title: Role of IS6110-targeted PCR, culture, biochemical, clinical, and immunological criteria for diagnosis of tuberculous meningitis.
abstract: An open prospective clinical, microbiological, and molecular analysis of a national molecular diagnostic service for tuberculous meningitis (TBM) using an in-house IS6110-targeted PCR for molecular "Fastrack" diagnosis was carried out. Between April 1997 and June 1998. Consecutive cerebrospinal fluid (CSF) samples from 131 patients were assessed. Against a culture on the same sample, PCR had a sensitivity of 75% and a specificity of 94%. Of samples from patients classified as definite or probable TBM cases based on clinical criteria, 81% had raised CSF protein levels and 73% had a lymphocytosis, although 57% of all submitted samples showed a raised lymphocyte count. While only 46% had a CSF glucose level below the normal range, the CSF glucose level was significantly lower (P = 0. 0281) than in cases of meningitis of other etiologies. Levels of tumor necrosis factor alpha were also found to be significantly raised in definite or probable TBM cases (P = 0.028), while adenosine deaminase levels were not. The study showed IS6110-targeted PCR to be a rapid, sensitive, and specific test in routine use for the diagnosis of TBM.
authors.affiliation: PHLS Mycobacterium Reference Unit, Dulwich PHL and Department of Microbiology, Guy's King's and St. Thomas School of Medicine, King's College (Dulwich), London SE22 8QF, United Kingdom. maxine.caws@kcl.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Caws
authors.forename: S M
authors.initials: SM
authors.lastname: Wilson
authors.forename: C
authors.initials: C
authors.lastname: Clough
authors.forename: F
authors.initials: F
authors.lastname: Drobniewski
mesh_terms: D000243:Adenosine Deaminase / Q000378:metabolism; D000328:Adult; D000368:Aged; D002555:Cerebrospinal Fluid / Q000378:metabolism / Q000382:microbiology / Q000821:virology; D003470:Culture Media; D004251:DNA Transposable Elements / Q000235:genetics*; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D014409:Tumor Necrosis Factor-alpha / Q000134:cerebrospinal fluid
chemical_list: D003470:Culture Media; D004251:DNA Transposable Elements; D014409:Tumor Necrosis Factor-alpha; D000243:Adenosine Deaminase; D005947:Glucose