Polymerase chain reaction in the diagnosis of tuberculous meningitis: preliminary report

Machado, L. R.; Livramento, José Antônio; Bydlowski, Sérgio Paulo; Bendit, Israel; Bravo, Laura; Spina-França, A.

doi:10.1590/s0004-282x1994000300029

Cited by 7 publications

(7 citation statements)

References 5 publications

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“…The type of cell response can have a prognostic effect. A higher percentage of neutrophils was associated to higher survival rates 12 . It has been suggested that neutrophils may have a protective role against Mycobacterium tuberculosis.…”

Section: Discussionmentioning

confidence: 94%

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Factors associated to the positive cerebrospinal fuid culture in the tuberculous meningitis

Puccioni-Sohler

Brandão

2007

Arq. Neuro-Psiquiatr.

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-Central nervous system involvement is the most common neurological complication in the course of tuberculosis. The lack of rapid and sensitive tests delays the early diagnosis. Here, we retrospectively reviewed the cerebrospinal fluid (CSF) examination of 30 patients with tuberculous meningitis confirmed by bacteriological tests (culture and/or polymerase chain reaction). The purpose of the present study was to determine the CSF parameters associated to the positive CSF culture for Mycobacterium tuberculosis in tuberculous meningitis. We found higher frequency of positive CSF culture in patients infected with HIV as well in patients with high number of neutrophils and high protein content (characteristic in the early or acute-stage patients), which suggests that the positive culture found in these patients may be associated with the presence of high bacillary load in CSF occurring in these stages.KEY WORDS: tuberculous meningitis, cerebrospinal fluid, HIV, Mycobacterium tuberculosis, culture. Fatores associados à positividade da cultura do líquido cefalorraquidiano na meningite tuberculosaRESUMO -A meningite tuberculosa é a complicação neurológica mais freqüente no curso da tuberculose. Entretanto, a carência de testes rápidos e sensíveis dificulta o diagnóstico precoce, contribuindo para o elevado índice de letalidade desta condição. Na presente análise, é feita revisão dos achados do líquido cefalorraquidiano (LCR) de 30 pacientes com o diagnóstico de meningite tuberculosa confirmado pelo exame bacteriológico. O objetivo do estudo consiste em caracterizar os parâmetros associados à positividade da cultura para Mycobacterium tuberculosis no LCR. Observamos maior freqüência de cultura positiva entre os pacientes infectados pelo HIV e naqueles que apresentam aumento de neutrófilos e da concentração de proteína no LCR. Nossos achados se justificam pelo fato de que na co-infecção com o HIV ocorre maior carga bacilífera em comparação aos pacientes não co-infectados. A presença de neutrofilorraquia e hiperproteinorraquia são marcadores de inflamação aguda, onde se supõe existir também maior concentração de bactérias no LCR.

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Section: Discussionmentioning

confidence: 94%

“…It is simple to execute and allows for an immediate confirmation of the diagnosis. Most researchers mention a sensitivity range that varies between 10% and 40% 10,12 . However, when larger volumes of CSF (>5 mL) and/or serial samples are analyzed, the positivity may reach 87% 6,[13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

Factors associated to the positive cerebrospinal fuid culture in the tuberculous meningitis

Puccioni-Sohler

Brandão

2007

Arq. Neuro-Psiquiatr.

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“…A recent example of this method includes the use of an IS6110 uniplex PCR assay that had 98% sensitivity (NPV, 99%) and a specificity of 100% (PPV ϭ 100%) against the "gold standard" of culture (167) and an overall sensitivity of 76.4% (NPV, 59.9%) and specificity of 89.2% (PPV, 94.7%) when clinical TBM was included (166). Several methods of PCR have been evaluated, including quantitative nested real-time PCR (208)(209)(210), the Amplicor Mycobacterium tuberculosis Test (23,24), and a variety of other in-house PCR assays (45,46,51,83,104,111,120,123,138,141,165,189,193). These assays have been evaluated specifically in HIV-coinfected patients (59,180) and also as a means to monitor therapy (180,210).…”

