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  Vol. 53 No. 8, August 1996 TABLE OF CONTENTS
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The Potential Contribution of the Polymerase Chain Reaction to the Diagnosis of Tuberculous Meningitis

Lan N. Nguyen, MD; Linda F. F. Kox, MSc; Linh D. Pham, MD; Sjoukje Kuijper, Ing; Arend H. J. Kolk, PhD

Arch Neurol. 1996;53(8):771-776.


Abstract

Objective
To examine diagnostic utility of polymerase chain reaction (PCR) on cerebrospinal fluid (CSF) in tuberculous meningitis (TBM).

Design
Comparison study.

Setting
Referral center for tuberculosis diagnosis and treatment in Ho Chi Minh City, Vietnam, and research laboratory in Amsterdam, the Netherlands.

Patients
One hundred thirty-six consecutive patients, aged 4 months to 85 years, with features compatible with TBM seen during a 12-month period.

Measurements
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.

Results
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 falsepositive 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%.

Conclusions
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.



Author Affiliations

From the Pham Ngoc Thach Tuberculosis and Lung Disease Center, Ho Chi Minh City, Vietnam (Drs Nguyen and Pham); Department of Biomedical Research, Royal Tropical Institute (Mss Kox and Kuijper and Dr Kolk), and Division of Pulmonary Diseases, Academic Medical Center (Ms Kox), Amsterdam, the Netherlands.



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