Seth P, Ahuja G K, Bhanu N V, Behari M, Bhowmik S, Broor S, Dar L, Chakraborty M
Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Tuber Lung Dis. 1996 Aug;77(4):353-7. doi: 10.1016/s0962-8479(96)90101-x.
Since conventional bacteriological methods rarely detect Mycobacterium tuberculosis in cerebrospinal fluid (CSF) and are of limited use in the diagnosis of tuberculous meningitis (TBM), clinical features suggestive of TBM supported by indirect evidence such as CSF examination and computerized tomography (CT) of the head have been used for the early diagnosis of TBM.
We evaluated the efficacy of polymerase chain reaction (PCR) in the diagnosis of TBM.
Coded CSF samples from 40 patients with TBM and from 49 patients with other neurological disorders were processed. In the absence of a reliable sensitive and specific test for M. tuberculosis in CSF, we used a set of established clinical criteria as the gold standard. Accordingly, the patients were divided into definite, highly probable, probable and possible TBM. The samples were decoded only after completion of the laboratory tests.
PCR was positive in 2/4, 19/20, 13/16 patients with highly probable, probable and possible TBM respectively. None of the samples were positive by conventional bacteriological methods. However, 3/49 CSF samples from non-TBM patients were also found positive by PCR. PCR detected M. tuberculosis genomic DNA in the CSF of 85% of clinically suspected TBM cases and 6.1% of non-tuberculous controls.
PCR, along with the suggested clinical criteria, offers a rapid and fairly accurate diagnosis of TBM.
由于传统细菌学方法很少能在脑脊液（CSF）中检测到结核分枝杆菌，且在结核性脑膜炎（TBM）诊断中的作用有限，因此，结合脑脊液检查和头颅计算机断层扫描（CT）等间接证据支持的提示TBM的临床特征已被用于TBM的早期诊断。
我们评估了聚合酶链反应（PCR）在TBM诊断中的有效性。
对40例TBM患者和49例其他神经系统疾病患者的编码脑脊液样本进行处理。由于缺乏可靠的脑脊液中结核分枝杆菌敏感且特异的检测方法，我们采用一套既定的临床标准作为金标准。据此，将患者分为确诊、高度可能、可能和疑似TBM。样本仅在实验室检测完成后才进行解码。
在高度可能、可能和疑似TBM患者中，PCR阳性分别为2/4、19/20和13/16。常规细菌学方法检测的样本均为阴性。然而，49例非TBM患者的脑脊液样本中有3例PCR检测也呈阳性。PCR在85%临床疑似TBM病例的脑脊液中检测到结核分枝杆菌基因组DNA，在6.1%的非结核对照中也检测到。
PCR结合建议的临床标准能快速且相当准确地诊断TBM。
