The role of molecular techniques for the study of historic tuberculosis

We describe the molecular identification of the M. tuberculosis complex DNA in bone tissue samples from recent and historic populations. In a first set, archival paraffin material from vertebral bodies of 12 recent cases with clinically/microbiologically proven tuberculosis was compared to 12 further cases without tuberculosis. While eight TB cases revealed a specific mycobacterial amplification product, none of the controls was positive. Interestingly, one case with tuberculous sepsis (Landouzy sepsis), five cases with tuberculous spread beyond the primarily affected organ (i.e., lymph node or miliar involvement), and also two of six cases with restricted pulmonary tuberculosis reacted positively in the vertebral specimens. This indicates that a molecular analysis can detect mycobacteria even in unremarkable bone tissue, proving that organ tuberculosis is present. In addition, the extent of spread is of high significance for the frequency of positive reactions. In addition, we investigated a series of vertebral samples coming from an Egyptian population of the necropolis of Thebes-West dating to approximately 1450-500 BC. In this group of 36 cases, three of five cases with typical macromorphological signs for tuberculous spondylitis, 2 of 12 cases with nonspecific alterations, and 2 of 19 cases without macroscopic pathology revealed a specific amplicon of the M. tuberculosis complex. This suggests a significant frequency of infected people in that ancient population. Finally, a fourth group of 51 long bone samples with pathological alterations coming form a southern German ossuary (between AD 1400-1800) was investigated, and 10 cases were positive for the M. tuberculosis complex. These studies of historic material clearly support the notion that tuberculous infections can be unequivocally identified by molecular techniques. The relatively high frequency of ancient bacterial DNA amplifications in unremarkable bone is well-explained by our analysis of the recent material. Our data form an important basis for the investigation of tuberculosis frequency and spread in historic periods.

Skeletal tuberculosis mimicking seronegative spondyloarthropathy

Skeletal tuberculosis (TB) is still a common problem in developing countries. It is a postprimary manifestation of TB and appears usually with fever, pain, tenderness, and limitation of motion at the involved site. We present a patient with a clinical course very suggestive of seronegative spondyloarthropathy and who had partially responded to sulphasalazine (SSZ) and nonsteroidal anti-inflammatory drugs (NSAID) but proved later to be a TB case.