Background The study was designed to investigate the clinical usefulness of Amplified Mycobacterium Tuberculosis Direct (AMTD) tests for diagnosing TB pleurisy. Methods One hundred and fifty-two patients for whom the exclusion of tuberculous pleural effusion was necessary were retrospectively analyzed. Results The sensitivity of AMTD in diagnosing pleural TB was 36.4% (20 of 55). Combining sputum and pleural effusion AFB smear, pleural biopsy, and AMTD test of pleural effusion increased sensitivity to 82.5% (33/40). There were significantly higher percentages of neutrophils in the pleural effusion in the positive than in the negative AMTD group (38.0±6.7% vs. 11.1±3.7%, p<0.001). Patients with symptom duration <18 days prior to pleural effusion studies had more positive AMTD tests than those with symptom >18 days (70% vs. 31.4%; OR 5.09; 95% CI 1.54–16.79; p = 0.011). Conclusions Combining AMTD tests with conventional diagnostic methods offer good sensitivity for pleural TB diagnosis. Patients in the early course of the disease are better candidates for AMTD tests.
References
[1]
Valdes L, Pose A, San Jose E, Marti nez Vazquez JM (2003) Tuberculous pleural effusions. Eur J Intern Med 14: 77–88.
[2]
Liam CK, Lim KH, Wong CM (2000) Causes of pleural exudates in a region with a high incidence of tuberculosis. Respirology 5: 33–38.
[3]
Valdes L, Alvarez D, Valle JM, Pose A, San Jose E (1996) The etiology of pleural effusions in an area with high incidence of tuberculosis. Chest 109: 158–162.
[4]
Baumann MH, Nolan R, Petrini M, Lee YC, Light RW, et al. (2007) Pleural tuberculosis in the United States: incidence and drug resistance. Chest 131: 1125–1132.
[5]
Barnes PF, Mistry SD, Cooper CL, Pirmez C, Rea TH, et al. (1989) Compartmentalization of a CD4+ T lymphocyte subpopulation in tuberculous pleuritis. J Immunol 142: 1114–1119.
[6]
Lin MT, Wang JY, Yu CJ, Lee LN, Yang PC (2009) Mycobacterium tuberculosis and polymorphonuclear pleural effusion: incidence and clinical pointers. Respir Med 103: 820–826.
[7]
Light RW (1999) Useful tests on the pleural fluid in the management of patients with pleural effusions. Curr Opin Pulm Med 5: 245–249.
[8]
Escudero Bueno C, Garcia Clemente M, Cuesta Castro B, Molinos Martin L, Rodriguez Ramos S, et al. (1990) Cytologic and bacteriologic analysis of fluid and pleural biopsy specimens with Cope's needle. Study of 414 patients. Arch Intern Med 150: 1190–1194.
[9]
Seibert AF, Haynes J Jr, Middleton R, Bass JB Jr (1991) Tuberculous pleural effusion. Twenty-year experience. Chest 99: 883–886.
[10]
Cohen RA, Muzaffar S, Schwartz D, Bashir S, Luke S, et al. (1998) Diagnosis of pulmonary tuberculosis using PCR assays on sputum collected within 24 hours of hospital admission. Am J Respir Crit Care Med 157: 156–161.
Conaty SJ, Claxton AP, Enoch DA, Hayward AC, Lipman MC, et al. (2005) The interpretation of nucleic acid amplification tests for tuberculosis: do rapid tests change treatment decisions? J Infect 50: 187–192.
[13]
Cheng VC, Yew WW, Yuen KY (2005) Molecular diagnostics in tuberculosis. Eur J Clin Microbiol Infect Dis 24: 711–720.
[14]
American Thoracic Society (1997) Rapid diagnostic tests for tuberculosis: what is the appropriate use? American Thoracic Society Workshop. Am J Respir Crit Care Med 155: 1804–1814.
[15]
Moon JW, Chang YS, Kim SK, Kim YS, Lee HM, et al. (2005) The clinical utility of polymerase chain reaction for the diagnosis of pleural tuberculosis. Clin Infect Dis 41: 660–666.
[16]
Lin SM, Ni YL, Kuo CH, Lin TY, Wang TY, et al. (2010) Endobronchial ultrasound increases the diagnostic yields of polymerase chain reaction and smear for pulmonary tuberculosis. The Journal of thoracic and cardiovascular surgery 139: 1554–1560.
[17]
Miller N, Hernandez SG, Cleary TJ (1994) Evaluation of Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test and PCR for direct detection of Mycobacterium tuberculosis in clinical specimens. J Clin Microbiol 32: 393–397.
[18]
Bradley SP, Reed SL, Catanzaro A (1996) Clinical efficacy of the amplified Mycobacterium tuberculosis direct test for the diagnosis of pulmonary tuberculosis. Am J Respir Crit Care Med 153: 1606–1610.
[19]
Pai M, Flores LL, Hubbard A, Riley LW, Colford JM Jr (2004) Nucleic acid amplification tests in the diagnosis of tuberculous pleuritis: a systematic review and meta-analysis. BMC Infect Dis 4: 6.
[20]
Ruiz-Manzano J, Manterola JM, Gamboa F, Calatrava A, Monso E, et al. (2000) Detection of mycobacterium tuberculosis in paraffin-embedded pleural biopsy specimens by commercial ribosomal RNA and DNA amplification kits. Chest 118: 648–655.
[21]
Mitarai S, Shishido H, Kurashima A, Tamura A, Nagai H (2000) Comparative study of amplicor Mycobacterium PCR and conventional methods for the diagnosis of pleuritis caused by mycobacterial infection. The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 4: 871–876.
[22]
Johansen IS, Thomsen VO, Johansen A, Andersen P, Lundgren B (2002) Evaluation of a new commercial assay for diagnosis of pulmonary and nonpulmonary tuberculosis. European journal of clinical microbiology & infectious diseases: official publication of the European Society of Clinical Microbiology 21: 455–460.
[23]
de Wit D, Maartens G, Steyn L (1992) A comparative study of the polymerase chain reaction and conventional procedures for the diagnosis of tuberculous pleural effusion. Tubercle and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 73: 262–267.
[24]
Burgess LJ, Maritz FJ, Le Roux I, Taljaard JJ (1996) Combined use of pleural adenosine deaminase with lymphocyte/neutrophil ratio. Increased specificity for the diagnosis of tuberculous pleuritis. Chest 109: 414–419.
[25]
Neves DD, Dias RM, Cunha AJ (2007) Predictive model for the diagnosis of tuberculous pleural effusion. Braz J Infect Dis 11: 83–88.
