Validity of tuberculous pleuritis diagnosed in a resource-constrained setting in Dindigul district of Tamil Nadu
Context: Majority of the Indians live in rural areas where resource constrained settings depend on cheaper and less invasive tests to diagnose extrapulmonary tuberculosis (TB). The decline in prevalence of TB in the country could affect the validity of the diagnosis. The aim was to measure validity...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2016-01-01
|
| Series: | Journal of Family Medicine and Primary Care |
| Subjects: | |
| Online Access: | http://www.jfmpc.com/article.asp?issn=2249-4863;year=2016;volume=5;issue=3;spage=615;epage=618;aulast=Chennaiyan |
| _version_ | 1818263516013920256 |
|---|---|
| author | Baranidharan Chennaiyan Arun N Bhatt Roopa Kancherla Cijoy K Kuriakose Anand Vimal Dev George A Philip |
| author_facet | Baranidharan Chennaiyan Arun N Bhatt Roopa Kancherla Cijoy K Kuriakose Anand Vimal Dev George A Philip |
| author_sort | Baranidharan Chennaiyan |
| collection | DOAJ |
| description | Context: Majority of the Indians live in rural areas where resource constrained settings depend on cheaper and less invasive tests to diagnose extrapulmonary tuberculosis (TB). The decline in prevalence of TB in the country could affect the validity of the diagnosis. The aim was to measure validity of the pleural fluid study of proteins, lactate dehydrogenase (LDH), and cell counts in diagnosis of tuberculous pleuritis. Materials and Methods: This was a cross-sectional study conducted in a 300 bedded secondary care hospital in rural Tamil Nadu. Exhaustive sampling was performed during April 2013 to March 2014. Pleural fluid study of 54 patients with exudative pleural effusion was conducted. Diagnosis was established by closed needle pleural biopsy. Receiver operator curves were plotted and area under curve (AUC) was calculated for various parameters. Sensitivity, specificity, and predictive values were calculated for different cut-off values of the parameter with significant AUC. Results: Prevalence of tuberculous pleural effusion was 56% (95% confidence interval [95% CI] - 42.5-69.5%). Lymphocyte predominance in pleural fluid was the only valid test, and cut-off >80% had sensitivity of 70.0% (95% CI - 53.3-86.7%) and specificity of 70.8% (95% CI - 52.2-89.4%). Pleural fluid pH, protein or its ratio with serum protein, sugar, total leukocyte count, LDH or its ratio with serum LDH; erythrocyte sedimentation rate were not valid screening tests. Conclusions: Lymphocyte predominance > 80% can be used as a marker of tuberculous pleuritis. Since the prevalence of tuberculous pleuritis in India has come down considerably, newer tests need to be included to make a valid diagnosis. |
| first_indexed | 2024-12-12T19:20:15Z |
| format | Article |
| id | doaj.art-41f3dcc33dee4714b8a979e5c31382d7 |
| institution | Directory Open Access Journal |
| issn | 2249-4863 |
| language | English |
| last_indexed | 2024-12-12T19:20:15Z |
| publishDate | 2016-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Family Medicine and Primary Care |
| spelling | doaj.art-41f3dcc33dee4714b8a979e5c31382d72022-12-22T00:14:37ZengWolters Kluwer Medknow PublicationsJournal of Family Medicine and Primary Care2249-48632016-01-015361561810.4103/2249-4863.197322Validity of tuberculous pleuritis diagnosed in a resource-constrained setting in Dindigul district of Tamil NaduBaranidharan ChennaiyanArun N BhattRoopa KancherlaCijoy K KuriakoseAnand Vimal DevGeorge A PhilipContext: Majority of the Indians live in rural areas where resource constrained settings depend on cheaper and less invasive tests to diagnose extrapulmonary tuberculosis (TB). The decline in prevalence of TB in the country could