A diagnostic algorithm for tuberculous pleurisy using the ELISPOT assay on peripheral blood and pleural effusion

Kim, Min‐Chul; Kim, Sunmi; Lee, Sang‐Oh; Choi, Sang‐Ho; Kim, Yang Soo; Woo, Jun Hee; Kim, Sung-Han

doi:10.1080/23744235.2016.1183816

Cited by 14 publications

(11 citation statements)

References 33 publications

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“…As a common extrapulmonary TB, Tuberculous pleurisy (TBP) accounts for 25% of TB cases in China (2)(3)(4). The diagnosis of TBP is difficult (5,6), with the thoracoscopic pleural pathology as the gold standard method (7). However, thoracoscopic pleural biopsy is an invasive operation with the issues of considerable risks and cost.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Pleural Effusion Mononuclear Cells Count and Adenosine Deaminase for Tuberculous Pleurisy Patients in China: A Case-Control Study

et al. 2019

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Background: The diagnostic value of pleural effusion mononuclear cells count for tuberculous pleurisy (TBP) is unclear. We aimed to evaluate the diagnostic value of pleural effusion mononuclear cells count and its combination with adenosine deaminase (ADA) in TBP patients. Methods: We initially analyzed 296 patients with unknown pleural effusion from the Department of Respiratory Medicine at Provincial People's Hospital during January 2014 to February 2018. Ultimately, 100 tuberculous pleurisy (TBP) patients and 105 non-tuberculous pleurisy (non-TBP) patients with pleural effusion were investigated in the current study. Meanwhile, pleural effusion mononuclear cells count and ADA test were performed to evaluate the diagnostic value for TBP. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), accuracy and area under the receiver operating characteristic (ROC) curve (AUC) of pleural effusion mononuclear cells count only and its combination with ADA for TBP diagnosis were investigated. Results: (i) The best cutoff value of pleural effusion mononuclear cells count for TBP diagnosis was 969.6 × 10 6 /L, with the sensitivity, specificity and accuracy of 76, 57, and 66%, respectively. (ii) Combination of pleural effusion mononuclear cells count and ADA test suggested diagnostic value for TBP. Specifically, serial test showed the sensitivity, specificity, accuracy of 65, 90, 78%, respectively, whereas parallel test revealed the sensitivity, specificity, accuracy of 92, 45, 68%, respectively. The sensitivity of parallel test (92%) was significantly higher than pleural effusion mononuclear cells count alone (76%) (X² = 23.19, p < 0.001). (iii) The area under the ROC of pleural effusion mononuclear cells count and it combined with ADA were 0.66 (95% CI, 0.59-0.72) and 0.83 (95% CI, 0.78-0.89), respectively, with statistically significant difference (Z = 3.46, p < 0.001). Lei et al. Combination Test for TBP Conclusion: This retrospective case-control study demonstrated that pleural effusion mononuclear cells count is relatively useful for TBP diagnosis. Furthermore, the pleural effusion mononuclear cells count in combination with ADA can further improve the diagnostic accuracy of TBP.

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Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Pleural Effusion Mononuclear Cells Count and Adenosine Deaminase for Tuberculous Pleurisy Patients in China: A Case-Control Study

et al. 2019

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“…After loss of special phenotypical T-cell surface markers, these cell populations are probably unable to re-enter the bloodstream and become enriched at the site of disease [9,10]. In contrast to detection of M. tuberculosis-specific effector T-cells in peripheral blood, detection of M. tuberculosis-specific effector T-cells by the interferon (IFN)-γ release assay at the site of the infection has a high diagnostic accuracy for active TB even when AFB and M. tuberculosis DNA are not detectable from local samples such as bronchoalveolar lavage (BAL) [11][12][13][14][15], pleural fluid [16,17], pericardial fluid [18], cerebrospinal fluid [19] or ascites [20]. ELISPOT test results are available within 24 h.…”

