DIAGNOSIS OF MENINGOCOCCAL MENINGITIS BY BROAD-RANGE BACTERIAL PCR WITH CEREBROSPINAL-FLUID

We used broad-range bacterial PCR combined with DNA sequencing to exam ine prospectively cerebrospinal fluid (CSF) samples from patients with suspected meningitis. Fifty-six CSF samples from 46 patients were stu died during the year 1995. Genes coding for bacterial 16S and/or 23S r RNA genes could be amplified from the CSF samples from five patients w ith a clinical picture consistent with acute bacterial meningitis. For these patients, the sequenced PCR product shared 98.3 to 100% homolog y with the Neisseria meningitidis sequence. For one patient, the diagn osis was initially made by PCR alone. Of the remaining 51 CSF samples, for 50 (98.0%) samples the negative PCR findings were in accordance w ith the negative findings by bacterial culture and Gram staining, as w ell as with the eventual clinical diagnosis for the patient. However, the PCR test failed to detect the bacterial rRNA gene in one CSF sampl e, the culture of which yielded Listeria monocytogenes, These results invite new research efforts to be focused on the application of PCR,vi th broad-range bacterial primers to improve the etiologic diagnosis of bacterial meningitis. In a clinical setting, Gram staining and bacter ial culture still remain the cornerstones of diagnosis.