Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusion
Background: Noninvasive diagnosis of pleural tuberculosis (TB) remains a challenge due to the paucibacillary nature of the disease. As Mycobacterium tuberculosis (MTB)-specific T cells are recruited into pleural space in TB effusion; their indirect detection may provide useful clinical information....
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2012-01-01
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| Series: | Annals of Thoracic Medicine |
| Subjects: | |
| Online Access: | http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2012;volume=7;issue=4;spage=220;epage=225;aulast=Eldin |
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| author | Eman N Eldin Asmaa Omar Mahmoud Khairy Adel H.M Mekawy Maha K Ghanem |
| author_facet | Eman N Eldin Asmaa Omar Mahmoud Khairy Adel H.M Mekawy Maha K Ghanem |
| author_sort | Eman N Eldin |
| collection | DOAJ |
| description | Background: Noninvasive diagnosis of pleural tuberculosis (TB) remains a challenge due to the paucibacillary nature of the disease. As Mycobacterium tuberculosis (MTB)-specific T cells are recruited into pleural space in TB effusion; their indirect detection may provide useful clinical information.
Objectives: Evaluation of pleural fluid interferon (INF)-γ levels vs Quantiferon−TB Gold In tube assay (QFT- IT) in blood and its adapted variants, using pleural fluid or isolated pleural fluid cells in the diagnosis of pleural TB.
Methods: Thirty-eight patients with pleural effusion of unknown etiology presented at Assiut University Hospital, Egypt, were recruited. Blood and pleural fluid were collected at presentation for INF-γ assays. Ex vivo pleural fluid INF-γ levels, QFT-IT in blood and its adapted variants were compared with final diagnosis as confirmed by other tools including blind and/or thoracoscopic pleural biopsy.
Results: The final clinical diagnosis was TB in 20 (53%), malignancy in 10 (26%), and effusion due to other causes in eight patients (21%). Ex vivo pleural fluid INF-γ levels accurately identified TB in all patients and were superior to the QFT-IT assays using blood or pleural fluid (70 and 78% sensitivity, with 60 and 83% specificity, respectively). QFT-IT assay applied to isolated pleural fluid cells had 100% sensitivity and 72% specificity. The optimal cut-off obtained with ROC analysis was 0.73 for TB Gold assay in blood assay, 0.82 IU/ml for the cultured pleural fluid assay, and 0.94 for isolated pleural cells assay.
Conclusion: The ex vivo pleural fluid INF-γ level is an accurate marker for the diagnosis of pleural TB. QFT- IT assay in peripheral blood or its adapted versions of the assay using pleural fluid and/or washed pleural fluid cells had no diagnostic advantage over pleural fluid INF-γ in the diagnosis of pleural TB. |
| first_indexed | 2024-04-12T18:43:28Z |
| format | Article |
| id | doaj.art-788f93b3fb1f4431b7b0f4c5a5043a0d |
| institution | Directory Open Access Journal |
| issn | 1817-1737 1998-3557 |
| language | English |
| last_indexed | 2024-04-12T18:43:28Z |
| publishDate | 2012-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Thoracic Medicine |
| spelling | doaj.art-788f93b3fb1f4431b7b0f4c5a5043a0d2022-12-22T03:20:42ZengWolters Kluwer Medknow PublicationsAnnals of Thoracic Medicine1817-17371998-35572012-01-017422022510.4103/1817-1737.102181Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusionEman N EldinAsmaa OmarMahmoud KhairyAdel H.M MekawyMaha K GhanemBackground: Noninvasive diagnosis of pleural tuberculosis (TB) remains a challenge due to the paucibacillary nature of the disease. As Mycobacterium tuberculosis (MTB)-specific T cells are recruited into pleural space in TB effusion; their indirect detection may provide useful clinical information. Objectives: Evaluation of pleural fluid interferon (INF)-γ levels vs Quantiferon−TB Gold In tube assay (QFT- IT) in blood and its adapted variants, using pleural fluid or isolated pleural fluid cells in the diagnosis of pleural TB. Methods: Thirty-eight patients with pleural effusion of unknown etiology presented at Assiut University Hospital, Egypt, were recruited. Blood and pleural fluid were collected at presentation for INF-γ assays. Ex vivo pleural fluid INF-γ levels, QFT-IT in blood and its adapted variants were compared with final diagnosis as confirmed by other tools including blind and/or thoracoscopic pleural biopsy. Results: The final clinical diagnosis was TB in 20 (53%), malignancy in 10 (26%), and effusion due to other causes in eight patients (21%). Ex vivo pleural fluid INF-γ levels accurately identified TB in all patients and were superior to the QFT-IT assays using blood or pleural fluid (70 and 78% sensitivity, with 60 and 83% specificity, respectively). QFT-IT assay applied to isolated pleural fluid cells had 100% sensitivity and 72% specificity. The optimal cut-off obtained with ROC analysis was 0.73 for TB Gold assay in blood assay, 0.82 IU/ml for the cultured pleural fluid assay, and 0.94 for isolated pleural cells assay. Conclusion: The ex vivo pleural fluid INF-γ level is an accurate marker for the diagnosis of pleural TB. QFT- IT assay in peripheral blood or its adapted versions of the assay using pleural fluid and/or washed pleural fluid cells had no diagnostic advantage over pleural fluid INF-γ in the diagnosis of pleural TB.http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2012;volume=7;issue=4;spage=220;epage=225;aulast=EldinDiagnosisinterferon-γinterferon-γ release assaysquantiferon−TB gold in tube assaytuberculous effusion |
| spellingShingle | Eman N Eldin Asmaa Omar Mahmoud Khairy Adel H.M Mekawy Maha K Ghanem Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusion Annals of Thoracic Medicine Diagnosis interferon-γ interferon-γ release assays quantiferon−TB gold in tube assay tuberculous effusion |
| title | Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusion |
| title_full | Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusion |
| title_fullStr | Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusion |
| title_full_unstemmed | Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusion |
| title_short | Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusion |
| title_sort | diagnostic value of ex vivo pleural fluid interferon gamma versus adapted whole blood quantiferon tb gold in tube assays in tuberculous pleural effusion |
| topic | Diagnosis interferon-γ interferon-γ release assays quantiferon−TB gold in tube assay tuberculous effusion |
| url | http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2012;volume=7;issue=4;spage=220;epage=225;aulast=Eldin |
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