Diagnostic Value of Interferon-γ in Tuberculous Pleurisy

Jiang, Jing; Shi, Huan‐Zhong; Liang, Qiwei; Qin, Simeng; Qin, Xuejun

doi:10.1378/chest.06-2273

Cited by 186 publications

(144 citation statements)

References 48 publications

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“…Moreover, it was significantly higher in confirmed TB than in probable TB group. Observed data were in agreement with previous reports that looked for the utility of IFN-γ levels in differential diagnosis of TPE [5,6,[19][20][21].…”

Section: Discussionsupporting

confidence: 92%

Interferon Gamma (IFN-Υ) and Soluble Interleukin-2 Receptor (sIL-2R): Combined Diagnostic Markers of Tuberculous Pleural Effusion

Abdel-Latif¹,

Abou-Shamaa²,

El-Sherbini³

et al. 2013

IJI

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Abstract:Background: pleural TB is a diagnostic challenge because of its nonspecific clinical manifestation. The efficiency of conventional laboratory method and the reliance on pleural biopsy have motivated the evaluation of alternative diagnostic strategies. The objective of the current study is to evaluate the diagnostic efficiency of IFN-γ and sIL-2R levels in pleural effusion for differential diagnosis of tuberculous pleurisy. Methods: estimated levels of IFN-γ and sIL-2R were compared with the result of conventional PCR and Z-N staining used for detection of M. tuberculosis DNA and acid fast bacilli screening of pleural effusion, respectively. Involved study population included 60 patients with pleural effusion, divided into two groups: Tuberculous group (40 patients: 7 confirmed TB and 33 probable TB cases) and control group (20 patients: 10 cases due to malignancy and 10 cases due to heart failure). Results: our results showed that IFN-γ and sIL-2R levels are significantly higher in tuberculous group than in control group. Conclusion: current study suggested that measurement of IFN-γ and sIL-2R in pleural effusion could be less invasive and quicker diagnostic tools of TPE compared to conventional microbiological diagnostic methods.

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Section: Discussionsupporting

confidence: 92%

Interferon Gamma (IFN-Υ) and Soluble Interleukin-2 Receptor (sIL-2R): Combined Diagnostic Markers of Tuberculous Pleural Effusion

Abdel-Latif¹,

Abou-Shamaa²,

El-Sherbini³

et al. 2013

IJI

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“…A large study from 2003 Villena et al [48] measured pleural fluid γ-interferon levels in 595 patients, including 82 with TB, and reported that a cut-off level of 3.7 IU/mL yielded a sensitivity of 0.98 and a specificity of 0.98. A second larger meta-analysis of 22 studies that included 782 patients with TB and 1319 patients with non-TB pleural effusions showed that the mean sensitivity of the γ-interferon assay was 89% and that the mean specificity was 97% [49].…”

Section: Interferon-gammamentioning

confidence: 99%

Tuberculous Pleural Effusion

Cohen

Light

2015

Tur Toraks Der

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When a patient presents with new pleural effusion, the diagnosis of tuberculous (TB) pleuritis should be considered. The patient is at risk for developing pulmonary or extrapulmonary TB if the diagnosis is not made. Between 3% and 25% of patients with TB will have TB pleuritis. The incidence of TB pleuritis is higher in patients who are human immunodeficiency virus (HIV)-positive. Pleural fluid is an exudate that usually has a predominance of lymphocytes. The easiest way to diagnose TB pleuritis in a patient with lymphocytic pleural effusion is to demonstrate a pleural fluid adenosine deaminase level above 40 IU/L. The treatment for TB pleuritis is the same as that for pulmonary TB. Tuberculous empyema is a rare occurrence, and the treatment is difficult. KEY WORDS:Tuberculosis, pleural effusions, adenosine deaminase, gamma interferon, pleural biopsy, empyema INTRODUCTION Tuberculosis (TB) remains a major public health problem in developing countries. Most patients with TB have pulmonary TB; however, 25% of adults can present with extrapulmonary TB, which mainly involves the lymph nodes and pleura but can affect any organ system, including the central nervous system (CNS), cardiovascular system, and gastrointestinal (GI) tract [1]. The most common form of extrapulmonary TB is infection of the pleura. In a patient who presents with undiagnosed pleural effusion, the diagnosis of TB pleuritis should be considered. Pleural effusion, as an isolated manifestation of TB, may be selflimited and of little immediate concern, but untreated, it can lead to serious disease many years later. Pathogenesis and Pathologic FeaturesTuberculous pleural effusion may occur in the absence of radiologically apparent TB [2]. The effusion may result as a sequela to a primary infection from 6-12 weeks earlier, or it may represent the reactivation of TB [2]. In developed countries, TB pleural effusions present more often in older patients. The median age in one North American study was 56, suggesting reactivation of the disease [3]. However, a study from 2004 in San Francisco showed that pleural TB cases were 2 times more likely to be clustered (when assessed by genotyping of the mycobacterial organisms) than pulmonary TB and 3 times more likely to be clustered than nonrespiratory TB cases [4]. The observations made in the San Francisco study suggest that the majority of patients has a postprimary infection [4]. This was not confirmed in studies performed in both Houston [5] and Baltimore [6] or in a study in sub-Saharan Africa, in which the prevalence of pleural TB was 63.2% in patients with a primary TB infection [7].The pathogenesis of TB pleural effusion is thought to be related to the rupture of a subpleural caseous focus in the lung into the pleural space [8]. The basis for this was the observation that a caseous TB focus could be demonstrated in the lung, contiguous with the diseased pleural, in 12 to 15 patients with TB pleuritis [9]. The 3 other patients in this study had parenchymal disease but did not have caseous foci adjacent...

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“…These studies were reported from an area where prevalence was 59 per 100,000 population (6,9). A more recent meta-analysis of 63 studies found that ADA has a sensitivity and specificity of 92% and 90% respectively and a metaanalysis of 22 studies found that IFN-γ has a sensitivity and specificity of 89% and 97% respectively (10,11). Acceptance of these tests for the diagnosis of pleural TB has not been universal and remains contentious in some countries with diagnostic performance very variable between populations (12).…”

Section: Major Commentsmentioning

confidence: 99%

Diagnostic tests for tuberculous pleural effusion

McGrath

Anderson

2010

Eur J Clin Microbiol Infect Dis

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The investigation of pleural effusion has been greatly assisted by advancements in pleural fluid analysis. In the case of tuberculous pleural effusion, diagnosis traditionally requires the demonstration of acid fast bacilli in the pleural space using microbiological or histological techniques. In recent years there has been progress in pleural fluid analysis in suspected tuberculous effusions with particular interest in adenosine deaminase and interferon-γ. These individual tests are quite sensitive and specific, however data is sparse on the benefits multiple parameter testing may have when analysed in combination. We reviewed the literature to investigate the evidence for multiple parameters testing, both biochemical and clinical, in the evaluation of tuberculous effusion.Dear Editor, Thank you for giving us the opportunity to submit a revised manuscript. I very much appreciated the reviewers' comments and have made every effort to address them. I have highlighted the changes to the manuscript in red font and will specifically address each comment below chronologically. As ever, we would be only too delighted to make any further changes the reviewers' recommend. Yours faithfullyDr. Emmet McGrath MB PhD MRCPI NIHR Clinical Lecturer in Respiratory Medicine Sheffield Reviewer #1 comments addressed:I have now critically appraised each individual study as requested. Major comments1. I have now cited Diacon reference as recommended. 2. I have now described that it is the combination of all 4 features of thoracoscopy which offers significant advantages over other biopsy techniques. 3. I have followed the reviewer's advice re. Introduction--last sentence. 4. I have now included a critical appraisal of the strengths and weaknesses of each study. 5. I was talking about closed pleural biopsy (Abrams etc) and I have now made this point clearer. 6. I have removed the text concerning Porcel's recommendation. Both reviewers felt it was not required. I have appraised 2 of Porcel's research studies instead. 7. I have now specified which biopsy type I was referring to in the text. 8. I have now linked in the lack of specificity of ADA to the section on "disadvantages" of the tests. 9. I have again pointed out several advantages of thoracoscopy as recommended. 10. I have discussed the problems of variable prevalence, lack of gold standard controls in all but one study, variable study design (retro-versus prosp-) as well as the variable and generally low n numbers. Diagnostic tests for tuberculous pleural effusion AbstractThe investigation of pleural effusion has been greatly assisted by advancements in pleural fluid analysis. In the case of tuberculous pleural effusion, diagnosis traditionally requires the demonstration of acid fast bacilli in the pleural space using microbiological or histological techniques. In recent years there has been progress in pleural fluid analysis in suspected tuberculous effusions with particular interest in adenosine deaminase and interferon-γ. These individual tests are quite se...

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Diagnostic Value of Interferon-γ in Tuberculous Pleurisy

Cited by 186 publications

References 48 publications

Interferon Gamma (IFN-Υ) and Soluble Interleukin-2 Receptor (sIL-2R): Combined Diagnostic Markers of Tuberculous Pleural Effusion

Interferon Gamma (IFN-Υ) and Soluble Interleukin-2 Receptor (sIL-2R): Combined Diagnostic Markers of Tuberculous Pleural Effusion

Tuberculous Pleural Effusion

Diagnostic tests for tuberculous pleural effusion

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