Background: Adenosine deaminase (ADA) is already used for the differential diagnosis of tuberculosis pleurisy. Tumour necrosis factor-α (TNF) is another marker which has been investigated for this purpose. Objective: We evaluated the diagnostic value of pleural fluid and serum TNF concentrations in tuberculous pleuritis and compared them to ADA. Methods: Sixty-two patients (24 tuberculous pleuritis, 38 non-tuberculous pleuritis) with exudative pleurisy were included. Serum and pleural fluid TNF concentrations were determined in all patients and ADA activity in 54 patients. Pleural fluid TNF concentrations and pleural fluid/serum TNF were compared to pleural fluid ADA activity and pleural fluid/serum ADA. Results: When the tuberculous and non-tuberculous groups were compared, pleural fluid TNF concentrations (65.4 ± 136.9 pg/ml vs. 54.5 ± 144.2 pg/ml, respectively; p < 0.001), pleural fluid ADA activity (74.2 ± 33.3 U/l vs. 23 ± 16.3 U/l; p < 0.0001), pleural fluid/serum TNF (2.55 ± 5.23 vs. 0.26 ± 0.2; p < 0.001) and pleural fluid/serum ADA (4.58 ± 8.14 vs. 1.15 ± 0.7; p < 0.0001) were significantly higher in the tuberculous group. When cut-off points were assessed, 8 pg/ml and 40 U/l were found for pleural fluid TNF concentrations and pleural fluid ADA activity, respectively. Sensitivity, specificity, area under the curve were 87.5%, 76.3%, 0.772 for pleural fluid TNF concentrations and 90.9%, 89.5%, 0.952 for pleural fluid ADA activity, respectively; the difference between these areas under the curves was significant (p < 0.05). Conclusions: Pleural fluid TNF levels and pleural fluid/serum TNF were higher in tuberculous effusions than in other exudates, but their diagnostic value appears to be poorer than that of ADA.

Eighty-four patients (25 tb, 30 lung cancer and 29 COPD) were included in the study. ADA activity in sputum and serum was measured. Sputum ADA activities of tb patients were significantly higher than the other two groups (P < 0.05). Sputum/serum ADA ratios were similar in all groups. Sputum ADA activities between 150 and 200 U/L were the measurements with the best test performance according to the ROC curve. Sensitivity, specificity, positive predictive value, and negative predictive value were 44.0, 86.4, 57.8, 78.4% for 150 U/L and 32.0, 96.6, 80.0, 77.0% for 200 U/L, respectively. Area under the curve was 0.663. Because of low sensitivity, routine determination of ADA activity in sputum for the diagnosis of pulmonary tb is not recommended. However, it can be helpful in the diagnosis of smear-negative cases who are strongly suspected of tb.

Introduction: New diagnostic tools are being investigated for rapid and accurate TB detection. We aimed to find out the diagnostic yield and accuracy of chemokine CXCL12 (SDF-1a) levels in diagnosing active TB (aTB) and making a differential diagnosis from other several infectious/non-infectious pulmonary conditions. Methodology: We collected demographic, clinic features and studied plasma CXCL12 levels using ELISA kit of the participants, classified into five categories: aTB (n = 30); cured TB (cTB, n = 15); close contacts of aTB (CC, n = 15); chronic obstructive pulmonary disease (COPD) with active nonspecific pulmonary infection (infCOPD, n = 15); and healthy controls (HC, n = 15). Results: CXCL12 levels were highest in aTB, but no significant difference was seen between other groups. When a cut-off level for CXCL12 was determined as 2835 pg/mL, the increased CXCL12 rate was significantly more in aTB than CC and HC (p = 0.02, p = 0.05). Also, participants with an active infection (aTB and infCOPD) had significantly higher increased CXCL12 rates (p = 0.01). The sensitivity and specificity of CXCL12 for diagnosing aTB were found to be 0.56 and 0.63, respectively. We found that bacterial load, the radiological severity and the extent of chest x-ray involvement were independent factors for increased CXCL12 levels. Conclusions: Our study demonstrates that CXCL12 may be a representative of active pulmonary infection regardless of the cause but correlated with the severity of the disease; enabling this test to be used as a prognostic factor rather than a diagnostic test for aTB.

