Aetiological diagnosis of brain abscesses and spinal infections: application of broad range bacterial polymerase chain reaction analysis
- L Kupila1,
- K Rantakokko-Jalava2,
- J Jalava3,
- S Nikkari4,
- R Peltonen5,
- O Meurman4,
- R J Marttila1,
- E Kotilainen6,
- P Kotilainen5
- 1Department of Neurology, Turku University Central Hospital, Turku, Finland
- 2Department of Medical Microbiology, Turku University
- 3Antimicrobial Research Laboratory, National Public Health Institute, Turku
- 4Clinical Microbiology, Turku University Central Hospital
- 5Department of Medicine, Turku University Central Hospital
- 6Department of Surgery, Division of Neurosurgery, Turku University Central Hospital
- Correspondence to: Dr Laura Kupila, Department of Neurology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland; laura.kupila{at}tyks.fi
- Received 9 July 2002
- Accepted 28 January 2003
- Revised 28 November 2002
Abstract
Objective: To evaluate the usefulness of the broad range bacterial rDNA polymerase chain reaction (PCR) method combined with DNA sequencing in the aetiological diagnosis of intracranial or spinal infections in neurosurgical patients.
Methods: In addition to conventional methods, the broad range bacterial PCR approach was applied to examine pus or tissue specimens from cerebral or spinal lesions in patients treated in a neurosurgical unit for a clinical or neuroradiological suspicion of bacterial brain abscess or spondylitis.
Results: Among the 44 patients with intracranial or spinal lesions, the final diagnosis suggested bacterial disease in 25 patients, among whom the aetiological agent was identified in 17. A causative bacterial species was identified only by the rDNA PCR method in six cases, by both the PCR methodology and bacterial culture in six cases, and by bacterial culture alone in five. All samples in which a bacterial aetiology was identified only by the PCR approach were taken during antimicrobial treatment, and in three patients the method yielded the diagnosis even after ≥ 12 days of parenteral treatment. One case also identified by the PCR approach alone involved a brain abscess caused by Mycoplasma hominis, which is not readily cultured by routine methods.
Conclusions: In patients with brain abscesses and spinal infections, the broad range bacterial rDNA PCR approach may be the only method to provide an aetiological diagnosis when the patient is receiving antimicrobial treatment, or when the causative agent is fastidious.
Footnotes
-
Competing interests: none declared
