Nguyen L N, Kox L F, Pham L D, Kuijper S, Kolk A H
Pham Ngoc Thach Tuberculosis and Lung Disease Center, Ho Chi Minh City, Vietnam.
Arch Neurol. 1996 Aug;53(8):771-6. doi: 10.1001/archneur.1996.00550080093017.
To examine diagnostic utility of polymerase chain reaction (PCR) on cerebrospinal fluid (CSF) in tuberculous meningitis (TBM).
Comparison study.
Referral center for tuberculosis diagnosis and treatment in Ho Chi Minh City, Vietnam, and research laboratory in Amsterdam, the Netherlands.
One hundred thirty-six consecutive patients, aged 4 months to 85 years, with features compatible with TBM seen during a 12-month period.
Clinical examination; cytology; Gram, india ink, and Ziehl-Neelsen staining; culture of CSF for bacteria, mycobacteria, fungi, and viruses; and CSF chloride, protein, and glucose. All these tests were performed in Vietnam. The PCR on CSF was performed in the Netherlands.
Patients were managed in Vietnam without knowledge of PCR results. Based on clinical grounds and the results of initial CSF microscopy, antituberculous treatment was given to 104 patients, 66 of whom had evidence of extraneural tuberculosis. Among the 39 patients with confirmed TBM (ie, positive Ziehl-Neelsen staining or culture or PCR results for Mycobacterium tuberculosis), PCR detected 32 patients (82%), 1 case was proven positive through microscopy and 17 (44%) had positive culture results. There were no false-positive PCR results. In 99 patients with a final diagnosis of confirmed or probable TBM (ie, clinical features of TBM and response to antituberculous treatment), PCR had a sensitivity of 32%; culture, 17% and microscopy, 1%.
Many patients who respond to treatment for TBM do not have M tuberculosis in the CSF identifiable by microscopy, PCR, or culture. Polymerase chain reaction on CSF is the best method for the laboratory diagnosis of TBM. Polymerase chain reaction is especially useful for the early diagnosis of TBM in those without active extraneural tuberculosis.
探讨聚合酶链反应（PCR）检测脑脊液（CSF）在结核性脑膜炎（TBM）中的诊断价值。
对比研究。
越南胡志明市结核病诊断与治疗转诊中心以及荷兰阿姆斯特丹的研究实验室。
136例连续患者，年龄4个月至85岁，在12个月期间出现与TBM相符的症状。
临床检查；细胞学检查；革兰氏染色、墨汁染色和萋 - 尼氏染色；CSF细菌、分枝杆菌、真菌和病毒培养；以及CSF氯化物、蛋白质和葡萄糖检测。所有这些检测均在越南进行。CSF的PCR检测在荷兰进行。
患者在越南接受治疗时并不知道PCR检测结果。基于临床依据和初始CSF显微镜检查结果，104例患者接受了抗结核治疗，其中66例有神经外结核的证据。在39例确诊为TBM的患者中（即结核分枝杆菌萋 - 尼氏染色、培养或PCR结果呈阳性），PCR检测出32例（82%），1例通过显微镜检查证实为阳性，17例（44%）培养结果呈阳性。PCR检测无假阳性结果。在99例最终诊断为确诊或可能为TBM的患者中（即具有TBM的临床特征且对抗结核治疗有反应），PCR的敏感性为32%；培养的敏感性为17%，显微镜检查的敏感性为1%。
许多对TBM治疗有反应的患者，其CSF中无法通过显微镜检查、PCR或培养鉴定出结核分枝杆菌。CSF的聚合酶链反应是TBM实验室诊断的最佳方法。聚合酶链反应对于无活动性神经外结核的TBM早期诊断尤其有用。
