Assessment of A Real-time PCR Method to Detect Human Non-Cryptococcal Fungal Meningitis

Background: The signs and symptoms associated with fungal meningitis are similar to those seen with more common bacterial infections. In this study, we investigate whether Aspergillus or Candida DNA can be detected in cerebrospinal fluid (CSF) samples from patients suspected of fungal meningitis using real-time PCR assay. Methods: From April 2007 to November 2009, we evaluated CSF samples and sera from patients with risk factors for cerebral fungal meningitis in Nemazi Hospital, Shiraz University of Medical Sciences, Iran, by real-time PCR assay and routine mycological studies (direct microscopy examination and culture). Two CSF and two serum samples from each patient were examined. Results: CSF and serum samples from 38 patients (total: 152) suspected of fungal meningitis were examined. India ink staining and KOH smear were negative for all patients. C. albicans was isolated from two CSF samples. There were ten patients with positive real-time PCR results in their CSF samples: three patients had C. albicans, one with C. glabrata, four with Aspergillus species and two with both C. albicans and Aspergillus species DNA. Four patients had positive serum results for Aspergillus or Candida infections. Conclusion: Considering the findings, it seems that molecular examination can help in the diagnosis of fungal meningitis in patients with clinical and radiological presentations. Further studies should be conducted in other regions and settings to confirm these findings.