d'Arminio Monforte A, Cinque P, Vago L, Rocca A, Castagna A, Gervasoni C, Terreni M R, Novati R, Gori A, Lazzarin A, Moroni M
Infectious Diseases Clinic, L Sacco Hospital, Milan, Italy.
J Neurol. 1997 Jan;244(1):35-9. doi: 10.1007/pl00007727.
Twenty patients with AIDS who had intracranial lesions underwent both brain biopsy and cerebrospinal fluid (CSF) examination to compare histological diagnosis with the polymerase chain reaction (CSF-PCR) for the identification of infectious agents. CSF-PCR was performed for herpes simplex virus, varicella zoster virus, cytomegalovirus (CMV), JC virus (JCV), Epstein-Barr virus (EBV), Toxoplasma gondii and Mycobacterium tuberculosis. A definitive diagnosis was obtained by brain biopsy in 14 patients (2 with astrocytoma, 12 with brain infection). CSF-PCR was positive for EBV DNA in 3 of 3 cases of primary cerebral lymphoma, positive for JCV DNA in 6 of 7 biopsy-proven (and one autopsy-proven) cases of progressive multifocal leukoencephalopathy (PML). CSF-PCR was positive for CMV DNA in one biopsy-proven and one autopsy-proven case of CMV encephalitis (the former also had PML) and positive for M. tuberculosis DNA in one case of tuberculous encephalitis. None of the five toxoplasmic encephalitis cases (one definite, four presumptive) were T. gondii DNA positive. There was close correlation between histology and CSF-PCR for CMV encephalitis, PML and PCL. Antitoxoplasma therapy affected the sensitivity of both histological and CSF-PCR methods.
20例患有颅内病变的艾滋病患者接受了脑活检和脑脊液（CSF）检查，以比较组织学诊断与聚合酶链反应（CSF-PCR）在识别感染因子方面的差异。针对单纯疱疹病毒、水痘带状疱疹病毒、巨细胞病毒（CMV）、JC病毒（JCV）、爱泼斯坦-巴尔病毒（EBV）、弓形虫和结核分枝杆菌进行了CSF-PCR检测。14例患者通过脑活检获得了明确诊断（2例为星形细胞瘤，12例为脑部感染）。在3例原发性脑淋巴瘤患者中，有3例CSF-PCR检测EBV DNA呈阳性；在7例经活检证实（1例经尸检证实）的进行性多灶性白质脑病（PML）患者中，有6例CSF-PCR检测JCV DNA呈阳性。在1例经活检证实和1例经尸检证实的CMV脑炎患者中（前者还患有PML），CSF-PCR检测CMV DNA呈阳性；在1例结核性脑炎患者中，CSF-PCR检测结核分枝杆菌DNA呈阳性。5例弓形虫脑炎病例（1例确诊，4例疑似）中，均未检测到弓形虫DNA阳性。对于CMV脑炎、PML和原发性中枢神经系统淋巴瘤（PCL），组织学检查与CSF-PCR检测结果密切相关。抗弓形虫治疗影响了组织学检查和CSF-PCR检测方法的敏感性。