affect the validity of the diagnosis. The aim was to measure validity of the pleural fluid study of proteins, lactate dehydrogenase (LDH), and cell counts in diagnosis of tuberculous pleuritis. Materials and Methods: This was a cross-sectional study conducted in a 300 bedded secondary care hospital in rural Tamil Nadu. Exhaustive sampling was performed during April 2013 to March 2014. Pleural fluid study of 54 patients with exudative pleural effusion was conducted. Diagnosis was established by closed needle pleural biopsy. Receiver operator curves were plotted and area under curve (AUC) was calculated for various parameters. Sensitivity, specificity, and predictive values were calculated for different cut-off values of the parameter with significant AUC. Results: Prevalence of tuberculous pleural effusion was 56% (95% confidence interval [95% CI] - 42.5-69.5%). Lymphocyte predominance in pleural fluid was the only valid test, and cut-off >80% had sensitivity of 70.0% (95% CI - 53.3-86.7%) and specificity of 70.8% (95% CI - 52.2-89.4%). Pleural fluid pH, protein or its ratio with serum protein, sugar, total leukocyte count, LDH or its ratio with serum LDH; erythrocyte sedimentation rate were not valid screening tests. Conclusions: Lymphocyte predominance > 80% can be used as a marker of tuberculous pleuritis. Since the prevalence of tuberculous pleuritis in India has come down considerably, newer tests need to be included to make a valid diagnosis.http://www.jfmpc.com/article.asp?issn=2249-4863;year=2016;volume=5;issue=3;spage=615;epage=618;aulast=ChennaiyanExtrapulmonary tuberculosispleural tuberculosistuberculosistuberculous pleuritis |
| spellingShingle | Baranidharan Chennaiyan Arun N Bhatt Roopa Kancherla Cijoy K Kuriakose Anand Vimal Dev George A Philip Validity of tuberculous pleuritis diagnosed in a resource-constrained setting in Dindigul district of Tamil Nadu Journal of Family Medicine and Primary Care Extrapulmonary tuberculosis pleural tuberculosis tuberculosis tuberculous pleuritis |
| title | Validity of tuberculous pleuritis diagnosed in a resource-constrained setting in Dindigul district of Tamil Nadu |
| title_full | Validity of tuberculous pleuritis diagnosed in a resource-constrained setting in Dindigul district of Tamil Nadu |
| title_fullStr | Validity of tuberculous pleuritis diagnosed in a resource-constrained setting in Dindigul district of Tamil Nadu |
| title_full_unstemmed | Validity of tuberculous pleuritis diagnosed in a resource-constrained setting in Dindigul district of Tamil Nadu |
| title_short | Validity of tuberculous pleuritis diagnosed in a resource-constrained setting in Dindigul district of Tamil Nadu |
| title_sort | validity of tuberculous pleuritis diagnosed in a resource constrained setting in dindigul district of tamil nadu |
| topic | Extrapulmonary tuberculosis pleural tuberculosis tuberculosis tuberculous pleuritis |
| url | http://www.jfmpc.com/article.asp?issn=2249-4863;year=2016;volume=5;issue=3;spage=615;epage=618;aulast=Chennaiyan |
| work_keys_str_mv | AT baranidharanchennaiyan validityoftuberculouspleuritisdiagnosedinaresourceconstrainedsettingindindiguldistrictoftamilnadu AT arunnbhatt validityoftuberculouspleuritisdiagnosedinaresourceconstrainedsettingindindiguldistrictoftamilnadu AT roopakancherla validityoftuberculouspleuritisdiagnosedinaresourceconstrainedsettingindindiguldistrictoftamilnadu AT cijoykkuriakose validityoftuberculouspleuritisdiagnosedinaresourceconstrainedsettingindindiguldistrictoftamilnadu AT anandvimaldev validityoftuberculouspleuritisdiagnosedinaresourceconstrainedsettingindindiguldistrictoftamilnadu AT georgeaphilip validityoftuberculouspleuritisdiagnosedinaresourceconstrainedsettingindindiguldistrictoftamilnadu |