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

Agarwal, Abhishek; Hussain, Ahbab; Prasad, Rajendra; Verma, A.K.; Banka, Amitabh; Raza, Tasleem

doi:10.18203/2349-3933.ijam20180071

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…Similar observation has been made in an Indian study done on 106 subjects. They found that in patients with pleural effusion with underlying lung consolidation, the overall sensitivity of PCR for MTB was 92.8% for diagnosing TB pleural effusion [11].…”

Section: Discussionmentioning

confidence: 99%

The Role of Genexpert in the Diagnosis of Tubercular Pleural Effusion in India

Chakraborty

Ramaswamy

Shivananjiah

et al. 2019

Advances in Respiratory Medicine

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Introduction: Tubercular pleural effusion is the second most common extrapulmonary form of tuberculosis in India. Developing nations like India face several health challenges and with limited resources, appropriate planning and channelization of the same is the need of the hour. Material and methods: The objective of the study was to determine the role of cartridge-based nucleic acid amplification test (CBNAAT) in the diagnosis of tubercular pleural effusion (TPE) and also to study if any association exists between CBNAAT and pleural fluid adenosine deaminase (ADA) and lymphocyte counts. Clinically suspected TPE, lymphocyte predominant (≥ 70%) exudates (according to the Lights criteria) with ADA ≥ 40 U/L and microbiologically confirmed pulmonary tuberculosis patients with a co-existent pleural effusion were included. Pleural fluid CBNAAT was performed on all the samples. Results: Out of a total of 75 patients, 57 were males and 18 were females. A lymphocyte predominance of ≥ 70% was seen in 73 subjects (97%). Mean ADA was 61.7 U/L ± 16.2 (SD). Pleural fluid CBNAAT was positive for Mycobacterium tuberculosis (MTB) in 24 patients (32%). Out of these patients, rifampicin resistance was detected in 2 individuals (8.3%). Sputum smear for acid fast bacilli (AFB) was positive in 3 (4%) patients, whereas in sputum CBNAAT MTB was detected in 8 (10.6%) persons. Association between pleural fluid ADA, lymphocyte count and CBNAAT positivity was evaluated by Student T-test. There was a significant association between higher ADA levels and CBNAAT (p value = 0.001). Conclusions: Pleural fluid CBNAAT, owing to its low sensitivity, should not be included in the diagnostic protocol of TPE in high prevalence areas. A high ADA ≥ 40 U/L in combination with Light's criteria to define exudates, with lymphocyte predominance is sufficient evidence to diagnose TPE and initiate anti-tubercular therapy, thereby deferring the need to perform an invasive pleural biopsy.

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Section: Discussionmentioning

confidence: 99%

The Role of Genexpert in the Diagnosis of Tubercular Pleural Effusion in India

Chakraborty

Ramaswamy

Shivananjiah

et al. 2019

Advances in Respiratory Medicine

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Diagnosis of Tubercular Pleural Effusion in a Tertiary Care Hospital of Western India: Role of Cartridge-based Nucleic Acid Amplification Test and other Laboratory Parameters

Mukhida,

Khan,

Vyawahare

et al. 2024

Journal of Marine Medical Society

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Introduction: Tubercular pleural effusion (TPE) is a paucibacillary disease, and mycobacterial culture positivity from pleural fluid samples is rare and time-consuming, leading to considerable delay in initiating antibiotic therapy. However, in high-burden settings, the diagnosis is presumed in individuals based on adenosine deaminase (ADA) level and a lymphocytic-predominant exudate on presentation. The current study was conducted to screen clinically TPE-suspected patients by cartridge-based nucleic acid amplification test (CBNAAT) as well as culture and to evaluate whether TPE correlates with pleural fluid laboratory counts. Materials and Methods: This observational study was done at a tertiary care hospital from January 2019 to June 2021 on 157 TPE-suspected patients. CBNAAT was performed for both pleural fluid and sputum specimens while solid culture was processed on pleural fluids only as per routine microbiological procedures. Pleural fluid was sent for biochemical analysis and investigation of ADA, total leukocyte count, and differential leukocyte count because of lymphocyte predominance. Results: A total of 314 specimens (pleural fluid and sputum) from 157 patients were processed for CBNAAT. Mycobacterium tuberculosis was detected in 22 (14.01%) of 157 sputum specimens and 19 (12.10%) of 157 pleural fluid specimens. A total of 25 pleural fluid specimens have growth on solid media. CBNAAT sensitivity was found 52% in the current study. A total of seven patients were detected with pulmonary tuberculosis (PTB) along with TPE. In TPE diagnosis, all laboratory parameters were found statistically significant (P < 0.5). Conclusion: The use of two tests for patient screening, such as the CBNAAT and supporting marker test, improves the early detection of TPE and stops the progression of problems from untreated, long-standing TPE. This study also reveals the significant correlation of PTB in clinically TPE-suspected patients.

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

Cited by 2 publications

References 10 publications

The Role of Genexpert in the Diagnosis of Tubercular Pleural Effusion in India

The Role of Genexpert in the Diagnosis of Tubercular Pleural Effusion in India

Diagnosis of Tubercular Pleural Effusion in a Tertiary Care Hospital of Western India: Role of Cartridge-based Nucleic Acid Amplification Test and other Laboratory Parameters

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