Novel tests for diagnosing tuberculous pleural effusion: what works and what does not?

Trajman, Anete; Pai, Madhukar; Dheda, Keertan; Zyl-Smit, Richard van; Zwerling, Alice; Joshi, Rajnish; Kalantri, Shriprakash; Daley, Peter; Menzies, Dick

doi:10.1183/09031936.00147507

Cited by 140 publications

(141 citation statements)

References 66 publications

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“…77 Wilkinson et al 73 found a 15-fold greater concentration of ESAT-6-specific spot-forming T cells in pleural fluid than of PBMCs in 10 patients with pleural TB. These cells were not found in the pleural fluid of 8 patients with nontuberculous pleuritis.…”

Section: Pleural Tuberculosismentioning

confidence: 99%

Diagnosis of tuberculosis infection using interferon-γ-based assays

Cerezales

Benítez

2011

Enfermedades Infecciosas y Microbiología Clínica

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Section: Pleural Tuberculosismentioning

confidence: 99%

Diagnosis of tuberculosis infection using interferon-γ-based assays

Cerezales

Benítez

2011

Enfermedades Infecciosas y Microbiología Clínica

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“…Approximately 30% of tuberculosis cases present as tuberculous pleurisy (Aktogu et al, 1996), for which the available diagnostic methods have significant limitations. Culture of pleural fluid shows sensitivities of only 24 to 58% (Trajman et al, 2008;Porcel, 2009), while pleural tissue biopsy is invasive and technically difficult (Pérez-Rodriguez and Jiménez Castro, 2000).…”

Section: Introductionmentioning

confidence: 99%

Accuracy of enzyme-linked immunospot assay for diagnosis of pleural tuberculosis: a meta-analysis

Li¹,

Qin²,

Li³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. Current methods for diagnosing tuberculous pleurisy are poor. Some studies have explored the diagnostic value of a pleural effusion enzyme-linked immunospot (ELISPOT) assay, but its accuracy remains controversial. Therefore, we performed a meta-analysis of the existing evidence on the ability of the ELISPOT assay to diagnose tuberculous pleurisy. We systematically searched PubMed, Google Scholar, and EMBASE databases for studies measuring the sensitivity, specificity, and other measures of accuracy of the pleural effusion ELISPOT assay for diagnosis of tuberculous pleurisy. A total of nine studies were identified and subjected to meta-analysis, giving the following pooled values for sufficiently accurate to diagnose tuberculous pleurisy as a stand-alone technique. In fact, it appears to be superior to assays based on adenosine deaminase and gamma interferon for screening patients and confirming the diagnosis of tuberculous pleurisy.

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“…Even in cases where ADA is unavailable, the use of clinical and demographic information in combination with a cell differential count, in high incidence settings, can yield a diagnosis of TB with a high predictive value (25). This concept has been further advanced with a number of groups recommending the use of pleural fluid and clinical parameter combinations in the diagnosis of tuberculous pleural effusions which we described in this review.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic tests for tuberculous pleural effusion

McGrath

Anderson

2010

Eur J Clin Microbiol Infect Dis

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The investigation of pleural effusion has been greatly assisted by advancements in pleural fluid analysis. In the case of tuberculous pleural effusion, diagnosis traditionally requires the demonstration of acid fast bacilli in the pleural space using microbiological or histological techniques. In recent years there has been progress in pleural fluid analysis in suspected tuberculous effusions with particular interest in adenosine deaminase and interferon-γ. These individual tests are quite sensitive and specific, however data is sparse on the benefits multiple parameter testing may have when analysed in combination. We reviewed the literature to investigate the evidence for multiple parameters testing, both biochemical and clinical, in the evaluation of tuberculous effusion.Dear Editor, Thank you for giving us the opportunity to submit a revised manuscript. I very much appreciated the reviewers' comments and have made every effort to address them. I have highlighted the changes to the manuscript in red font and will specifically address each comment below chronologically. As ever, we would be only too delighted to make any further changes the reviewers' recommend. Yours faithfullyDr. Emmet McGrath MB PhD MRCPI NIHR Clinical Lecturer in Respiratory Medicine Sheffield Reviewer #1 comments addressed:I have now critically appraised each individual study as requested. Major comments1. I have now cited Diacon reference as recommended. 2. I have now described that it is the combination of all 4 features of thoracoscopy which offers significant advantages over other biopsy techniques. 3. I have followed the reviewer's advice re. Introduction--last sentence. 4. I have now included a critical appraisal of the strengths and weaknesses of each study. 5. I was talking about closed pleural biopsy (Abrams etc) and I have now made this point clearer. 6. I have removed the text concerning Porcel's recommendation. Both reviewers felt it was not required. I have appraised 2 of Porcel's research studies instead. 7. I have now specified which biopsy type I was referring to in the text. 8. I have now linked in the lack of specificity of ADA to the section on "disadvantages" of the tests. 9. I have again pointed out several advantages of thoracoscopy as recommended. 10. I have discussed the problems of variable prevalence, lack of gold standard controls in all but one study, variable study design (retro-versus prosp-) as well as the variable and generally low n numbers. Diagnostic tests for tuberculous pleural effusion AbstractThe investigation of pleural effusion has been greatly assisted by advancements in pleural fluid analysis. In the case of tuberculous pleural effusion, diagnosis traditionally requires the demonstration of acid fast bacilli in the pleural space using microbiological or histological techniques. In recent years there has been progress in pleural fluid analysis in suspected tuberculous effusions with particular interest in adenosine deaminase and interferon-γ. These individual tests are quite se...

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Novel tests for diagnosing tuberculous pleural effusion: what works and what does not?

Cited by 140 publications

References 66 publications

Diagnosis of tuberculosis infection using interferon-γ-based assays

Diagnosis of tuberculosis infection using interferon-γ-based assays

Accuracy of enzyme-linked immunospot assay for diagnosis of pleural tuberculosis: a meta-analysis

Diagnostic tests for tuberculous pleural effusion

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