Highly accurate diagnosis of pleural tuberculosis by immunological analysis of the pleural effusion
Pleural TB is notoriously difficult to diagnose due to its paucibacillary nature yet it is the most common cause of pleural effusions in TB endemic countries such as The Gambia. We identified both cellular and soluble biomarkers in the pleural fluid that allowed highly accurate diagnosis of pleural...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Public Library of Science
2012
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| _version_ | 1797061680429006848 |
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| author | Sutherland, J Garba, D Fombah, A Mendy-Gomez, A Mendy, F Antonio, M Townend, J Ideh, R Corrah, T Ota, M |
| author_facet | Sutherland, J Garba, D Fombah, A Mendy-Gomez, A Mendy, F Antonio, M Townend, J Ideh, R Corrah, T Ota, M |
| author_sort | Sutherland, J |
| collection | OXFORD |
| description | Pleural TB is notoriously difficult to diagnose due to its paucibacillary nature yet it is the most common cause of pleural effusions in TB endemic countries such as The Gambia. We identified both cellular and soluble biomarkers in the pleural fluid that allowed highly accurate diagnosis of pleural TB compared to peripheral blood markers. Multi-plex cytokine analysis on unstimulated pleural fluid showed that IP-10 resulted in a positive likelihood ratio (LR) of 9.6 versus 2.8 for IFN-γ; a combination of IP-10, IL-6 and IL-10 resulted in an AUC of 0.96 and positive LR of 10. A striking finding was the significantly higher proportion of PPD-specific IFN-γ+TNF-α+ cell population (PPD-IGTA) in the pleural fluid compared to peripheral blood of TB subjects. Presence of this pleural PPD-IGTA population resulted in 95% correct classification of pleural TB disease with a sensitivity of 95% and specificity of 100%. These data suggest that analysis of the site of infection provides superior diagnostic accuracy compared to peripheral blood for pleural TB, likely due to the sequestration of effector cells at this acute stage of disease. |
| first_indexed | 2024-03-06T20:34:42Z |
| format | Journal article |
| id | oxford-uuid:323ac119-0960-4380-849e-311e048ac9b9 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T20:34:42Z |
| publishDate | 2012 |
| publisher | Public Library of Science |
| record_format | dspace |
| spelling | oxford-uuid:323ac119-0960-4380-849e-311e048ac9b92022-03-26T13:12:46ZHighly accurate diagnosis of pleural tuberculosis by immunological analysis of the pleural effusionJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:323ac119-0960-4380-849e-311e048ac9b9EnglishSymplectic Elements at OxfordPublic Library of Science2012Sutherland, JGarba, DFombah, AMendy-Gomez, AMendy, FAntonio, MTownend, JIdeh, RCorrah, TOta, MPleural TB is notoriously difficult to diagnose due to its paucibacillary nature yet it is the most common cause of pleural effusions in TB endemic countries such as The Gambia. We identified both cellular and soluble biomarkers in the pleural fluid that allowed highly accurate diagnosis of pleural TB compared to peripheral blood markers. Multi-plex cytokine analysis on unstimulated pleural fluid showed that IP-10 resulted in a positive likelihood ratio (LR) of 9.6 versus 2.8 for IFN-γ; a combination of IP-10, IL-6 and IL-10 resulted in an AUC of 0.96 and positive LR of 10. A striking finding was the significantly higher proportion of PPD-specific IFN-γ+TNF-α+ cell population (PPD-IGTA) in the pleural fluid compared to peripheral blood of TB subjects. Presence of this pleural PPD-IGTA population resulted in 95% correct classification of pleural TB disease with a sensitivity of 95% and specificity of 100%. These data suggest that analysis of the site of infection provides superior diagnostic accuracy compared to peripheral blood for pleural TB, likely due to the sequestration of effector cells at this acute stage of disease. |
| spellingShingle | Sutherland, J Garba, D Fombah, A Mendy-Gomez, A Mendy, F Antonio, M Townend, J Ideh, R Corrah, T Ota, M Highly accurate diagnosis of pleural tuberculosis by immunological analysis of the pleural effusion |
| title | Highly accurate diagnosis of pleural tuberculosis by immunological analysis of the pleural effusion |
| title_full | Highly accurate diagnosis of pleural tuberculosis by immunological analysis of the pleural effusion |
| title_fullStr | Highly accurate diagnosis of pleural tuberculosis by immunological analysis of the pleural effusion |
| title_full_unstemmed | Highly accurate diagnosis of pleural tuberculosis by immunological analysis of the pleural effusion |
| title_short | Highly accurate diagnosis of pleural tuberculosis by immunological analysis of the pleural effusion |
| title_sort | highly accurate diagnosis of pleural tuberculosis by immunological analysis of the pleural effusion |
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