Pleural fluid ADA, IgA‐ELISA and PCR sensitivities for the diagnosis of pleural tuberculosis

Trajman, Anete; Kaisermann, C; Luiz, Ronir Raggio; Sperhacke, Rosa Dea; Rossetti, Maria Lúcia Rosa; Saad, Maria Helena Féres; Sardella, Isabela Gama; Spector, Nelson; Kritski, Afrânio Lineu

doi:10.1080/00365510701459742

Cited by 34 publications

(32 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The combination of PCR, IFN-c and ADA activity allowed an increase of sensitivity and specificity compared with individual methods in isolation. However, in other studies using different tests in the same samples, in which ADA activity had a higher accuracy, no other test significantly added sensitivity to the ADA [20,65].…”

Section: Novel Tests For Tuberculous Pleuritismentioning

confidence: 81%

“…Using histopathology as the reference standard, pleural fluid ADA activity, PCR and immunoglobulin (Ig)A-ELISA tests were evaluated in a high TB incidence country [20] among 77 patients with pleural effusion, 60 of whom had TB pleuritis. ADA activity was the only test that had a significantly higher sensitivity than histopathological examination.…”

Section: Nonspecific Inflammatory and Immune Response Markersmentioning

confidence: 99%

“…Among pleural fluid antibody tests, detection of IgA against MPT-64 and MT-10.3 (Rv3019c), two recombinant protein antigens, had the best sensitivity [20,40]. Anti-A60 IgM and IgG antibodies in pleural fluid had suboptimal sensitivity for TB [41].…”

Section: B-cell Response (Antibody Detection)mentioning

confidence: 99%

See 2 more Smart Citations

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

Trajman

Pai²,

Dheda³

et al. 2008

European Respiratory Journal

Self Cite

137

117

View full text Add to dashboard Cite

Tuberculous pleuritis is a common manifestation of extrapulmonary tuberculosis and is the most common cause of pleural effusion in many countries. Conventional diagnostic tests, such as microscopic examination of the pleural fluid, biochemical tests, culture of pleural fluid, sputum or pleural tissue, and histopathological examination of pleural tissue, have known limitations. Due to these limitations, newer and more rapid diagnostic tests have been evaluated. In this review, the authors provide an overview of the performance of new diagnostic tests, including markers of specific and nonspecific immune response, nucleic acid amplification and detection, and predictive models based on combinations of markers. Directions for future development and evaluation of novel assays and biomarkers for pleural tuberculosis are also suggested.

show abstract

Section: Novel Tests For Tuberculous Pleuritismentioning

confidence: 81%

Section: Nonspecific Inflammatory and Immune Response Markersmentioning

confidence: 99%

See 1 more Smart Citation

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

Trajman

Pai²,

Dheda³

et al. 2008

European Respiratory Journal

Self Cite

137

117

View full text Add to dashboard Cite

show abstract

“…It is also absent from nontuberculosis mycobacteria and, although present in some BCG strains, including the one used in Brazil, MPT64 renders good reactivity in extrapulmonary TB (14,27,40,42). On the other hand, MT10.3, a member of a large family of mycobacterial proteins (CFP10/ESAT6 family) encoded by 23 genes, esxA to -W, has been detected in culture supernatants and is recognized by T cells in TB patients and infected animals.…”

mentioning

confidence: 99%

Assessment of the IgA Immunoassay Diagnostic Potential of the Mycobacterium tuberculosis MT10.3-MPT64 Fusion Protein in Tuberculous Pleural Fluid

