PCR in meningoencephalitis diagnosis.
Polymerase chain reaction (PCR) detection of a stretch of nucleic acid sequence of microbial origin from a clinical sample is not always diagnostic of disease unless the identified agent is a strict pathogen or its growth is documented. We describe here a case of acute meningoencephalitis in a 21-y-old man, in whom no pathogen was isolated by traditional bacterial or viral culture. Standard DNA PCR performed on the cerebrospinal fluid (CSF) identified the presence of 3 infectious agents: HHV-6, HHV-7 and Mycoplasma pneumoniae. Additional PCRs performed on CSF fractions along with gene transcript analysis proved the bystander role of the 2 herpesviruses and indicated M. pneumoniae as the relevant replicating agent, most likely playing to be a pathogenic role. Until this useful analysis becomes routine, clinicians should deal carefully with DNA PCR results, especially when assessing the aetiological role of agents, such as herpesviruses, which are known to undergo latency.
Sgarabotto
D
D
Infectious Diseases Department, Padua University Hospital, Italy.
Buoro
S
S
Mengoli
C
C
Scano
F
F
Cadrobbi
P
P
Di Luca
D
D
Palù
G
G
D000208:Acute Disease; D000328:Adult; D004269:DNA, Bacterial / Q000134:cerebrospinal fluid*; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D003937:Diagnosis, Differential; D005784:Gene Amplification; D015654:Herpesvirus 6, Human / Q000235:genetics / Q000302:isolation & purification; D016199:Herpesvirus 7, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis* / Q000209:etiology; D009175:Mycoplasma Infections / Q000175:diagnosis* / Q000209:etiology; D009177:Mycoplasma pneumoniae / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity; D016133:Polymerase Chain Reaction / Q000379:methods*; D019349:Roseolovirus Infections / Q000175:diagnosis / Q000821:virology
D004269:DNA, Bacterial; D004279:DNA, Viral