Section: Introductionmentioning

confidence: 99%

Rapid diagnosis of pulmonary tuberculosis by combined molecular and immunological methods

et al. 2018

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Diagnosing pulmonary tuberculosis (TB) may be delayed until culture results become available.We ascertained the accuracy of a stepwise diagnostic algorithm for the rapid diagnosis of pulmonary TB by GeneXpert from sputum and/or bronchoalveolar lavage (BAL) followed by a specific BAL ELISPOT assay in patients with a suspected diagnosis of pulmonary TB at a clinical referral centre in Germany.Among 166 patients with a presumptive diagnosis of pulmonary TB, 81 cases were confirmed by culture from sputum and/or BAL. In 66 out of 81 (81.5%) cases, patients initially had detected by GeneXpert from sputum; in addition, six out of 81 (7.4%) cases were diagnosed by GeneXpert on BAL fluid (together 72 out of 81 (88.9%) patients). Out of the remaining nine patients with negative GeneXpert results from sputum and BAL, BAL ELISPOT identified eight patients with culture-confirmed TB correctly (median time to culture positivity 26 days). At a cut-off of>4000 early secretory antigenic target-6- or culture filtrate protein-10-specific interferon-γ-producing lymphocytes per 1 000 0000 lymphocytes, the specificity of the BAL ELISPOT for active TB was 97%.In low TB incidence countries, nearly all patients with active pulmonary TB can be identified within the first few days of clinical presentation using a stepwise strategy with GeneXpert and BAL ELISPOT.

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“…After mycobacterium tuberculosis infection, macrophages in lesion site will be activated and IFN-γ content in pleural effusion and blood will gradually increase ( 20 ). Studies have shown that IL-27 has a dual regulatory effect on Th1-type immune responses in tuberculous diseases ( 21 , 22 ). On one hand, IL-27 can induce the differentiation of CD4 + in to Th1.…”

Section: Discussionmentioning

confidence: 99%

“…Cellular immune function plays an important role in the development of immune diseases. Related studies showed that mycobacterium tuberculosis control was closely related with macrophage ( 4 , 5 ). T cells spot test (T-Spot TB) was reported to possess relatively high sensitivity in the detection of extrapulmonary tuberculosis ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of T-Spot TB combined with INF-γ and IL-27 in tuberculous pleurisy

Zhang

Xiong

et al. 2017

Exp Ther Med

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The purpose of the present study was to investigate the diagnostic value of T cells spot test (T-Spot TB) combined with interferon-γ (INF-γ) and interleukin-27 (IL-27) in tuberculous pleurisy. Sixty patients with tuberculous pleurisy (observation group) and 60 patients with non-tuberculous pleurisy (control group) were enrolled in this study. T-Spot TB was performed to detect the pleural effusion of two groups of patients. Levels of IFN-γ and IL-27 in serum and pleural effusion were detected by enzyme-linked immunosorbent assay (ELISA). Relative expression of IFN-γ mRNA and IL-27 mRNA in peripheral blood mononuclear cells were detected by RT-PCR. Positive rate of T-Spot TB in observation group was 96.7% (58 cases), which was significantly higher than that in control group (p<0.05). Concentration of INF-γ in pleural effusion of observation group was 468.6±24.8 ng/l, which was significantly higher than that in control group (131.3±18.7 ng/l, p<0.05). Concentration of IL-27 in pleural effusion of observation group was 423.4±37.2 ng/l, which was significantly higher than that in control group (116.2±15.5 ng/l, p<0.05). Concentrations of INF-γ and IL-27 in serum of observation group were 48.2±13.4 and 41.7±10.6 ng/l, respectively, which were significantly higher than those in control group (38.6±11.2 and 35.3±8.4 ng/l, p<0.05). Relative expression levels of INF-γ mRNA and IL-27 mRNA in observation group were significantly higher than those in control group (p<0.05). Therefore, combination of T-Spot TB with INF-γ and IL-27 has significant application value in the clinical diagnosis of tuberculous pleurisy, and should be popularized.

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A diagnostic algorithm for tuberculous pleurisy using the ELISPOT assay on peripheral blood and pleural effusion

Abstract: A diagnostic algorithm combining ELISPOT assays and ADA levels in pleural fluid appears to be a promising and non-invasive approach for patients with suspected TB pleurisy.

Cited by 14 publications

References 33 publications

Diagnostic Value of Pleural Effusion Mononuclear Cells Count and Adenosine Deaminase for Tuberculous Pleurisy Patients in China: A Case-Control Study

Diagnostic Value of Pleural Effusion Mononuclear Cells Count and Adenosine Deaminase for Tuberculous Pleurisy Patients in China: A Case-Control Study

Rapid diagnosis of pulmonary tuberculosis by combined molecular and immunological methods

Diagnostic value of T-Spot TB combined with INF-γ and IL-27 in tuberculous pleurisy

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