title: Identification of Mycobacterium tuberculosis in the cerebrospinal fluid of patients with meningitis using nested PCR.
abstract: Tuberculous meningitis (TBM) is the most severe form of tuberculosis. It is caused by Mycobacterium tuberculosis (M. tuberculosis; MT) and it is very difficult to diagnose. The symptoms are similar to other infectious neurological diseases, such as neurocysticercosis, neuroborreliosis, or herpes viral infection. The aim of this study was to identify tuberculosis (TB) in cases of meningitis with clinical and laboratory evidence suggestive of TBM, and to confirm our findings with molecular tests for TB infection. We recruited patients with neurological symptoms who were examined at the neurology services of Hospitals of Instituto Mexicano del Seguro Social (IMSS) in Mexico City. A total of 144 consecutive patients with suggestive infectious meningitis were initially included; 94 cases of meningitis with clinical and laboratory evidence suggestive of TBM were included, but only 50 of these cases fulfilled the criteria for probable TBM. As the controls, we included 50 cases of meningitis with clinical and laboratory evidence suggestive of non-TBM. Cerebrospinal fluid (CSF) was collected from all 100 patients (cases and controls) and tested for TB by multiplex and nested PCR analyses. Nested PCR detected 0.1 fg of M. tuberculosis DNA. TB infection was confirmed with molecular tests in 49 patients from the 50 cases suggestive of TBM and in 1 of the 50 non-TBM cases. The analysis exhibited a sensitivity of 98.0%, a specificity of 92.0%, a positive predictive value of 88.0% and a negative predictive value of 98.0%. The use CSF for the analyses proved to be effective for the rapid diagnosis of TBM using a developed system of multiplex and nested PCR analyses in patients presenting neurological symptoms.
authors: Medical Research Unit on Infectious Diseases, Hospital of Pediatrics, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City 06720, Mexico.
authors: Nora
authors: N
authors: Rios-Sarabia
authors: Medical Research Unit on Infectious Diseases, Hospital of Pediatrics, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City 06720, Mexico.
authors: Olivia
authors: O
authors: Hernández-González
authors: Laboratory of Molecular Microbiology, Department of Microbiology, National School of Biological Sciences, National Polytechnic Institute, Mexico City 11340, Mexico.
authors: Jorge
authors: J
authors: González-Y-Merchand
authors: Medical Research Unit on Infectious Diseases, Hospital of Pediatrics, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City 06720, Mexico.
authors: Guadalupe
authors: G
authors: Gordillo
authors: Department of Infectious Diseases, Hospital of Pediatrics, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City 06720, Mexico.
authors: Guillermo
authors: G
authors: Vázquez-Rosales
authors: Medical Research Unit on Infectious Diseases, Hospital of Pediatrics, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City 06720, Mexico.
authors: Leopoldo
authors: L
authors: Muñoz-Pérez
authors: Medical Research Unit on Infectious Diseases, Hospital of Pediatrics, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City 06720, Mexico.
authors: Javier
authors: J
authors: Torres
authors: Research Laboratory in Immunology and Proteomics, Children's Hospital of Mexico Federico Gomez, Mexico City 06720, Mexico.
authors: Carmen
authors: C
authors: Maldonado-Bernal
mesh_terms: D000293:Adolescent; D000328:Adult; D001483:Base Sequence; D005260:Female; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D016133:Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid*