Skip to main content
PMC home page
Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1997 Dec;35(12):3254–3257. doi: 10.1128/jcm.35.12.3254-3257.1997

Comparison of PCR, culture, and histopathology for diagnosis of tuberculous pericarditis.

J P Cegielski 1, B H Devlin 1, A J Morris 1, J N Kitinya 1, U P Pulipaka 1, L E Lema 1, J Lwakatare 1, L B Reller 1
PMCID: PMC230157  PMID: 9399529

Abstract

Nucleic acid amplification techniques for the diagnosis of tuberculosis (TB) are rapidly being developed. Scant work, however, has focused on pericardial TB. Using cryopreserved specimens from a prior study of pericarditis, we compared PCR to culture and histopathology for the diagnosis of tuberculous pericarditis in 36 specimens of pericardial fluid and 19 specimens of pericardial tissue from 20 patients. Fluid and tissue were cultured on Lowenstein-Jensen and Middlebrook solid media and in BACTEC radiometric broth. Tissue specimens were stained with hematoxylin-eosin, Ziehl-Neelsen, auramine O, and Kinyoun stains and were examined for granuloma formation and acid-fast bacilli. PCR was performed with both fluid and tissue with IS6110-based primers specific for the Mycobacterium tuberculosis complex by published methods. Sixteen of the 20 patients had tuberculous pericarditis and 4 patients had other diagnoses. TB was correctly diagnosed by culture in 15 (93%) patients, by PCR in 13 (81%) patients, and by histology in 13 of 15 (87%) patients. PCR gave one false-positive result for a patient with Staphylococcus aureus pericarditis. Considering the individual specimens as the unit of analysis, M. tuberculosis was identified by culture in 30 of 43 specimens (70%) from patients with tuberculous pericarditis and by PCR in 14 of 28 specimens (50%) from patients with tuberculous pericarditis (P > 0.15). The sensitivity of PCR was higher with tissue specimens (12 of 15; 80%) than with fluid specimens (2 of 13; 15%; P = 0.002). In conclusion, the overall accuracy of PCR approached the results of conventional methods, although PCR was much faster. Therefore, PCR merits further development in this regard. The sensitivity of PCR with pericardial fluid was poor, and false-positive results with PCR remain a concern.

