Escobedo-Jaimes L, Cicero-Sabido R, Criales-Cortez J L, Ramirez E, Romero M, Rivero V, Islas F, Olivera H, Gonzalez S, Escobar-Gutierrez A
Facultad de Medicina, UNAM, Mexico.
Int J Tuberc Lung Dis. 2003 Jun;7(6):580-6.
Miliary tuberculosis (MTB) is difficult to diagnose. When prompt diagnosis is necessary, the polymerase chain reaction (PCR) to detect mycobacterial DNA may be valuable.
Tuberculosis clinic in an academic tertiary-level hospital in Mexico.
Bone marrow (BM) aspiration samples from 30 consecutive clinically suspected MTB patients and 58 non-tuberculosis hematologic patients were evaluated by in-house PCR using a fragment of the insertion sequence IS6110; results were compared with those obtained by acid-fast-stained smears, culture in Löwenstein-Jensen medium, histology, and serology.
Tuberculosis diagnosis was confirmed in all MTB suspects, 28 by microscopy and culture in pulmonary or extra-pulmonary samples other than BM, and two by clinical and radiologic improvement after antituberculosis treatment. In fresh BM specimens, in-house PCR was positive in 21/30 (70%) suspects, contrasting with only one positive (3.3%) in staining and culture, and four with compatible histologic findings (13.3%). BM samples from the control group showed negative results in bacteriologic and histologic studies, except in nine who had positive PCR results. These nine control cases had malignant processes.
PCR in aspirates of BM is a useful diagnostic assay in cases of MTB, mainly when bacteriological results are negative.
粟粒性肺结核（MTB）难以诊断。在需要快速诊断时，检测分枝杆菌DNA的聚合酶链反应（PCR）可能具有重要价值。
墨西哥一家学术性三级医院的结核病诊所。
对连续30例临床疑似MTB患者和58例非结核血液学患者的骨髓穿刺样本，使用插入序列IS6110片段通过内部PCR进行评估；将结果与抗酸染色涂片、罗氏培养基培养、组织学和血清学检查结果进行比较。
所有MTB疑似患者均确诊为结核病，28例通过肺部或肺部以外（非骨髓）样本的显微镜检查和培养确诊，2例通过抗结核治疗后临床和影像学改善确诊。在新鲜骨髓标本中，内部PCR在21/30（70%）的疑似患者中呈阳性，相比之下，染色和培养仅1例阳性（3.3%），4例有相符的组织学结果（13.3%）。对照组骨髓样本的细菌学和组织学研究结果均为阴性，但9例PCR结果呈阳性。这9例对照病例患有恶性疾病。
骨髓穿刺物PCR对MTB病例是一种有用的诊断方法，主要用于细菌学结果为阴性的情况。
