Evaluation of the polymerase chain reaction in the diagnosis of miliary tuberculosis in bone marrow smear.

Abstract

OBJECTIVE:

Miliary tuberculosis (MTB) is difficult to diagnose. When prompt diagnosis is necessary, the polymerase chain reaction (PCR) to detect mycobacterial DNA may be valuable.

SETTING:

Tuberculosis clinic in an academic tertiary-level hospital in Mexico.

DESIGN:

Bone marrow (BM) aspiration samples from 30 consecutive clinically suspected MTB patients and 58 non-tuberculosis hematologic patients were evaluated by in-house PCR using a fragment of the insertion sequence IS6110; results were compared with those obtained by acid-fast-stained smears, culture in Löwenstein-Jensen medium, histology, and serology.

RESULTS:

Tuberculosis diagnosis was confirmed in all MTB suspects, 28 by microscopy and culture in pulmonary or extra-pulmonary samples other than BM, and two by clinical and radiologic improvement after antituberculosis treatment. In fresh BM specimens, in-house PCR was positive in 21/30 (70%) suspects, contrasting with only one positive (3.3%) in staining and culture, and four with compatible histologic findings (13.3%). BM samples from the control group showed negative results in bacteriologic and histologic studies, except in nine who had positive PCR results. These nine control cases had malignant processes.

CONCLUSION:

PCR in aspirates of BM is a useful diagnostic assay in cases of MTB, mainly when bacteriological results are negative.

• Authors: L Escobedo-Jaimes, R Cicero-Sabido, J L Criales-Cortez, E Ramirez, M Romero, V Rivero, F Islas, H Olivera, S Gonzalez, A Escobar-Gutierrez
• Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (Int J Tuberc Lung Dis) Vol. 7 Issue 6 Pg. 580-6 (Jun 2003) ISSN: 1027-3719 [Print] France
• PMID: 12797702 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• DNA Transposable Elements
• DNA, Bacterial

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Bone Marrow (microbiology, pathology)
• DNA Transposable Elements (genetics)
• DNA, Bacterial (genetics, isolation & purification)
• Female
• Humans
• Male
• Middle Aged
• Mycobacterium tuberculosis (genetics, isolation & purification)
• Polymerase Chain Reaction
• Predictive Value of Tests
• Reproducibility of Results
• Sensitivity and Specificity
• Tuberculin Test
• Tuberculosis, Miliary (diagnosis, genetics, microbiology)