Contamination of blood, especially in borderline transudative pleural effusions, may result in misclassification as an exudate. Light's criteria appear to be the least effected and therefore the most reliable parameters in bloody effusions.

ÖzetGİRİŞ ve AMAÇ: Mediastinal benign lenfadenopatinin en sık nedenleri sarkoidoz ve tüberküloz lenfadenit hastalıklarıdır. Çalışmamızda, TB lenfadenitin ayırıcı tanısında yeni yöntemlerden birisi olan QuantiFERON-TB Gold (in tube) (QFT-GIT) testinin değerini araştırmayı amaçladık. YÖNTEM ve GEREÇLER: Toraks BT'de transvers çapı 10 mm ve üzerinde olan mediastinal lenf nodlarının etiyolojisinin araştırılması amacıyla kliniklerimize yönlendirilerek 36'sı sarkoidoz ve 37'si TB lenfadenit tanısı konulan toplam 73 hastanın prospektif olarak yaş, cinsiyet, eşlik eden ek hastalık, tüberküloz temas öyküsü, semptomları, BCG skar sayısı, TCT sonuçları ve QFT-GIT testi sonuçları kaydedildi. BULGULAR: Sarkoidoz hastalarının yaş ortalamaları 42,2±17,2 idi. Olguların 19'u kadın (%52.8), 17'si erkekti (% 47,2). Ortalama takip süreleri 14,6±12,3 ay idi (3 -36 ay). Sarkoidoz ile TB lenfadenit ayırıcı tanısında halen kullanılmakta olan TCT nin, TB lenfadenit tanısında duyarlılığı %62, özgüllüğü %75; QFT-GIT testinin duyarlılığı %92, özgüllüğü %83 olarak hesaplandı. Sarkoidozda QFT-GIT testi ve TCT sonuçları arasında anlamlı korelasyon bulunmazken [p=0,618]; TB lenfadenit için anlamlı korelasyon saptandı [p=0,028]. TARTIŞMA ve SONUÇ: Ülkemizde olduğu gibi rutin BCG aşılamasının ve TCT sonucuna göre yeniden aşılanmaların uygulandığı topluluklarda, tüberküloz enfeksiyonun ayırıcı tanısında BCG den etkilenmeyen QFT-GIT testinin TCT ile birlikte kullanılması önerilebilir. Ayrıca sistemik steroid tedavisi alması planlanan hastalarda INH proflaksisi başlanması için tek başına TCT'den ziyade QFT-GIT testi pozitifliğinin gözönüne alınması uygun olabilir. Abstract INTRODUCTION:There is one of the new methods in the differential diagnosis QuantiFERON-TB Gold (in tube) (QFT-GIT), in which the most common cause of sarcoidosis and tuberculosis lymphadenitis of benign mediastinal lymphadenopathy, we aimed to investigate the value of the test for TB lymphadenitis. METHODS: Chest CT transverse diameter of 10 mm and directed to our clinic to investigate the etiology of mediastinal lymph nodes above sarcoidosis was diagnosed in 36 patients with TB lymphadenitis was diagnosed in 37 patients, including 73 patients age, sex, comorbid disease, the tuberculosis contact history, symptoms, number of BCG scar, TST and QFT-GIT results were recorded test results. RESULTS: The mean age of patients with sarcoidosis 42.2± 17.2) were female (52.8%), 17 were male (47.2%). Average follow-up time was 14.6 ± 12.3 months. (3-36 months). With sarcoidosis, which is still being used in the differential diagnosis of TB lymphadenitis, TCT's sensitivity in diagnosis of TB lymphadenitis was 62%, specificity 75%; QFT-GIT sensitivity of the test was 92%, specificity of 83% was calculated. Sarcoidosis QFT-GIT and TST test results of there were no significant correlation between [p = 0.618]; Significant correlation was found for TB lymphadenitis [p = 0.028]. DISCUSSION AND CONCLUSION: As our country and communities of routine BCG vaccination should be vaccinated again applied a...