Diagnostic utility of Borrelia burgdorferi cerebrospinal fluid polymerase chain reaction-in children with Lyme meningitis
Diagnostic utility of Borrelia burgdorferi cerebrospinal fluid polymerase chain reaction-in children with Lyme meningitis
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DOI：
10.1097/01.inf.0000172903.14077.4c
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发表时间：
2005-08-01
影响因子：
3.6
通讯作者：
Eppes, SC
中科院分区：
文献类型：
--
作者：
Avery, RA;Frank, G;Eppes, SC
背景：脑脊液(CSF)实验室检测经常被用来帮助莱姆氏脑膜炎与其他原因的无菌性脑膜炎的鉴别。以前使用莱姆脑脊液聚合酶链式反应(PCR)的研究得出了不同的结果(敏感度在10%到90%之间)。还没有研究专门研究莱姆脑脊液-聚合酶链式反应在北美莱姆脑膜炎儿童中的诊断作用。方法：回顾1999年10月至2004年9月间在莱姆病流行地区的一家儿童医院就诊的儿童。如果患者在同一医院就诊期间同时进行了莱姆血清学和莱姆脑脊液聚合酶链式反应检查，并有脑膜炎记录，则纳入研究对象。如果患者患有脑膜炎，并符合疾病控制与预防中心的莱姆病标准，则被认为患有莱姆脑膜炎。结果：108例符合研究条件的脑膜炎患者中，20例符合莱姆氏脑膜炎诊断标准，88例为无菌性脑膜炎。莱姆脑膜炎1例阳性(I/20，5%)，无菌性脑膜炎1例(I/88，1%)。莱姆脑脊液-聚合酶链式反应的敏感性为5%，特异性为99%。与其他莱姆脑膜炎患者相比，莱姆脑膜炎患者中唯一阳性的莱姆脑膜炎患者的脑脊液白细胞计数和脑脊液蛋白含量最高。结论：这是首次在北美儿童中专门评估莱姆脑膜炎患者的研究。这种商业化的实验室检测通常对识别莱姆氏脑膜炎没有帮助，因为它的敏感性较低。
Background: Cerebrospinal fluid (CSF) laboratory tests are frequently collected to help differentiate Lyme meningitis from other causes of aseptic meningitis. Previous studies using Lyme CSF polymerase chain reaction (PCR) have yielded varied results (sensitivity between 10 and 90%). No studies have specifically examined the diagnostic utility of Lyme CSF-PCR in North American children with Lyme meningitis.Methods: Retrospective chart review of children presenting to a children's hospital in a Lyme-endemic region between October 1999 and September 2004. Patients were included if they had both Lyme serology and Lyme CSF-PCR performed during the same hospital encounter and had documented meningitis. Patients were considered to have Lyme meningitis if they had meningitis and met CDC criteria for Lyme disease. The Lyme CSF-PCR assay amplified a Borrelia burgdorferi DNA flagellin gene sequence.Results: Of 108 patients with meningitis who qualified for the study, 20 patients met criteria for Lyme meningitis and 88 were classified as aseptic meningitis. Positive Lyme CSF-PCR was found in I patient (I of 20, 5%) with Lyme meningitis and one patient classified as aseptic meningitis (I of 88, 1%). Lyme CSF-PCR had a sensitivity of 5% and a specificity of 99%. The only Lyme meningitis patient with positive Lyme CSF-PCR had the highest CSF white blood cell count and CSF protein values compared with the other Lyme meningitis patients.Conclusions: This is the first study to evaluate Lyme CSF-PCR exclusively in North American children. This commercially available laboratory test is not generally helpful for identifying Lyme meningitis because of its low sensitivity.