Evaluation of Immunocytochemistry on Pleural Fluid for the Diagnosis of Pleural Tuberculosis

Backgrounds: Tuberculosis pleural effusion is the most common extrapulmonary TB after lymphadenitis TB, but a definite diagnosis is still a challenge. Pleural biopsy has historically been the gold standard procedure for the diagnosis of pleural tuberculosis. GenXpert® is a computerize test based in nucleic acid amplification tahat automatically detect MTB and rifampicin resistance. This study aimed to prove the correlation between pleural fluid GenXpert® and histopathological findings of pleural biopsy in patients with pleural tuberculosis. Methods: This study used an observational analytic design with a cross-sectional design conducted in Dr. Soetomo Hospital, Surabaya in March-June 2017. Statistic analysis was using chi square test and contingensi coofisient. The pleural GenXpert® was tested in 23 patients with pleural effusion and their biopsy speciments underwent histopathological analysis. Results: Histopathological findings of pleural biopsy was positive in 4 subjects and pleural fluid GenXpert® resulted positive in 6 subjects. There was significant correlation between pleural fluid GenXpert® and histopathological findings of specimen pleural biopsy in patients with pleural tuberculosis (P=0.040) with moderate strenght (P=0.014). Sensitivity and specificity of pleural fluid GenXpert® were 75.0% dan 84.2% respectively. Conclusions: There was significant correlation between pleural fluid GenXpert® and histopathological findings of pleural biopsy in patients with pleural tuberculosis. (J Respir Indo 2018; 38(1): 1-6)

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The Utility of Pleural Fluid Lactate Dehydrogenase to Adenosine Deaminase Ratio in Pleural Tuberculosis

Respiration ◽

10.1159/000509555 ◽

2020 ◽

pp. 1-5

Author(s):

Amanda Beukes ◽

Jane Alexandra Shaw ◽

Andreas H. Diacon ◽

Elvis M. Irusen ◽

Coenraad F.N. Koegelenberg

Keyword(s):

Lactate Dehydrogenase ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Operating Characteristic ◽

Retrospective Studies ◽

Characteristic Curve ◽

Diagnostic Efficiency ◽

Pleural Tuberculosis ◽

High Incidence ◽

The Mean

In high-burden settings, the diagnosis of pleural tuberculosis (TB) is frequently inferred in patients who present with lymphocyte predominant exudative effusions and high adenosine deaminase (ADA) levels. Two recent small retrospective studies suggested that the lactate dehydrogenase (LDH)/ADA ratio is significantly lower in TB than in non-TB pleural effusions and that the LDH/ADA ratio may be useful in differentiating pleural TB from other pleural exudates. We compared the pleural LDH/ADA ratios, ADA levels, and lymphocyte predominance of a prospectively collected cohort of patients with proven pleural TB (n = 160) to those with a definitive alternative diagnosis (n = 68). The mean pleural fluid LDH/ADA ratio was lower in patients with pleural TB than alternative diagnoses (6.2 vs. 34.3, p < 0.001). The area under the receiver operating characteristic curve was 0.92 (p < 0.001) for LDH/ADA ratio and 0.88 (p < 0.001) for an ADA ≥40 U/L alone. A ratio of ≤12.5 had the best overall diagnostic efficiency, while a ratio of ≤10 had a specificity of 90% and a positive predictive value of 95%, with a sensitivity of 78%, making it a clinically useful “rule in” value for pleural TB in high incidence settings. When comparing the LDH/ADA ratio to an ADA level ≥40 U/L in the presence of a lymphocyte predominant effusion, the latter performed better. When lymphocyte values are unavailable, our data suggest that the LDH/ADA ratio is valuable in distinguishing TB effusions from other pleural exudates.

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Diagnostic value of pleural fluid interferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar

International Journal of General Medicine ◽

10.2147/ijgm.s39345 ◽

2013 ◽

pp. 13 ◽

Cited By ~ 5

Author(s):

Fahmi Yousef Khan ◽

Omran ◽

Hamza ◽

Saleh ◽

Lingawi ◽

...

Keyword(s):

Adenosine Deaminase ◽

Pleural Fluid ◽

Interferon Gamma ◽

Diagnostic Value ◽

Pleural Tuberculosis

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The utility of pleural fluid lactate dehydrogenase to adenosine deaminase ratio in pleural tuberculosis

10.1183/13993003.congress-2020.1587 ◽

2020 ◽

Author(s):

Amanda Beukes ◽

Jane Alexandra Shaw ◽

Elvis M Irusen ◽

Andreas H Diacon ◽

Coenraad Frederik Nicolaas Koegelenberg

Keyword(s):

Lactate Dehydrogenase ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Pleural Tuberculosis

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The neuro-endocrine-immune relationship in pulmonary and pleural tuberculosis: a better local profile in pleural fluid

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.17.0270 ◽

2018 ◽

Vol 22 (3) ◽

pp. 321-327 ◽

Cited By ~ 4

Author(s):

L. D'Attilio ◽

A. Díaz ◽

R. D. V. Fernández ◽

B. Bongiovanni ◽

N. Santucci ◽

...