Araujo

Maciel

Trajman

et al. 2010

Clin Vaccine Immunol

View full text Add to dashboard Cite

Pleural tuberculosis (PL-TB) remains difficult to diagnose. An enzyme-linked immunosorbent assay (ELISA) was developed based on a construction containing the fusion of the Rv3019c (MT10.3) and Rv1980c (MPT64) gene sequences, and its performance was evaluated in an area where TB is endemic. A total of 92 pleural fluid (PF) samples at serial dilutions of 1:50 to 1:800 were included in the ELISA IgA MT10. 4%). Our findings demonstrated the promising use of this test as an adjunct in PL-TB diagnoses, particularly in cases with lower bacterial loads and false-negative results in the reference tests, since the new test includes such important features as quick and easy application, high sensitivity and, perhaps most importantly, affordability, which is so crucial for its widespread use in developing countries.Tuberculosis (TB) is the leading cause of preventable morbidity and mortality from infectious agents worldwide. A global plan has been outlined to eradicate the disease by 2050 (37). To reach this goal, both political commitments and increments in interdisciplinary research are needed; because the specific diagnostics, drugs, and vaccines available for this purpose have been insufficient in eradicating the disease, the development of more effective tools and strategies is urgently needed (7).In Brazil, the TB prevalence rate is approximately 60 per 100,000 inhabitants (44). Generally speaking, the incidence of pleural tuberculosis (PL-TB) is closely related to the local disease prevalence. Moreover, PL-TB is the major cause of pleural effusions, responsible for approximately 50% of all related diagnoses in Brazil (25, 32).TB diagnoses have traditionally relied on the identification of acid-fast bacilli (AFB) and the culture of clinical specimens. However, low sensitivities (5 and 47%, respectively) are achieved with PL-TB. Besides, the final culture results may take as long as 4 to 6 weeks to complete, delaying the initiation of specific therapy.The histopathological examination of pleural biopsy specimens comprises the standard PL-TB reference test. Nevertheless, its sensitivity is highly variable (39 to 84%), it is expensive and time-consuming, and its proper administration requires skilled personnel. It is clear that there is an overriding need for the development of a simple, fast, effective, and affordable yet robust tool that would be readily available throughout the national public health care sector to aid in the diagnosis of PL-TB, with special emphasis on developing countries (12,15,30). What is most frequently used is an enzyme-linked immunosorbent assay (ELISA) together with commercial and inhouse antibody tests, which have been developed using antigens in a cocktail-like format. The downside is that lower reactivity has been described for this format compared with the rates obtained after testing these components individually (9,13,22). In our previous studies, when the single proteins MPT64 and MT10.3 were tested individually for each patient, the combined results achieved a 76% sensitivity rate in...

show abstract

“…Better results have been found for nucleic acid amplification tests (NAATs), but a disparity in sensitivity of NAATs demonstrated in different studies was very large (15-85 %, mean 62 %) (Krenke et al 2008;Trajman et al 2007;Pai et al 2004). A combined microbiological and histological examination of pleural biopsy samples is a reliable method to confirm the tuberculous etiology of pleural effusion, but biopsy methods are demanding and require considerable skills and experience.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Different Pleural Fluid Biomarkers in Tuberculous Pleurisy

Klimiuk

Krenke

Safianowska

et al. 2014

Advances in Experimental Medicine and Biology

View full text Add to dashboard Cite

Due to the paucibacillary nature of tuberculous pleural effusion the diagnosis of pleural tuberculosis is challenging. This prospective study was undertaken to evaluate the diagnostic performance of ten different pleural fluid biomarkers in the differentiation between tuberculous and non-tuberculous pleural effusions. Two hundred and three patients with pleural effusion (117 men and 86 women, median age 65 years) were enrolled. Routine diagnostic work-up, including thoracentesis and pleural fluid analysis, was performed to determine the cause of pleural effusion. The following biomarkers were measured in pleural fluid: adenosine deaminase (ADA), interferon gamma (IFN-γ), interleukin 2 soluble receptor (IL-2sRα), sub-unit p40 of interleukin 12b (IL-12p40), interleukin 18 (IL-18), interleukin 23 (IL-23), IFN-γ induced protein 10 kDa (IP-10), Fas-ligand, human macrophage-derived chemokine (MDC) and tumor necrosis factor alfa (TNF-α). There were 44 (21.7%) patients with tuberculous pleural effusion, 88 (43.3%) patients with malignant pleural effusion, 35 (17.2%) with parapneumonic effusion/pleural empyema, 30 (14.8%) with pleural transudates, and 6 (3%) with miscellaneous underlying diseases. Pleural fluid IFN-γ was found the most accurate marker differentiating tuberculous from non-tuberculous pleural effusion, with sensitivity, specificity, PPV, NPV, and AUC 97%, 98%, 95.5%, 99.4%, and 0.99, respectively. Two other biomarkers (IP-10 and Fas ligand) also showed very high diagnostic accuracy with AUC≥0.95. AUC for ADA was 0.92. We conclude that IFN-γ, IP-10, and Fas-ligand in pleural fluid are highly accurate biomarkers differentiating tuberculous from non-tuberculous pleural effusion.

show abstract

Pleural fluid ADA, IgA‐ELISA and PCR sensitivities for the diagnosis of pleural tuberculosis

Cited by 34 publications

References 19 publications

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

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

Assessment of the IgA Immunoassay Diagnostic Potential of the Mycobacterium tuberculosis MT10.3-MPT64 Fusion Protein in Tuberculous Pleural Fluid

Diagnostic Performance of Different Pleural Fluid Biomarkers in Tuberculous Pleurisy

Contact Info

Product

Resources

About