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Journal of Clinical Microbiology, September 2000, p. 3150-3155, Vol. 38, No. 9
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Role of IS6110-Targeted PCR, Culture, Biochemical, Clinical, and Immunological Criteria for Diagnosis of Tuberculous Meningitis

M. Caws,1,* S. M. Wilson,1 C. Clough,2 and F. Drobniewski1

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,1 and Department of Neurology, King's College Hospital, London SE5,2 United Kingdom

Received 6 March 2000/Returned for modification 11 May 2000/Accepted 13 June 2000

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.

* Corresponding author. Mailing address: PHLS Mycobacterium Reference Unit, Dulwich PHL and Department of Microbiology, Guy's King's and St. Thomas School of Medicine, Kings College (Dulwich), East Dulwich Grove, London SE22 8QF, United Kingdom. Phone: 0208-693-1312. Fax: 0207-346-6477. E-mail: maxine.caws{at}kcl.ac.uk.

Journal of Clinical Microbiology, September 2000, p. 3150-3155, Vol. 38, No. 9
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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