Full Text

The Full Text of this article is available as a PDF (122.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cegielski J. P., Lwakatare J., Dukes C. S., Lema L. E., Lallinger G. J., Kitinya J., Reller L. B., Sheriff F. Tuberculous pericarditis in Tanzanian patients with and without HIV infection. Tuber Lung Dis. 1994 Dec;75(6):429–434. doi: 10.1016/0962-8479(94)90116-3. [DOI] [PubMed] [Google Scholar]
  2. Cegielski J. P., Ramiya K., Lallinger G. J., Mtulia I. A., Mbaga I. M. Pericardial disease and human immunodeficiency virus in Dar es Salaam, Tanzania. Lancet. 1990 Jan 27;335(8683):209–212. doi: 10.1016/0140-6736(90)90288-g. [DOI] [PubMed] [Google Scholar]
  3. Choi Y. J., Hu Y., Mahmood A. Clinical significance of a polymerase chain reaction assay for the detection of Mycobacterium tuberculosis. Am J Clin Pathol. 1996 Feb;105(2):200–204. doi: 10.1093/ajcp/105.2.200. [DOI] [PubMed] [Google Scholar]
  4. Clarridge J. E., 3rd, Shawar R. M., Shinnick T. M., Plikaytis B. B. Large-scale use of polymerase chain reaction for detection of Mycobacterium tuberculosis in a routine mycobacteriology laboratory. J Clin Microbiol. 1993 Aug;31(8):2049–2056. doi: 10.1128/jcm.31.8.2049-2056.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ehlers S., Ignatius R., Regnath T., Hahn H. Diagnosis of extrapulmonary tuberculosis by Gen-Probe amplified Mycobacterium tuberculosis direct test. J Clin Microbiol. 1996 Sep;34(9):2275–2279. doi: 10.1128/jcm.34.9.2275-2279.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Eisenach K. D., Cave M. D., Bates J. H., Crawford J. T. Polymerase chain reaction amplification of a repetitive DNA sequence specific for Mycobacterium tuberculosis. J Infect Dis. 1990 May;161(5):977–981. doi: 10.1093/infdis/161.5.977. [DOI] [PubMed] [Google Scholar]
  7. Eisenach K. D., Sifford M. D., Cave M. D., Bates J. H., Crawford J. T. Detection of Mycobacterium tuberculosis in sputum samples using a polymerase chain reaction. Am Rev Respir Dis. 1991 Nov;144(5):1160–1163. doi: 10.1164/ajrccm/144.5.1160. [DOI] [PubMed] [Google Scholar]
  8. Ieven M., Goossens H. Relevance of nucleic acid amplification techniques for diagnosis of respiratory tract infections in the clinical laboratory. Clin Microbiol Rev. 1997 Apr;10(2):242–256. doi: 10.1128/cmr.10.2.242. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kaltwasser G., Garcia S., Salinas A. M., Montiel F. Enzymatic DNA amplification (PCR) in the diagnosis of extrapulmonary Mycobacterium tuberculosis infection. Mol Cell Probes. 1993 Dec;7(6):465–470. doi: 10.1006/mcpr.1993.1069. [DOI] [PubMed] [Google Scholar]
  10. Kox L. F., Rhienthong D., Miranda A. M., Udomsantisuk N., Ellis K., van Leeuwen J., van Heusden S., Kuijper S., Kolk A. H. A more reliable PCR for detection of Mycobacterium tuberculosis in clinical samples. J Clin Microbiol. 1994 Mar;32(3):672–678. doi: 10.1128/jcm.32.3.672-678.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kuwano K., Minamide W., Kusunoki S., Igimi H., Fujiki T., Matsuba K., Hara N. Evaluation of nested polymerase chain reaction for detecting mycobacterial DNA in pleural fluid. Kansenshogaku Zasshi. 1995 Feb;69(2):175–180. doi: 10.11150/kansenshogakuzasshi1970.69.175. [DOI] [PubMed] [Google Scholar]
  12. Machado L. R., Livramento J. A., Bydlowski S. P., Bendit I., Bravo L. M., Spina-França A. Polymerase chain reaction in the diagnosis of tuberculous meningitis. Preliminary report. Arq Neuropsiquiatr. 1994 Sep;52(3):445–446. doi: 10.1590/s0004-282x1994000300029. [DOI] [PubMed] [Google Scholar]
  13. Miller N., Hernandez S. G., Cleary T. J. Evaluation of Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test and PCR for direct detection of Mycobacterium tuberculosis in clinical specimens. J Clin Microbiol. 1994 Feb;32(2):393–397. doi: 10.1128/jcm.32.2.393-397.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Pfyffer G. E., Kissling P., Jahn E. M., Welscher H. M., Salfinger M., Weber R. Diagnostic performance of amplified Mycobacterium tuberculosis direct test with cerebrospinal fluid, other nonrespiratory, and respiratory specimens. J Clin Microbiol. 1996 Apr;34(4):834–841. doi: 10.1128/jcm.34.4.834-841.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Pietrzak J., Frei R., Senn H. P., Moroni C. Comparison of polymerase chain reaction with standard methods in the diagnosis of Mycobacterium tuberculosis infection. Eur J Clin Microbiol Infect Dis. 1994 Dec;13(12):1079–1083. doi: 10.1007/BF02111834. [DOI] [PubMed] [Google Scholar]
  16. Scarpellini P., Racca S., Cinque P., Delfanti F., Gianotti N., Terreni M. R., Vago L., Lazzarin A. Nested polymerase chain reaction for diagnosis and monitoring treatment response in AIDS patients with tuberculous meningitis. AIDS. 1995 Aug;9(8):895–900. doi: 10.1097/00002030-199508000-00010. [DOI] [PubMed] [Google Scholar]
  17. Seino Y., Ikeda U., Kawaguchi K., Yamamoto K., Sekiguchi H., Nakayama T., Takewaki S., Okubo A., Nagai R., Yazaki Y. Tuberculous pericarditis presumably diagnosed by polymerase chain reaction analysis. Am Heart J. 1993 Jul;126(1):249–251. doi: 10.1016/s0002-8703(07)80044-5. [DOI] [PubMed] [Google Scholar]
  18. Smith J. H., Radcliffe G., Rigby S., Mahan D., Lane D. J., Klinger J. D. Performance of an automated Q-beta replicase amplification assay for Mycobacterium tuberculosis in a clinical trial. J Clin Microbiol. 1997 Jun;35(6):1484–1491. doi: 10.1128/jcm.35.6.1484-1491.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Southern E. M. Detection of specific sequences among DNA fragments separated by gel electrophoresis. J Mol Biol. 1975 Nov 5;98(3):503–517. doi: 10.1016/s0022-2836(75)80083-0. [DOI] [PubMed] [Google Scholar]
  20. Victor T., du Toit R., van Helden P. D. Purification of sputum samples through sucrose improves detection of Mycobacterium tuberculosis by polymerase chain reaction. J Clin Microbiol. 1992 Jun;30(6):1514–1517. doi: 10.1128/jcm.30.6.1514-1517.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Vlaspolder F., Singer P., Roggeveen C. Diagnostic value of an amplification method (Gen-Probe) compared with that of culture for diagnosis of tuberculosis. J Clin Microbiol. 1995 Oct;33(10):2699–2703. doi: 10.1128/jcm.33.10.2699-2703.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Walsh P. S., Metzger D. A., Higuchi R. Chelex 100 as a medium for simple extraction of DNA for PCR-based typing from forensic material. Biotechniques. 1991 Apr;10(4):506–513. [PubMed] [Google Scholar]
  23. Yuen K. Y., Yam W. C., Wong L. P., Seto W. H. Comparison of two automated DNA amplification systems with a manual one-tube nested PCR assay for diagnosis of pulmonary tuberculosis. J Clin Microbiol. 1997 Jun;35(6):1385–1389. doi: 10.1128/jcm.35.6.1385-1389.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES