Advances in the diagnosis of tuberculous pleuritis

Porcel, José M.

doi:10.21037/atm.2016.07.23

Cited by 83 publications

(50 citation statements)

References 48 publications

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“…Although the available evidence suggests that IL-18 and IL-27 seem to have higher accuracy than ADA, the higher-cost and more complicated determination of IL-27 and IL-18 may limit their practical applicability. [69,70] In addition, it has been reported that the combination of positive IL-27 with positive ADA values [16,31,46], can reach a sensitivity of 100% for the identification of TBP, Our meta-analysis, combined with previous ones, suggests that combining IL-18 and IL-27 with INF-γ and ADA may strengthen TPE diagnosis. We also suggest further studies should be carried out to determine the diagnostic accuracy of IL-27 and IL-18 combination or their combination with ADA or INF-γ.…”

Section: Discussionsupporting

confidence: 53%

Diagnostic Value of Interleukins in Tuberculous Pleural Effusion: A Systematic Review and Meta‐analysis

2017

Respirology

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Methods: Intervention utilized-Treatment supporters (TS) and mobile clinics. Intention to provide daily DOT by TS. At the end of March 2017, 63 TS are assigned for 454 TB patients. Number of patients supported by one TS varies from 1 to 20 according to the ease of location and the amount of patient support required. MSF mobile clinic team consists of health extension officer and community health worker and TB patients are reviewed on monthly basis during their regular visit of Malalua and Ihu BMU as well as health posts in covering area. MSF is offering to the patients dinghy and bus transport to these health centers.Results: Since commencing the activity multiple complexities have been notedTraining and supervision of treatment supporters who are very remote is difficult Heavy workload on TS with multiple activities added Patient's acceptance of TS in multicultural context Emphasis on TS approach distracted from patient centred approach Conclusions:The geographical difficulties in Gulf has led to using TS for follow up. This approach has shown some limitations. In such a context, to facilitate treatment adherence, an individualized approach accompanied by adequate patient education and counseling may be a more effective approach than TS for all. IndonesiaBackground and Aims: One of the main strategies for the early detection of pulmonary tuberculosis (PTB) is through the screening of individuals with symptoms compatible with TB. In the hospital, people with symptoms compatible with TB have an opportunity to get proper diagnosis and treatment. Yet this opportunity is often missed. We hypothesize that a respiratory triage system recommended by WHO for prevention of the spread of respiratory infection at the outpatient department, can be improved to enhance early detection of TB. With this hypothesis an intervention study was conducted at Zainal Abidin Hospital.The objective of this intervention study was to compare the proportion of patients with cough >2 weeks, offered sputum test and TB case detection rate before versus after a respiratory triage system introduced.Methods: Before-and-after interventional study. Intervention; training of health personnel and setting up a respiratory triage system, to detect patients with >2 weeks cough and offering sputum test for acid-fast bacilli. Data from "exit poll" and central laboratory were compared before vs after the triage set up.Results: After the intervention, sampled patients who visited the hospital were more likely to be asked on >2 weeks cough (85.3% vs17.9%).In the whole samples (99.2% vs 64.7%) among them have >2 weeks cough patients. For TB detection, the changes were 39 positive results from 220 AFB tests of 61,871 outpatients to 55 positive from 365 AFB tests among 53,056 outpatients. The rates of sputum testing and TB case detection increased from 3.5 to 6.8 per 1,000 (OR=1.9, 95% CI=1.6-2.3) and 6.3 to 10.4 per 10,000 (OR=1.7, 95% CI=1.1-2.6) respectively. Conclusions:Respiratory triage can significantly increase TB detection rate.

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Section: Discussionsupporting

confidence: 53%

Diagnostic Value of Interleukins in Tuberculous Pleural Effusion: A Systematic Review and Meta‐analysis

2017

Respirology

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“…The major limitation of testing for interferon-gamma is its high cost and lack of a broadly accepted discriminative threshold (17,18).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of interferon-gamma in pericardial effusions for tuberculous pericarditis: a meta-analysis

Liu¹,

Cui²,

Ding³

et al. 2018

J. Thorac. Dis.

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“…3 The sensitivity of nucleic acid amplification test, Xpert MTB/RIF ranged from (70-100)% in most of the extrapulmonary samples but was much lower around (40-50)% in the pleural fluid. [9][10][11] In our study also the overall sensitivity of PCR for MTB for diagnosis of tubercular pleural effusion has been found to be 51.1% which is low. CB-NAAT has also been shown to be useful in diagnosing abdominal tuberculosis and meningeal tuberculosis.…”

Section: Discussionmentioning

confidence: 53%

The advantage of PCR for MTB in comparison to ADA in diagnosing tubercular pleural effusion

et al. 2018

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Background: Tuberculosis continues to be an important health problem globally. The bacteriological confirmation of diagnosis in extrapulmonary tuberculosis patients is more difficult because most of the cases of extrapulmonary tuberculosis are paucibacillary in nature. In this study we have compared the pleural fluid ADA levels with PCR for MTB in pleural fluid to confirm the diagnosis of tuberculosis in the pleural fluid.Methods: The study was done over two years and a total of 106 patients with a clinico-radiological diagnosis of pleural effusion were enrolled for the study. The pleural fluid was aspirated and examined for total cell count, differential cell count, protein, sugar, ADA and PCR for MTB.A CT Thorax was done in all the 106 patients of pleural effusion and underlying consolidation along with pleural effusion was found in 60 patients.Results: The pleural fluid was exudative in nature in all the patients. 90 patients (84.9%) had lymphocyte predominant pleural effusion while 16 patients (15.1%) had neutrophil predominant pleural effusion. The overall sensitivity of ADA in all the cases of pleural effusion was 85.2% while the overall sensitivity of PCR for MTB in all the cases of pleural effusion was 51.1%. However, in the 60 patients of pleural effusion with underlying lung consolidation, the overall sensitivity of ADA was 69.1% while the overall sensitivity of PCR for MTB was 92.8% for diagnosing tubercular pleural effusion.Conclusions: PCR for MTB is a useful test along with ADA for diagnosing tubercular pleural effusion. PCR for MTB is especially useful in the diagnosis of tubercular pleural effusion in patients with underlying lung consolidation.

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Advances in the diagnosis of tuberculous pleuritis

Cited by 83 publications

References 48 publications

Diagnostic Value of Interleukins in Tuberculous Pleural Effusion: A Systematic Review and Meta‐analysis

Diagnostic Value of Interleukins in Tuberculous Pleural Effusion: A Systematic Review and Meta‐analysis

Diagnostic accuracy of interferon-gamma in pericardial effusions for tuberculous pericarditis: a meta-analysis

The advantage of PCR for MTB in comparison to ADA in diagnosing tubercular pleural effusion

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