title: Aetiological diagnosis of brain abscesses and spinal infections: application of broad range bacterial polymerase chain reaction analysis.
abstract: OBJECTIVE
  To evaluate the usefulness of the broad range bacterial rDNA polymerase chain reaction (PCR) method combined with DNA sequencing in the aetiological diagnosis of intracranial or spinal infections in neurosurgical patients.
  
  
  METHODS
  In addition to conventional methods, the broad range bacterial PCR approach was applied to examine pus or tissue specimens from cerebral or spinal lesions in patients treated in a neurosurgical unit for a clinical or neuroradiological suspicion of bacterial brain abscess or spondylitis.
  
  
  RESULTS
  Among the 44 patients with intracranial or spinal lesions, the final diagnosis suggested bacterial disease in 25 patients, among whom the aetiological agent was identified in 17. A causative bacterial species was identified only by the rDNA PCR method in six cases, by both the PCR methodology and bacterial culture in six cases, and by bacterial culture alone in five. All samples in which a bacterial aetiology was identified only by the PCR approach were taken during antimicrobial treatment, and in three patients the method yielded the diagnosis even after >/= 12 days of parenteral treatment. One case also identified by the PCR approach alone involved a brain abscess caused by Mycoplasma hominis, which is not readily cultured by routine methods.
  
  
  CONCLUSIONS
  In patients with brain abscesses and spinal infections, the broad range bacterial rDNA PCR approach may be the only method to provide an aetiological diagnosis when the patient is receiving antimicrobial treatment, or when the causative agent is fastidious.
authors.affiliation: Department of Neurology, Turku University Central Hospital, Turku, Finland. laura.kupila@tyks.fi
authors.forename: L
authors.initials: L
authors.lastname: Kupila
authors.forename: K
authors.initials: K
authors.lastname: Rantakokko-Jalava
authors.forename: J
authors.initials: J
authors.lastname: Jalava
authors.forename: S
authors.initials: S
authors.lastname: Nikkari
authors.forename: R
authors.initials: R
authors.lastname: Peltonen
authors.forename: O
authors.initials: O
authors.lastname: Meurman
authors.forename: R J
authors.initials: RJ
authors.lastname: Marttila
authors.forename: E
authors.initials: E
authors.lastname: Kotilainen
authors.forename: P
authors.initials: P
authors.lastname: Kotilainen
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000235:genetics* / Q000382:microbiology*; D001706:Biopsy; D001922:Brain Abscess / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D001932:Brain Neoplasms / Q000382:microbiology / Q000473:pathology; D046508:Culture Techniques; D004269:DNA, Bacterial / Q000235:genetics; D004275:DNA, Ribosomal / Q000032:analysis*; D006801:Humans; D009187:Myelitis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D016133:Polymerase Chain Reaction / Q000379:methods*; D013238:Stereotaxic Techniques
chemical_list: D000890:Anti-Infective Agents; D004269:DNA, Bacterial; D004275:DNA, Ribosomal