Comparison of PCR, culture, and histopathology for diagnosis of tuberculous pericarditis

Abstract

Nucleic acid amplification techniques for the diagnosis of tuberculosis (TB) are rapidly being developed. Scant work, however, has focused on pericardial TB. Using cryopreserved specimens from a prior study of pericarditis, we compared PCR to culture and histopathology for the diagnosis of tuberculous pericarditis in 36 specimens of pericardial fluid and 19 specimens of pericardial tissue from 20 patients. Fluid and tissue were cultured on Lowenstein-Jensen and Middlebrook solid media and in BACTEC radiometric broth. Tissue specimens were stained with hematoxylin-eosin, Ziehl-Neelsen, auramine O, and Kinyoun stains and were examined for granuloma formation and acid-fast bacilli. PCR was performed with both fluid and tissue with IS6110-based primers specific for the Mycobacterium tuberculosis complex by published methods. Sixteen of the 20 patients had tuberculous pericarditis and 4 patients had other diagnoses. TB was correctly diagnosed by culture in 15 (93%) patients, by PCR in 13 (81%) patients, and by histology in 13 of 15 (87%) patients. PCR gave one false-positive result for a patient with Staphylococcus aureus pericarditis. Considering the individual specimens as the unit of analysis, M. tuberculosis was identified by culture in 30 of 43 specimens (70%) from patients with tuberculous pericarditis and by PCR in 14 of 28 specimens (50%) from patients with tuberculous pericarditis (P > 0.15). The sensitivity of PCR was higher with tissue specimens (12 of 15; 80%) than with fluid specimens (2 of 13; 15%; P = 0.002). In conclusion, the overall accuracy of PCR approached the results of conventional methods, although PCR was much faster. Therefore, PCR merits further development in this regard. The sensitivity of PCR with pericardial fluid was poor, and false-positive results with PCR remain a concern.

Polymerase Chain Reaction of Pleural Biopsy Is a Rapid and Sensitive Method for the Diagnosis of Tuberculous Pleural Effusion

“…10 This method has been tested extensively for the detection of M tuberculosis in sputum specimens, 10 -13 cerebrospinal fluid, 14 and pericardial fluid and biopsy specimens. 15 PCR also has been used to detect M tuberculosis in pleural fluid samples, with highly variable sensitivity (11 to 81%) in different studies. 16 -18 Comparatively little work has focused on the utility of PCR and the BACTEC 460 TB system in detecting M tuberculosis in pleural biopsy specimens.…”

Pericarditis por Mycobacterium tuberculosis multiresistente en un paciente con infección por VIH: Reporte de un caso clínico y revisión de la literatura

“…En 80% de los casos el líquido pericárdico de la TBC es un exudado hemorrágico con predominio mononuclear, proteínas elevadas y glucosa muy baja. Las BK pueden ser positivas en 0 a 42% de las veces, los cultivos entre 53 y 75% y el estudio anátomo-patológico de la biopsia de pericardio tiene una sensibilidad de 10 a 64% para el diagnóstico de TBC 10 . En nuestro paciente llamó la atención una glucosa en líquido pericárdico en valor normal.…”

“…En la pericarditis tuberculosa el diagnóstico se certifica con la anatomía patológica clásica y con el cultivo de líquido o tejido pericárdico; este segundo demora entre uno y dos meses. Las técnicas de RPC para M. tuberculosis no han sido una solución en este aspecto por su pobre sensibilidad en fluidos, fácil contaminación y presencia de falsos positivos 10,12 .…”

Tuberculous Pericarditis

“…Pericardial biopsy specimens may also be used to diagnose tuberculous pericarditis. The polymerase chain reaction (PCR) has also been suggested for detecting M. tuberculosis DNA in pericardial fluid [19]. The probability of obtaining a definitive bacteriological result is greatest when pericardial fluid and biopsy specimens are examined early in the effusive stage [18].…”