Diagnostic of clinically virulent tuberculosis spondylitis with polimerase chain reaction (PCR)

Tuberculosis spondylitis affects vertebrae and is clinically divided into 2 types; virulent and not virulent. In addition, early diagnosis remains a challenge in orthopedic, thus this study is aimed to established the diagnostics to predict the virulence morbidity and mortality. Moreover, Polymerase Chain Reaction (PCR) is a tool adopted in the detection of bacteria DNA multiplication. Thus, the Beijing (a virulent strain of Mycobacterium tuberculosis recently known) and the non Beiging primers were evaluated. The specimen of all clinically virulent tuberculosis spondylitis patients in Dr.Soetomo Hospital within October 2011-January 2014 were collected from surgery and sent for culture and PCR method using 3 primers (IS6110, Beijing and non-Beijing strain). In addition, clinical observational study was performed with cross sectional design and the data obtained were abscess size, ESR, sum of vertebral destruction, skip lesion, constitutional symptom and PCR result. Out of the total 11 clinically virulent tuberculosis spondylitis patients, 9 matched with the inclution criteria, with 67% female and 44.4% were between 20 - 29 y.o age. In addition, the abcess of 300-1000 mm3, an ESR of 50 - 100mm, and 2 level vertebral destructions were 80, 71.4 and 75% Beijing-strain, with 60% multilevel. Thus, all disseminated tuberculosis spondylitis were Beijing, and the constitutional symptoms were dominated by Non-Beijing (66.7%), while those without any related symptom were Beijing (83.3%). All patients had clinically virulent tuberculosis spondylitis, dominantly caused by the Beijing-strain. In addition, Literature stated that PCR had a sensitivity of 80-98%, and specificity of 98%, thus, the possibility of clinically evaluating Mycobacterium tuberculosis virulence (morbidity and mortality). Moreover, Beijing-strain possess the capacity to escape BCG vaccination, based on the emerging strain, MDR, as in vivo animal research showed a massive necrosis tissue destruction process, rather than an apoptotic, bacteria outgrowth, subsequently increasing patient mortality. There is a possibility of utilizing the PCR method with Beijing andNon-Beijing primer, as a tool to establish the early diagnosis of clinically virulent tuberculosis.