Rapid diagnosis of tuberculous meningitis by polymerase chain reaction

Lancet. 1991 Jan 5;337(8732):5-7. doi: 10.1016/0140-6736(91)93328-7.


The polymerase chain reaction (PCR) in cerebrospinal fluid was compared with conventional bacteriology and an enzyme-linked immunosorbent assay (ELISA) for cerebrospinal fluid antibodies in the diagnosis of tuberculous meningitis (TBM). PCR was the most sensitive technique; it detected 15 (75%) of 20 cases of highly probable TBM (based on clinical features), 4 (57%) of 7 probable cases, and 3 (43%) of 7 possible cases. ELISA detected 11 (55%) of the highly probable cases and 2 each of the probable and possible cases. Culture was positive in only 4 of the highly probable cases. Among the controls (14 pyogenic meningitis, 3 aseptic meningitis, 34 other neurological disorders), 6 subjects tested early in the study (2 pyogenic meningitis, 4 other disorders) were PCR positive. Second DNA preparations from their stored cerebrospinal fluid samples were all PCR negative, suggesting that the false-positive results were due to cross-contamination. 18 PCR-positive TBM samples retested were all still PCR positive. The antibody ELISA was positive in 3 controls despite the use of a high cutoff value.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Bacteriological Techniques
  • DNA, Bacterial
  • Diagnosis, Differential
  • Enzyme-Linked Immunosorbent Assay
  • False Positive Reactions
  • Humans
  • Mycobacterium tuberculosis / isolation & purification*
  • Polymerase Chain Reaction*
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Tuberculosis, Meningeal / cerebrospinal fluid
  • Tuberculosis, Meningeal / diagnosis*
  • Tuberculosis, Meningeal / microbiology


  • DNA, Bacterial