Muralidhar B, Rumore P M, Steinman C R
State University of New York at Stony Brook 11794-8161.
Arthritis Rheum. 1994 May;37(5):710-7. doi: 10.1002/art.1780370515.
To explore the utility of the polymerase chain reaction (PCR) in the diagnosis, management, and investigation of arthritis due to Neisseria gonorrhoeae.
The PCR was used to detect DNA from N gonorrhoeae in model systems and in extracts of synovial fluid (SF) from patients with systemic gonococcal infections and objective evidence of arthritis.
One N gonorrhoeae organism or its equivalent was detectable in human SF from inflamed joints. Five of 8 patients with systemic N gonorrhoeae infection and arthritis had N gonorrhoeae DNA demonstrated by PCR in at least 1 pretreatment SF specimen that was N gonorrhoeae culture positive. Thirty-seven of 38 control specimens were negative, the exception probably being due to cross-contamination from a positive specimen. All specimens that were positive for N gonorrhoeae by other methods were also positive by PCR. Two others were positive by PCR but negative by other methods. Four pretreatment specimens were negative by all methods, including PCR. This suggests that, for these patients, negative cultures reflected true absence of N gonorrhoeae, and not the presence of unculturable organisms. This group also had a significantly shorter duration of disease than did the patients with N gonorrhoeae DNA found in their SF. All patients had a prompt response to antibiotic treatment. Two of 3 patients whose specimens were previously positive showed marked decreases in SF N gonorrhoeae DNA after treatment.
The PCR using these or similar oligonucleotide primers can be a useful adjunct in the diagnosis of gonococcal arthritis and can be of value in assessing its response to therapy. In some N gonorrhoeae-associated arthritides, there appears to be a lack of both viable and nonviable N gonorrhoeae organisms in the SF. These observations may have implications regarding the pathogenesis of this form of arthritis.
探讨聚合酶链反应（PCR）在淋病奈瑟菌所致关节炎的诊断、管理及研究中的应用价值。
运用PCR检测模型系统以及患有全身性淋球菌感染且有明确关节炎证据患者的滑液（SF）提取物中淋病奈瑟菌的DNA。
在发炎关节的人体SF中可检测到一个淋病奈瑟菌生物体或其等效物。8例患有全身性淋病奈瑟菌感染和关节炎的患者中，有5例在至少1份预处理SF标本中通过PCR检测出淋病奈瑟菌DNA，这些标本淋病奈瑟菌培养呈阳性。38份对照标本中有37份为阴性，例外情况可能是受到阳性标本的交叉污染。所有通过其他方法检测为淋病奈瑟菌阳性的标本经PCR检测也呈阳性。另外两份标本经PCR检测呈阳性，但其他方法检测为阴性。4份预处理标本所有方法检测均为阴性，包括PCR。这表明，对于这些患者，培养阴性反映的是真正不存在淋病奈瑟菌，而非存在不可培养的生物体。该组患者的病程也明显短于SF中发现淋病奈瑟菌DNA的患者。所有患者对抗生素治疗均有迅速反应。3例标本先前呈阳性的患者中有2例在治疗后SF中淋病奈瑟菌DNA显著减少。
使用这些或类似寡核苷酸引物的PCR可作为诊断淋菌性关节炎的有用辅助手段，且在评估其对治疗的反应方面具有价值。在一些与淋病奈瑟菌相关的关节炎中，SF中似乎既缺乏活的也缺乏非活的淋病奈瑟菌生物体。这些观察结果可能对这种关节炎的发病机制有影响。
