Pleural fluid characteristics of tuberculous pleural effusions

McGrath, Emmet E.; Warriner, David; Anderson, Paul B.

doi:10.1016/j.hrtlng.2009.12.004

Cited by 12 publications

(14 citation statements)

References 35 publications

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“…The specificity of ADA may be improved if the proportion of lymphocytes is taken into account as was recently shown [22]. However, this is not universally helpful as about ~25% of TB pleural effusions , may be neutrophil predominant [23]. …”

Section: Discussionmentioning

confidence: 99%

“…However, given that HIV increases the concentration of organisms in pleural fluid and that the upper limit of the Xpert sensitivity (95% CI) was 37% suggests that Xpert is unlikely to perform well in any setting when using pleural fluid. We did not evaluate the potential impact on morbidity and length of hospital stay of ADA, IFN-γ and Xpert compared to empiric treatment based on laboratory analysis alone (lymphocyte predominance), however, this would have require a randomized design and up to ~25% of TB effusions are known to be neutrophil pre-dominant [23]. The confidence intervals of the sensitivity estimates for interferon gamma and the GeneXpert MTB/ RIF assay are not ideal and therefore our findings should be confirmed using larger sample numbers and from different parts of the world.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of same day diagnostic tools including Gene Xpert and unstimulated IFN-γ for the evaluation of pleural tuberculosis: a prospective cohort study

et al. 2014

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BackgroundThe accuracy of currently available same-day diagnostic tools (smear microscopy and conventional nucleic acid amplification tests) for pleural tuberculosis (TB) is sub-optimal. Newer technologies may offer improved detection.MethodsSmear-microscopy, adenosine deaminase (ADA), interferon gamma (IFN-γ), and Xpert MTB/RIF [using an unprocessed (1 ml) and centrifuged (~20 ml) sample] test accuracy was evaluated in pleural fluid from 103 consecutive patients with suspected pleural TB. Culture for M.tuberculosis and/or histopathology (pleural biopsy) served as the reference standard. Patients were followed prospectively to determine their diagnostic categorisation.ResultsOf 93 evaluable participants, 40 had definite-TB (reference positive), 5 probable-TB (not definite but treated for TB) and 48 non-TB (culture and histology negative, and not treated for TB). Xpert MTB/RIF sensitivity and specificity (95% CI) was 22.5% (12.4 - 37.6) and 98% (89.2 - 99.7), respectively, and centrifugation did not improve sensitivity (23.7%). The Xpert MTB/RIF internal positive control showed no evidence of inhibition. Biomarker specific sensitivity, specificity, PPV, and NPVs were: ADA (48.85 IU/L; rule-in cut-point) 55.3% (39.8 - 69.9), 95.2% (83.9 - 98.7), 91.4 (73.4 - 95.4), 69.7% (56.7 - 80.1); ADA (30 IU/L; clinically used cut-point) 79% (63.7 - 89), 92.7% (80.6 - 97.5), 91.0 (73.4 - 95.4), 82.7% (69.3 - 90.1); and IFN-γ (107.7 pg/ml; rule-in cut-point) 92.5% (80.2 - 97.5), 95.9% (86.1 - 98.9), 94.9% (83.2 - 98.6), 93.9% (83.5 - 97.9), respectively (IFN-γ sensitivity and NPV better than Xpert [p < 0.05] and rule-in ADA [p < 0.05]).ConclusionThe usefulness of Xpert MTB/RIF to diagnose pleural TB is limited by its poor sensitivity. IFN-γ is an excellent rule-in test and, compared to ADA, has significantly better sensitivity and rule-out value in a TB-endemic setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of same day diagnostic tools including Gene Xpert and unstimulated IFN-γ for the evaluation of pleural tuberculosis: a prospective cohort study

et al. 2014

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“…Asbestos pleural effusions are exudative. However, in cases of exudative pleural effusions, a pleural biopsy may be needed to evaluate for tuberculosis (TB) and malignancy [10]. When followed over time, these effusions may wax and wane.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous pleural effusion occurring concurrently with asbestos-related pleural disease

Zantah

Datta

2017

Respiratory Medicine Case Reports

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An eighty-four-year-old man presented with progressive exertional dyspnea, productive cough and weight loss for two months. His physical exam was notable for diminished breath sounds at the right base, with dullness to percussion. Chest-x-ray showed moderate right-sided pleural effusion and bilateral calcified pleural plaques as well as diaphragmatic plaques consistent with asbestos-related pleural disease (ARPD). Pleural fluid was exudative with predominantly mononuclear cells, negative acid fast bacilli stain, negative cultures, and negative cytology for malignant cells. Due to recurrence of the effusion, 4 weeks after drainage, thoracoscopic pleural biopsy was planned but pleural fluid cultures came back positive for mycobacteria tuberculosis. Patient was started on anti-tubercular therapy but treatment had to be stopped due to liver toxicity. Patient subsequently developed pneumonia and deteriorated despite antibiotic therapy and expired.

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“…Despite the high diagnostic performances of both biomarkers, ADA is commonly used in clinical practice, due to lower costs and the lack of a definite cutoff point for IFN-γ. However, since none of these PF biomarkers is specific for tuberculous pleuritis, results should be interpreted in accordance with clinical and microbiologic findings (22,33,37,38). …”

Section: Pleural Effusionsmentioning

confidence: 96%

“…It is released by activated lymphocytes, macrophages and neutrophils, and is considered a nonspecific marker of inflammation (36). Elevated ADA activity in PF is a sensitive and specific marker for the diagnosis of tuberculous pleuritis, particularly in high prevalence areas, with reported sensitivity of 92% and specificity of 90% at a generally accepted cutoff point of 40 U/L (37,38). Despite the high diagnostic performances of both biomarkers, ADA is commonly used in clinical practice, due to lower costs and the lack of a definite cutoff point for IFN-γ.…”

Section: Pleural Effusionsmentioning

confidence: 99%

Pleural, peritoneal and pericardial effusions – a biochemical approach

Kopcinovic

Culej

2014

Biochem Med

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The pathological accumulation of serous fluids in the pleural, peritoneal and pericardial space occurs in a variety of conditions. Since patient management depends on right and timely diagnosis, biochemical analysis of extravascular body fluids is considered a valuable tool in the patient management process.The biochemical evaluation of serous fluids includes the determination of gross appearance, differentiation of transudative from exudative effusions and additional specific biochemical testing to assess the effusion etiology. This article summarized data from the most relevant literature concerning practice with special emphasis on usefulness of biochemical tests used for the investigation of pleural, peritoneal and pericardial effusions. Additionally, preanalytical issues concerning serous fluid analysis were addressed and recommendations concerning acceptable analytical practice in serous fluid analysis were presented.

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Pleural fluid characteristics of tuberculous pleural effusions

Cited by 12 publications

References 35 publications

Comparison of same day diagnostic tools including Gene Xpert and unstimulated IFN-γ for the evaluation of pleural tuberculosis: a prospective cohort study

Comparison of same day diagnostic tools including Gene Xpert and unstimulated IFN-γ for the evaluation of pleural tuberculosis: a prospective cohort study

Tuberculous pleural effusion occurring concurrently with asbestos-related pleural disease

Pleural, peritoneal and pericardial effusions – a biochemical approach

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