Section: Molecular and Biochemical Analysismentioning

confidence: 99%

Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects

et al. 2008

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SUMMARY Tuberculosis of the central nervous system (CNS) is a highly devastating form of tuberculosis, which, even in the setting of appropriate antitubercular therapy, leads to unacceptable levels of morbidity and mortality. Despite the development of promising molecular diagnostic techniques, diagnosis of CNS tuberculosis relies largely on microbiological methods that are insensitive, and as such, CNS tuberculosis remains a formidable diagnostic challenge. Insights into the basic neuropathogenesis of Mycobacterium tuberculosis and the development of an appropriate animal model are desperately needed. The optimal regimen and length of treatment are largely unknown, and with the rising incidence of multidrug-resistant strains of M. tuberculosis, the development of well-tolerated and effective antibiotics remains a continued need. While the most widely used vaccine in the world largely targets this manifestation of tuberculosis, the BCG vaccine has not fulfilled the promise of eliminating CNS tuberculosis. We put forth this review to highlight the current understanding of the neuropathogenesis of M. tuberculosis, to discuss certain epidemiological, clinical, diagnostic, and therapeutic aspects of CNS tuberculosis, and also to underscore the many unmet needs in this important field.

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“…To the authors' knowledge, only one previous paper on this subject had been published in Brazil. Machado and colleagues amplified a fragment of the 65kDa HSP gene in 7 of 10 patients with suspected M. tuberculosis meningitis and in none of 10 patients with other infections 14 . Sample volumes used for PCR analysis were not described 14 .…”

mentioning

confidence: 99%

“…Machado and colleagues amplified a fragment of the 65kDa HSP gene in 7 of 10 patients with suspected M. tuberculosis meningitis and in none of 10 patients with other infections 14 . Sample volumes used for PCR analysis were not described 14 . Further studies are clearly needed to evaluate the performance of PCR in different clinical settings, including empirically treated patients, before the role of this technique in routine diagnosis of tuberculous meningitis in Brazil may be established.…”

mentioning

confidence: 99%

Low sensitivity of polymerase chain reaction for diagnosis of tuberculous meningitis in southeastern Brazil

Brienze

et al. 2001

Rev. Soc. Bras. Med. Trop.

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Two polymerase chain reaction (PCR) protocols showed low sensitivity (36% and 53% for TB AMPLICOR and MPB64 nested PCR, respectively), when compared with classic microbiological methods (73% and 54% for Ziehl-Neelsen staining and culture, respectively), in the diagnosis of tuberculous meningitis in 91 patients in southeastern Brazil. Only three PCR-positive, microbiologically negative patients were found. Analysis of sequential cerebrospinal fluid samples by nested PCR detected Mycobacterium tuberculosis DNA up to 29 days after the introduction of antituberculosis chemotherapy. Key-words: Diagnosis of tuberculous meningitis. PCR. Mycobacterium tuberculosis.Resumo Dois protocolos de reação em cadeia da polimerase (PCR) apresentaram baixa sensibilidade (36% e 53%, respectivamente), para TB AMPLICOR e PCR aninhado baseado no gene MPB64), quando comparados aos métodos microbiológicos clássicos (73% e 54% respectivamente para baciloscopia e cultura), no diagnóstico de meningite tuberculosa em 91 pacientes do sudeste do Brasil. Somente três pacientes apresentaram PCR positiva e microbiologia negativa. A análise de amostras seqüenciais de líquor com a PCR aninhada detectou DNA de Mycobacterium tuberculosis até 29 dias após a introdução de tratamento. Palavras-chaves: Diagnóstico da meningite tuberculosa. PCR. Mycobacterium tuberculosis.

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Polymerase chain reaction in the diagnosis of tuberculous meningitis: preliminary report

Cited by 7 publications

References 5 publications

Factors associated to the positive cerebrospinal fuid culture in the tuberculous meningitis

Factors associated to the positive cerebrospinal fuid culture in the tuberculous meningitis

Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects

Low sensitivity of polymerase chain reaction for diagnosis of tuberculous meningitis in southeastern Brazil

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