Detection of Toxoplasma gondii, Epstein-Barr virus, and JC virus DNAs in the cerebrospinal fluid in acquired immunodeficiency syndrome patients with focal central nervous system complications

Object Toxoplasmic encephalitis (TE), primary central nervous system lympho ma (PCNSL) and progressive multifocal leukoencephalopathy (PML) are major c entral nervous system (CNS) diseases in patients with acquired immunodefiei ency syndrome (AIDS). We assessed the diagnostic value of polymerase chain reaction (PCR) in the detection of DNAs of Toxoplasma gondii (T. gondii), E pstein-Barr virus (EBV) and JC virus (JCV) in the cerebrospinal fluid (CSF) . Methods We compared the PCR results with those of pathological findings a t autopsy. Patients or Materials The present study included 23 autopsies re presenting those in whom CSF samples were obtained before death while the p atient was hospitalized or at autopsy. Results The threshold levels for PCR detection were 4 tachyzoites of T. gondii, 5-15 genomes of EBV and 10 geno mes of JCV. We identified T. gondii DNA in 4 out of 5 autopsy-defined cases of TE, EBV DNA in 5 out of 5 cases with PCNSL, and JCV DNA in 2 out of 2 c ases with PML. The specificity of PCR was 100% in TE, 78% in PCNSL, and 100 % in PML. Conclusion Although the number of cases was relatively small in t his study PCR correctly identified T. gondii DNA in those cases in which PM L or PCNSL was the sole clinical diagnosis. Our results indicate that PCR e xamination of CSF is a clinically useful tool for the diagnosis of focal br ain lesions in patients with AIDS.