Use of T-SPOT.TB for the diagnosis of unconventional pleural tuberculosis is superior to ADA in high prevalence areas: a prospective analysis of 601 cases

Abstract

Background Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation and may have lasting effect on lung function. However conventional diagnostic tests for TPE register multiple limitations. This study estimates diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics. Methods We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively enrolled from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, technical cut-offs and the utility of T-SPOT on pleural fluid (PF) were determined and analysed. Logistic regression analysis was performed to obtain the independent risk factors for TPE, and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA. Results A total of 601 individuals were consecutively recruited. The maximum spot-forming cells (SFCs) of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, which was equal to ADA (0.885 vs 0.887, P = 0.957) and superior to peripheral blood (PB), with a sensitivity of 83.0% and a specificity of 83.1% (The cut-off value was 466 SFCs/106 mononuclear cells). Among the TPE patients with low ADA (< 40 IU/L), the sensitivity and specificity of PF T-SPOT were still 87.9 and 90.5%, respectively. The utility of ADA was negatively related to increasing age, but the PF T-SPOT test had a steady performance at all ages. Age (< 45 yrs.; odds ratio (OR) = 5.61, 95% confidence interval (CI) 3.59–8.78; P < 0.001), gender (male; OR = 2.68, 95% CI 1.75–2.88; P < 0.001) and body mass index (BMI) (< 22; OR = 1.93, 95% CI 1.30–2.88; P = 0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity for ADA (76.5% vs. 23.5%, P = 0.016) and had noninferior specificity (84.4% vs. 96.9%, P = 0.370). Conclusions In conclusion, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is superior to ADA in unconventional TPE patients (age ≥ 45 yrs., female or BMI ≥ 22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.

The negative impact of increasing age and underlying cirrhosis on the sensitivity of adenosine deaminase in the diagnosis of tuberculous peritonitis: a cross-sectional study in eastern China

“…Our data showed that the older (＞ 45 yr.) patients with TBP had significantly lower ADA activity in ascites than the younger patients. This finding is consistent to previous research (Yang et al, 2021). The negative trend may be linked to dynamic variations in cell-mediated immunity during ageing, including T lymphocytes (Licastro et al, 2005, Namdeo et al, 2020, Rocamora-Reverte et al, 2020, monocytes, and proinflammatory cytokines (Lafuse et al, 2019, Martinez et al, 2016.…”

“…Consistent with previous studies (Burgess et al, 2001, Guirat et al, 2011, Liu et al, 2020, Vaid and Kane, 2017, Yang et al, 2021, our data showed that ascites testings by AFB culture or Xpert are not sensitive enough to support definitive diagnosis of TBP, and that the efficacy of T.SPOTTB assay is less influenced by patient age or cirrhosis status compared with the above-mentioned three detection methods.…”

“…Laboratory data evaluated in the current study included ADA, AFB culture, Xpert, and T-SPOT.TB; the first three methods were performed using samples of ascites, with rest one using peripheral blood. ADA activity was determined using peroxidase assay (Beijing Strong Biotechnology, Inc, Beijing, China) followed by colorimetrically determination as previously described (Yang et al, 2021); the results were expressed in international units per liter of ascites (IU/L). Twenty-one patients underwent ascites ADA test via other methods before admission to the participating center and were excluded to avoid the possibility of variance in the results of ADA assays.…”

“…Additionally, low sensitivities of ADA test were serially reported in TBP patients complicated with liver cirrhosis or other forms of immune-disorders (Burgess et al, 2001, Hillebrand et al, 1996, Sathar et al, 1995. Additionally, recent research has shown that the sensitivity of ADA test in diagnosis of tuberculous pleural effusion is negatively associated with increasing age of a patient (Yang et al, 2021). Thus, we conducted this multicenter study to evaluate the correlation between efficacy of ascites ADA test and either patient age or cirrhosis status.…”

New Biocomposite Electrospun Fiber/Alginate Hydrogel for Probiotic Bacteria Immobilization

“…To maintain optimal microorganism cultivation, growth media parameters such as pH, temperature, oxygen level, and nutrition agents must be ensured, depending on the species of microbe (Thomas, 2015 [ 1 ]). This causes the use of many different specific and non-specific growth media, such as general-purpose nutrient agar (Smułek et al, 2020 [ 2 ]) and enrichment broth (Rahman et al, 2020 [ 3 ]), specific for certain fungi Sabouraud’s agar (Cultrera et al, 2021 [ 4 ]), and Middlebrook and Löwenstein-Jensen media used for Mycobacterium spp. culture (Schön et al, 2020 [ 5 ]; Xie et al, 2021 [ 6 ]) (Mikolajczyk et al, 2016 [ 7 ]).…”