Diagnosis of cytomegalovirus infection of the nervous system in AIDS by polymerase chain reaction analysis of cerebrospinal fluid.

To evaluate the diagnostic relevance and the clinical impact of the cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for cytomegalovirus (CMV) DNA in the diagnosis of CMV infection of the central nervous system (CNS), 220 acquired immune deficiency syndrome (AIDS) patients with neurological disease were examined. CSF was drawn 1-180 days before death, concomitantly with clinical neurological disease, and autopsy was performed in all the cases. CMV DNA was detected in the CSF from 36 of 45 patients (82%) with CMV infection of the CNS, and in 2 of 175 without CMV infection of the CNS at autopsy. The sensitivity of the method was 82%, the specificity 99%, the positive predictive value 95%, and the negative predictive value 96%. An extensive CMV ventriculitis or encephalitis was shown by histopathology in the majority of the CSF PCR-positive patients with overt clinical encephalitis. Minor CMV lesions only, not likely to cause relevant clinical symptoms, were observed in some CSF PCR-positive patients, concomitant with other opportunistic CNS diseases. CSF PCR is a reliable means for diagnosis of CMV infection of the CNS in patients with AIDS. A positive PCR result, however, requires careful interpretation in the individual clinical context.