Detection of Toxoplasma gondii, Epstein-Barr virus, and JC virus DNAs in the cerebrospinal fluid in acquired immunodeficiency syndrome patients with focal central nervous system complications.
OBJECTIVE
Toxoplasmic encephalitis (TE), primary central nervous system lymphoma (PCNSL) and progressive multifocal leukoencephalopathy (PML) are major central nervous system (CNS) diseases in patients with acquired immunodeficiency syndrome (AIDS). We assessed the diagnostic value of polymerase chain reaction (PCR) in the detection of DNAs of Toxoplasma gondii (T. gondii), Epstein-Barr virus (EBV) and JC virus (JCV) in the cerebrospinal fluid (CSF).


METHODS
We compared the PCR results with those of pathological findings at autopsy.


METHODS
The present study included 23 autopsies representing those in whom CSF samples were obtained before death while the patient was hospitalized or at autopsy.


RESULTS
The threshold levels for PCR detection were 4 tachyzoites of T. gondii, 5-15 genomes of EBV and 10 genomes of JCV. We identified T. gondii DNA in 4 out of 5 autopsy-defined cases of TE, EBV DNA in 5 out of 5 cases with PCNSL, and JCV DNA in 2 out of 2 cases with PML. The specificity of PCR was 100% in TE, 78% in PCNSL, and 100% in PML.


CONCLUSIONS
Although the number of cases was relatively small in this study, PCR correctly identified T. gondii DNA in those cases in which PML or PCNSL was the sole clinical diagnosis. Our results indicate that PCR examination of CSF is a clinically useful tool for the diagnosis of focal brain lesions in patients with AIDS.
Tachikawa
N
N
AIDS Clinical Center, International Medical Center of Japan, Tokyo.
Goto
M
M
Hoshino
Y
Y
Gatanaga
H
H
Yasuoka
A
A
Wakabayashi
T
T
Katano
H
H
Kimura
S
S
Oka
S
S
Iwamoto
A
A
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000818:Animals; D001483:Base Sequence; D001927:Brain Diseases / Q000150:complications* / Q000175:diagnosis*; D017931:DNA Primers / Q000235:genetics; D016054:DNA, Protozoan / Q000134:cerebrospinal fluid* / Q000235:genetics; D004279:DNA, Viral / Q000134:cerebrospinal fluid* / Q000235:genetics; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007577:JC Virus / Q000235:genetics / Q000302:isolation & purification; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications / Q000175:diagnosis; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods; D014122:Toxoplasma / Q000235:genetics / Q000302:isolation & purification; D016781:Toxoplasmosis, Cerebral / Q000150:complications / Q000175:diagnosis
D017931:DNA Primers; D016054:DNA, Protozoan; D004279:DNA, Viral