Accuracy of polimerase chain reaction for the diagnosis of pleural tuberculosis

Trajman, Anete; Oliveira, Elen; Bastos, Mayara Lisboa; Neto, Epaminondas Belo; Silva, Edgar Manoel; Lourenço, Maria Cristina da Silva; Kritski, Afrânio Lineu; Oliveira, Martha Maria de

doi:10.1016/j.rmed.2014.04.007

Cited by 28 publications

(22 citation statements)

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“…The percentage of confirmed diagnosis varies widely (from 12% to 80%) depending on the study location and prevalence of the disease (Porcel et al, 2015;Na, 2014). Although molecular biology methods are being generalized for samples other than sputum, the diagnostic yield of molecular biology studies on pleural effusion is variable and usually lower than that for sputum (Trajman et al, 2014;Porcel et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and diagnosis of pleural tuberculosis in a low incidence country with high rate of immigrant population: A retrospective study

Macías

Sánchez-Montalvà

Salvador

et al. 2019

International Journal of Infectious Diseases

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Background: The confirmatory diagnosis of pleural tuberculosis (pTB) remains challenging. The aim of this study was to describe the clinical and epidemiological characteristics of pTB patients and assess the yield of different diagnostic procedures in a low burden country with a high rate of immigrant population. Methods: All adult patients with pTB between 2007 and 2014 were studied retrospectively. Results: One hundred and three out of 843 patients with tuberculosis had pTB. Fifty-three (54.1%) were male, and the median age was 45 years (range 18-87 years). Fifty-two (50.49%) patients were immigrants. A confirmed diagnosis was reached in 16 patients (15.5%) by microbiological studies of pleural effusion. Lung involvement was demonstrated by sputum smear microscopy in 13/49 (26.5%), sputum GeneXpert MTB/RIF test in 13/20 (65%), and sputum culture in 16/37 (43.2%). High-resolution computed tomography (CT) showed lung involvement in 47.7% of the patients. The cure rate was 91.3% at the 1-year follow-up. Three patients died, all of them within the first month after diagnosis. Conclusions: The detection of lung involvement increased by two-fold when lung CT was used; this correlated with the likelihood of finding a positive microbiological result on sputum sample testing. Pleural microbiological studies had a low diagnostic yield, and sputum could have a complementary role.

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Section: Introductionmentioning

confidence: 99%

Epidemiology and diagnosis of pleural tuberculosis in a low incidence country with high rate of immigrant population: A retrospective study

Macías

Sánchez-Montalvà

Salvador

et al. 2019

International Journal of Infectious Diseases

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“…Only two studies included children (13,15). Seven studies included people living with HIV infection (8,17,18,(20)(21)(22)27). Twenty-one studies (2,167 patients) and 10 studies (937 patients) used a microbiological standard (mycobacterial culture) (7, 8, 13-16, 19, 20, 22-34) or a composite reference standard (CRS) (7, 14-18, 21, 22, 24, 28), respectively, to assess the diagnostic accuracy of GeneXpert (see Table S3).…”

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confidence: 99%

“…Twenty-one studies (2,167 patients) and 10 studies (937 patients) used a microbiological standard (mycobacterial culture) (7, 8, 13-16, 19, 20, 22-34) or a composite reference standard (CRS) (7, 14-18, 21, 22, 24, 28), respectively, to assess the diagnostic accuracy of GeneXpert (see Table S3). Seven studies performed Xpert MTB/RIF on frozen pleural fluid (7,15,19,21,23,28,30), while the remaining used fresh samples (see Table S4). Nine studies concentrated the pleural fluid sample by centrifugation before performance of GeneXpert (7, 8, 16-18, 20, 22, 24, 29).…”

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confidence: 99%

Diagnostic Performance of Xpert MTB/RIF in Tuberculous Pleural Effusion: Systematic Review and Meta-analysis

