Value of a novel Neisseria meningitidis--specific polymerase chain reaction assay in skin biopsy specimens as a diagnostic tool in chronic meningococcemia.
Value of a novel Neisseria meningitidis--specific polymerase chain reaction assay in skin biopsy specimens as a diagnostic tool in chronic meningococcemia.
复制标题
一种新型脑膜炎奈瑟菌——皮肤活检标本特异性聚合酶链反应测定作为慢性脑膜炎球菌血症诊断工具的价值。
作者：
L. Parmentier;C. Garzoni;C. Antille;L. Kaiser;B. Ninet;L. Borradori
背景
慢性脑膜炎球菌血症(CM)是一种诊断挑战。皮肤损害是常见的，但在大多数情况下是非特异性的。在常规微生物检测未能分离细菌的患者中，血液和脑脊液中基于聚合酶链式反应(PCR)的诊断已被证实为急性脑膜炎奈瑟菌感染。在2例CM患者中，我们通过对皮肤活检标本进行的一种新开发的基于PCR的方法确定了诊断。
观察
2例患者出现发热，并伴有提示CM的全身和皮肤表现。尽管血液培养的结果仍然是阴性的，但我们能够通过一种新开发的聚合酶链式反应方法在皮肤病变中鉴定出N个脑膜炎。在1例患者中，从咽拭子标本中也分离到同一血清组的N株脑膜炎病毒。经过适当的抗生素治疗后，两名患者的病情都迅速好转。
结论
据我们所知，我们报告了第一例通过皮肤活检标本的聚合酶链式反应检测而诊断的CM病例。值得注意的是，尽管N脑膜炎特异性聚合酶链式反应在急性感染的血液和脑脊液中高度敏感，但我们的观察强调了在皮肤病变上进行聚合酶链式反应对慢性N脑膜炎感染的诊断的有效性。只要可能，这种方法应该系统地应用于常规微生物学检查不能证实N脑膜炎感染的患者。
BACKGROUND
Chronic meningococcemia (CM) is a diagnostic challenge. Skin lesions are frequent but in most cases nonspecific. Polymerase chain reaction (PCR)-based diagnosis has been validated in blood and cerebrospinal fluid for acute Neisseria meningitidis infection, in patients in whom routine microbiologic tests have failed to isolate the bacteria. In 2 patients with CM, we established the diagnosis by a newly developed PCR-based approach performed on skin biopsy specimens.
OBSERVATIONS
Two patients presented with fever together with systemic and cutaneous manifestations suggestive of CM. Although findings from blood cultures remained negative, we were able to identify N meningitidis in the skin lesions by a newly developed PCR assay. In 1 patient, an N meningitidis strain of the same serogroup was also isolated from a throat swab specimen. Both patients rapidly improved after appropriate antibiotherapy.
CONCLUSIONS
To our knowledge, we report the first cases of CM diagnosed by PCR testing on skin biopsy specimens. It is noteworthy that, although N meningitidis-specific PCR is highly sensitive in blood and cerebrospinal fluid in acute infections, our observations underscore the usefulness of PCR performed on skin lesions for the diagnosis of chronic N meningitidis infections. Whenever possible, this approach should be systematically employed in patients for whom N meningitidis infection cannot be confirmed by routine microbiologic investigations.
白色萎缩。
影响因子：
4.6
作者：
Pizzo,SV;Murray,JC;Gonias,SL
通讯作者：
Gonias,SL