Pleural SC5b-9 in Differential Diagnosis of Tuberculous, Malignant, and Other Effusions

Hara, N; Abe, Masayoshi; Inuzuka, Satoru; Kawarada, Yuji; Shigematsu, Nobuaki

doi:10.1378/chest.102.4.1060

Cited by 16 publications

(10 citation statements)

References 9 publications

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“…The sensitivity was 84% for SC5b-9 and 81% for C3a-desArg. HARA et al [35] showed SC5b-9 had a higher sensitivity (100%) and ADA activity had a higher specificity than conventional tests (culture and/or histopathological examination). Discrimination of TB pleuritis from malignant effusions was better than discrimination from autoimmune or parapneumonic effusions.…”

Section: Cytokinesmentioning

confidence: 99%

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

Trajman

Pai²,

Dheda³

et al. 2008

European Respiratory Journal

140

121

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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.

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Section: Cytokinesmentioning

confidence: 99%

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

Trajman

Pai²,

Dheda³

et al. 2008

European Respiratory Journal

140

121

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“…Tuberculous pleural effusions are not always easy to diagnose because the standard criterion (the presence of a lymphocyte-rich exudate associated with case- ous necrotic granulomas in pleural biopsy tissue samples, positive Ziehl-Neelsen stains or Lowenstein cultures of effusion or tissue samples, and cutaneous sensitivity to purified tuberculin protein antigen derivative [PPD]) is not invariably satisfied. [6][7][8] In recent years, numerous authors studied possible biochemical markers such as adenosine deaminase (ADA), ADA isoenzymes, lysozyme, interferon gamma (IFN-␥), and other lymphokines [9][10][11][12][13][14][15][16][17][18] to improve diagnostic efficiency, but diagnosis is still sometimes difficult. In this article, we review all the case histories of patients with TPE who have been diagnosed with certainty in our center during the past 8 years.…”

Section: Arch Internmentioning

confidence: 99%

Tuberculous Pleurisy

Valdés¹,

Álvarez²,

José³

et al. 1998

Arch Intern Med

333

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In these patients, lymphocyte-rich exudative pleural effusions occurred, on average, at a young age, with no preference for either the right or the left side; normally affected no more than two thirds of the hemithorax; and were generally unaccompanied by pulmonary infiltrates. High ADA concentration was a highly sensitive diagnostic sign and was caused by a rise in ADA2 concentration. The most sensitive criterion based on pleural biopsy was the observation of caseous granulomas, and culture of biopsy material further increased overall sensitivity. Negative skin test results were no guarantee of the effusion being nontuberculous. This, together with the low mean age of the patients and the low frequency of associated pulmonary lesions, suggests that tuberculous pleural effusion is a primary form of tuberculosis in this region.

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“…Research on SC5b-9, a product formed by the binding of S protein to C5b-9 complexes at the C5b-7 stage of assembly in consequence of complement activation, has found that this product is elevated in the pleural fluid of patients with tuberculous effusions unlike malignant and transudative effusions. 54,56 In particular Hara et al demonstrated that all tuberculous effusions in their study had SC5b-9 levels >2 mg/L, with malignant effusions <2 mg/L. 54 Using 2 mg/L as the cut-off they reported a sensitivity of 100% with a specificity of 79% (also raised in rheumatoid, parapneumonic and some treated malignant effusions) and found a positive correlation between pleural fluid ADA and SC5b-9.…”

Section: Complementmentioning

confidence: 93%

“…Increased serum complement activity is found in cancer and certain infections whilst decreased activity is seen in cirrhosis, glomerulonephritis, systemic lupus erythematosis (SLE), paroxysmal nocturnal haemoglobinuria (PNH), hereditary angioedema and malnutrition. 53 Despite the fact that several studies have highlighted complement activation in the pleural fluid of patients with rheumatoid arthritis, SLE and tuberculosis, 54,55 the routine analysis of complement (C3, C4) in rheumatoid arthritis and SLE is not recommended due to low specificity and the fact that serum rheumatoid factor (RF) and antinuclear antibody (ANA) are more sensitive and specific. 7 The measurement of complement activation products has also been analysed.…”

Section: Complementmentioning

confidence: 99%

The use of non-routine pleural fluid analysis in the diagnosis of pleural effusion

McGrath

Warriner

Anderson

2010

Respiratory Medicine

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The investigation of a pleural effusion is, in general, a very straight forward process with the combination of clinical history, examination, radiology and pleural fluid analysis leading to diagnosis in most cases. While most fluid samples are sent for routine analysis including protein, LDH, glucose, cytology and microbiology, there are a number of more unusual fluid analyses available which in some cases directly lead to, and in others are suggestive of the diagnosis. Moreover, other fluid markers are constantly being evaluated as a diagnostic tool. In this review, we describe these non-routine pleural fluid analyses in detail. English language publications in MEDLINE and references from relevant articles from January 1 1990 to August 1 2009 were reviewed. Keywords searched in combination were pleural fluid, effusion, analysis, transudate, exudate and diagnosis.

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Pleural SC5b-9 in Differential Diagnosis of Tuberculous, Malignant, and Other Effusions

Cited by 16 publications

References 9 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?

Tuberculous Pleurisy

The use of non-routine pleural fluid analysis in the diagnosis of pleural effusion

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