et al. 2016

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A systematic review investigating the role of Xpert MTB/RIF in the diagnosis of tuberculous pleural effusion (TPE) was conducted. The pooled sensitivities and specificities of Xpert MTB/RIF were 51.4% and 98.6%, respectively, with culture used as a reference standard and 22.7% and 99.8%, respectively, with a composite reference standard (CRS) used as the benchmark. Xpert MTB/RIF has low sensitivity but excellent specificity in the diagnosis of TPE.T uberculous pleural effusion (TPE) is the second most common site of extrapulmonary tuberculosis (EPTB) (1). Currently, the best tool for diagnosing TPE is a thoracoscopic pleural biopsy, an invasive procedure, with sensitivity ranging from 93 to 100% (2-5). The most widely used diagnostic test for TPE is the pleural fluid adenosine deaminase (ADA) level, which has variable sensitivity ranging from 47 to 100% (6). The sensitivities of pleural fluid microscopy and culture in TPE are about 10% and 20%, respectively (5, 7, 8). The absence of a simple reference standard makes the treatment of TPE empirical (nonmicrobiological) in most circumstances.Xpert MTB/RIF (GeneXpert) has not only high sensitivity and specificity in smear-positive pulmonary tuberculosis (TB) (98% and 98%, respectively) but also reasonable diagnostic performance in smear-negative pulmonary tuberculosis (67% and 99%, respectively) (9). However, a recent meta-analysis reported the pooled sensitivity and specificity of GeneXpert in TPE as 46.4% and 99.1%, respectively, compared with those of pleural fluid mycobacterial culture (10). Since then, several new studies evaluating GeneXpert in TPE have been published. Herein, we perform an updated meta-analysis on the role of Xpert MTB/RIF in the diagnosis of TPE.The systematic review was conducted using the standard methodology for systematic reviews of diagnostic test accuracy (see the detailed methodology in the supplemental material) (11,12). Institutional ethics committee approval was not required as this was a systematic review of published data.Our search yielded 155 citations, of which 24 studies (2,486 patients) were included in the current analysis (see Fig. S1 in the supplemental material) (7,8,. There were equal numbers of studies from the developed and the developing countries (see Tables S1 and S2 in the supplemental material) (8, 14, 16-22, 24, 32, 33). Only two studies included children (13,15). Seven studies included people living with HIV infection (8,17,18,(20)(21)(22)27). Twenty-one studies (2,167 patients) and 10 studies (937 patients) used a microbiological standard (mycobacterial culture) (7, 8, 13-16, 19, 20, 22-34) or a composite reference standard (CRS) (7, 14-18, 21, 22, 24, 28), respectively, to assess the diagnostic accuracy of GeneXpert (see Table S3). Seven studies performed Xpert MTB/RIF on frozen pleural fluid (7,15,19,21,23,28,30), while the remaining used fresh samples (see Table S4). Nine studies concentrated the pleural fluid sample by centrifugation before performance of GeneXpert (7, 8, 16-18, 20, 22, 24, 29). The ov...

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“…Although the diagnostic yield of pleural fluid is highly variable, ranging from 7% to 58% [17], [18], [19], [20], [21], it is mandatory to perform a thoracocentesis. The value of TB-NAAT on extra-pulmonary specimens is controversial [22]. Pleural fluid cytology can be helpful in the diagnosis of pleural TB as the exudate is lymphocyte predominant (≥50%) in the majority of cases [23], [24].…”

Section: Discussionmentioning

confidence: 99%

An undiagnosed pleural effusion with surprising consequences

Casalini

Cusmano²,

Sverzellati

et al. 2017

Respiratory Medicine Case Reports

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We present the case of a 43-year-old Italian woman with a left undiagnosed pleural effusion, which in subsequent months presented a clinically unexpected evolution with the appearance at first of a right wrist tenosynovitis and subsequently a bilateral lung involvement caused by M. Tuberculosis.With this case report, we would like to underline the importance of making a correct diagnosis of any pleural effusion as soon as possible by at least a thoracocentesis. If untreated, tuberculosis may easily disseminate to other organs. Some considerations and suggestions for antibiotic treatment of pleural effusion will also be given, since many antibiotics have some anti-tuberculosis effect and may delay the diagnosis of this infectious disease.

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Accuracy of polimerase chain reaction for the diagnosis of pleural tuberculosis

Abstract: Compared to the 95% sensitivity of adenosine deaminase, the most sensitive test for pleural tuberculosis, the sensitivities of the three PCR-based tests were very low. We conclude that at present, there is no major place for such tests in routine clinical use.

Cited by 28 publications

References 25 publications

Epidemiology and diagnosis of pleural tuberculosis in a low incidence country with high rate of immigrant population: A retrospective study

Epidemiology and diagnosis of pleural tuberculosis in a low incidence country with high rate of immigrant population: A retrospective study

Diagnostic Performance of Xpert MTB/RIF in Tuberculous Pleural Effusion: Systematic Review and Meta-analysis

An undiagnosed pleural effusion with surprising consequences

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