The use of non-routine pleural fluid analysis in the diagnosis of pleural effusion

McGrath, Emmet E.; Warriner, David; Anderson, Paul B.

doi:10.1016/j.rmed.2010.03.008

Cited by 15 publications

(13 citation statements)

References 73 publications

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“…Consequently, the development of noninvasive methods is important to differentially diagnose these two diseases, including clinical decision trees 12 and nonroutine pleural fluid analysis (eg, ADA). 13 Accordingly, various PE biomarkers released during the immune response triggered by the presence of mycobacterial antigens or tumors in the pleural space have been investigated, such as ADA and interferon-g (IFN-g), particularly as well-recognized biomarkers for TPE, 14 , 15 but the diagnostic methods and performance seem to be variable. Thus, the objective of our study was to investigate PE biomarkers according to TB and cancer immunology to help distinguish these two common lymphocyte-predominant exudative PEs.…”

Section: Introductionmentioning

confidence: 99%

Novel biomarker analysis of pleural effusion enhances differentiation of tuberculous from malignant pleural effusion

Chen

Feng

Chang

et al. 2016

IJGM

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Lymphocytic pleurisy is commonly observed in tuberculosis and cancer. Noninvasive biomarkers are needed to distinguish tuberculous pleural effusion (TPE) from malignant pleural effusion (MPE) because current clinical diagnostic procedures are often invasive. We identified immune response biomarkers that can discriminate between TPE and MPE. Fourteen pleural effusion biomarkers were compared in 22 MPE patients and five TPE patients. Of the innate immunity biomarkers, the median levels of interleukin (IL)-1β and interferon-induced protein-10 (IP-10) were higher in TPE patients than in MPE patients (P<0.05 and P<0.01, respectively). Of the adaptive immunity biomarkers, the median levels of IL-13 and interferon-γ (IFN-γ) were higher in TPE patients than in MPE patients (P<0.05). In addition, the levels of basic fibroblast growth factor were higher in MPE patients than in TPE patients (P<0.05). Receiver operator characteristic analysis of these biomarkers was performed, resulting in the highest area under the curve (AUC) for IP-10 (AUC =0.95, 95% confidence interval, P<0.01), followed by IL-13 (AUC =0.86, 95% confidence interval, P<0.05). Our study shows that five biomarkers (IL-1β, IP-10, IFN-γ, IL-13, and basic fibroblast growth factor) have a potential diagnostic role in differentiating TPE from MPE, particularly in lung cancer-related MPE.

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Section: Introductionmentioning

confidence: 99%

Novel biomarker analysis of pleural effusion enhances differentiation of tuberculous from malignant pleural effusion

Chen

Feng

Chang

et al. 2016

IJGM

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“…Interferon-γ, a cytokine released from CD4 + lymphocytes, is elevated in TBPE [11], [15]. A recent meta-analysis revealed that this has a sensitivity of 89% and a specificity of 97% when diagnosing TB [16].…”

Section: Discussionmentioning

confidence: 99%

Tuberculous pleural effusion occurring concurrently with asbestos-related pleural disease

Zantah

Datta

2017

Respiratory Medicine Case Reports

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An eighty-four-year-old man presented with progressive exertional dyspnea, productive cough and weight loss for two months. His physical exam was notable for diminished breath sounds at the right base, with dullness to percussion. Chest-x-ray showed moderate right-sided pleural effusion and bilateral calcified pleural plaques as well as diaphragmatic plaques consistent with asbestos-related pleural disease (ARPD). Pleural fluid was exudative with predominantly mononuclear cells, negative acid fast bacilli stain, negative cultures, and negative cytology for malignant cells. Due to recurrence of the effusion, 4 weeks after drainage, thoracoscopic pleural biopsy was planned but pleural fluid cultures came back positive for mycobacteria tuberculosis. Patient was started on anti-tubercular therapy but treatment had to be stopped due to liver toxicity. Patient subsequently developed pneumonia and deteriorated despite antibiotic therapy and expired.

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“…9 ADA is an enzyme that converts adenosine to inosine-deoxyadenosine to deoxyinosine in purine catabolism that is dominantly found on T cells, that plays an important role in cell differentiation, and that shows immune cell activity. 10 ADA has two isoenzymes: ADA1 and ADA2. While ADA1 isoenzyme is found in many cells, ADA2 enzyme is only produced by monocytes/macrophages and constitutes the main component of increased ADA activity in TPE.…”

Section: Adenosine Deaminasementioning

confidence: 99%

New Biomarkers Used in the Diagnosis of Tuberculosis-Related Pleural Effusions

Teke

2020

J Pediatr Infect Dis

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Tuberculosis-related pleural effusion (TPE) is reported in 12 to 38% of thoracic tuberculosis (TB) cases in the pediatric population. In TPE, the pleural fluid bacilli load is very low, generally resulting in negative acid-fast bacill (AFB) staining and Mycobacterium culture. In the pleural fluid, AFB stain positivity is reported in <20%, and Mycobacterium tuberculosis positive culture in 18 to 38%. In childhood, this ratio is even lower. Also, pleural effusion (PE) mycobacterial culture gives late results (2–8 weeks). Therefore, TPE is diagnosed with pleura biopsy and pleural liquid examination. However, pleura biopsy is a more invasive operation and the diagnosis rates vary. The clinical and laboratory findings are not typical; it is very hard to distinguish between TPE and another cause of exudative PE. This situation makes it essential for research on reliable new biomarkers that can provide fast and accurate diagnosis of TPE. Adenosine deaminase (ADA) activity being above 40 to 50 U/L (despite varying depending on age) strongly suggests TPE. Other new biomarkers featured in TPE diagnosis are interferon-γ, cytokines, and nucleic acid multiplication tests. However, the results of ADA and other potential biomarkers shown to be beneficial in TPE diagnosis should always be interpreted with clinical and microbiological findings because no biomarker can provide information about M. tuberculosis culture and drug resistance. Especially in countries with high resistance against TB drugs, performing pleura biopsy, culture and drug resistance tests are important with regard to diagnosis and therapy planning.

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The use of non-routine pleural fluid analysis in the diagnosis of pleural effusion

Cited by 15 publications

References 73 publications

Novel biomarker analysis of pleural effusion enhances differentiation of tuberculous from malignant pleural effusion

Novel biomarker analysis of pleural effusion enhances differentiation of tuberculous from malignant pleural effusion

Tuberculous pleural effusion occurring concurrently with asbestos-related pleural disease

New Biomarkers Used in the Diagnosis of Tuberculosis-Related Pleural Effusions

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