Keyword(s):

Pleural Fluid ◽

Pleural Tuberculosis

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MOLECULAR DIAGNOSIS OF CLINICALLY SUSPECTED PLEURAL TUBERCULOSIS IN MOROCCO

Russian Journal of Infection and Immunity ◽

10.15789/2220-7619-mdo-1399 ◽

2019 ◽

Author(s):

I. CHAOUI ◽

S. Taoudi ◽

A. Oudghiri ◽

J. Benamor ◽

J. Bourkadi ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Prospective Study ◽

Pleural Fluid ◽

Sensitivity And Specificity ◽

Molecular Diagnosis ◽

Histopathologic Examination ◽

Chain Reaction ◽

Pleural Tuberculosis ◽

Polymerase Chain ◽

Pleural Tissue

Pleural tuberculosis (pTB) is a very common form of extrapulmonary tuberculosis (TB). Its diagnosis presents worldwidea major burning challenge due to the limitations of available conventional diagnosis tools. These latter include microscopic examination of the pleural fluid for acid-fast bacilli, mycobacterial culture of pleural fluid in solid or liquid media, sputum or pleural tissue, and histopathological examination of pleural tissue; these tests have recognized limitations for clinical use. Hence, to overcome these limitations, attention has been devoted to new nucleic acid amplification (NAA) diagnosistests such as the polymerase chain reaction (PCR) and real-time PCR (RT-PCR), owing to their accuracy, rapidity, high sensitivity and specificity. Within this context, this prospective study was conducted to evaluate the performance of molecular diagnosis methods for differentiation between tuberculosis and non-tuberculosis pleural effusions. Fifty patients with pleural effusion were enrolled in this prospective study in Rabat, Morocco. The efficacy of conventional polymerase chain reaction (PCR) in the diagnosis of tuberculous pleurisy by targeting IS6110 and mycobacterial internal transcribed spacer(MYITS) was evaluated against histopathologic examination and culture results.Our results showed that IS6110 PCR could “rule in” pTB, the sensitivity and specificity being 41.6 % and 85.7 % respectively.Therefore, the findings confirmed that molecular tests have a relatively high specificity in EPTB but lower sensitivity, thus a positive test is treated as a pTB case whereas negative one cannot exclude the disease. Although the study was limited by small sample size, it adds to the body of evidence of usefulness of molecular testing as adjunctsto histopathologic examination for accurate diagnosis of pTB, to treat timely and to avoid the emergence and spread of drug resistant pTB. However, further efforts should be made to increase the sensitivity of NAA methods and to identify the best molecular targets to be useful in clinical practice.

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Chylothorax with Transudate: An Unusual Presentation of Tuberculosis

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_001645 ◽

2020 ◽

Author(s):

Miguel Angel Zamora-López ◽

Iris Camelia Farias-Navarro ◽

Erick Joel Rendon-Ramirez

Keyword(s):

Mycobacterium Tuberculosis ◽

Pleural Effusion ◽

Pleural Fluid ◽

Lung Nodule ◽

Cholesterol Content ◽

Tuberculosis Patients ◽

Fluid Analysis ◽

Pleural Tuberculosis ◽

Uncommon Presentation ◽

Low Cholesterol

Introduction: Twenty-five per cent of tuberculosis patients have pleural tuberculosis, which is the third most common form of presentation. Most cases present as an exudative pleural effusion with just few cases reported as chylothorax in the literature. All pleural effusions from confirmed cases, including tuberculous chylothorax, had exudate features. Aim: To describe a patient with Mycobacterium tuberculosis affecting the lungs and pleura, which laboratory testing demonstrated had features of transudate chylothorax. Patient and methods: A 70-year-old man presented with constitutional symptoms, progressive exertional dyspnoea and right pleural effusion with fibrocavitary changes on chest imaging. Thoracentesis and pleural fluid analysis revealed chylous fluid with transudate features, high triglycerides, low cholesterol content and mononuclear cell predominance. Acid-fast sputum stains and pleural fluid were negative for Mycobacterium tuberculosis as was an adenosine deaminase test for pleural effusion. Tomography-directed lung biopsy sampling of a lung nodule revealed a chronic granulomatous inflammatory process associated with the presence of acid-fast bacilli. Discussion: Tuberculosis-associated chylothorax is an uncommon presentation of the disease. A recent review found only 37 cases of confirmed tuberculous chylothorax had been reported in the literature. All cases had exudate characteristics. The diagnosis of pleural tuberculosis was made through culture or testing of sputum, pleural fluid or biopsy samples in 72.2% of cases, with the rest identified by histopathology.

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