Pleural fluid tests to diagnose tuberculous pleuritis

• Published in: Current opinion in pulmonary medicine Vol. 22; no. 4; p. 367
• Main Authors: Skouras, Vasileios S, Kalomenidis, Ioannis
• Format: Journal Article
• Language: English
• Published: United States 01.07.2016
• Subjects: Adenosine Deaminase - analysis; Biomarkers - analysis; Exudates and Transudates - chemistry; Exudates and Transudates - enzymology; Exudates and Transudates - immunology; Exudates and Transudates - microbiology; Humans; Interferon-gamma - analysis; Interleukins - analysis; Mycobacterium tuberculosis - isolation & purification; Pleural Effusion - enzymology; Pleural Effusion - epidemiology; Pleural Effusion - immunology; Pleural Effusion - microbiology; Pleurisy - diagnosis; Pleurisy - epidemiology; Pleurisy - immunology; Prevalence; Tuberculosis, Pleural - diagnosis; Tuberculosis, Pleural - epidemiology; Tuberculosis, Pleural - microbiology
• ISSN: 1531-6971
• DOI: 10.1097/MCP.0000000000000277

This article summarizes current data regarding the accuracy of pleural fluid tests assisting the diagnosis of tuberculous pleuritis (TBP). No pleural fluid test reliably rules-in TBP in settings with low TBP prevalence. Interferon-γ) alone or in combination with adenosine deaminase (ADA) is more reliable than ADA for this purpose in nonlow prevalences. ADA can reliably rule-out TBP in prevalences of less than 40% although in higher prevalences the product of interleukin-27 and ADA is the most accurate rule-out test. The definite diagnosis of TBP requires the isolation of Mycobacterium tuberculosis from pleural fluid or biopsies. Because of the low sensitivity of pleural fluid cultures and the invasiveness of pleural biopsy techniques, the concept of a pleural fluid test that accurately establishes or excludes TBP diagnosis has been proposed. Numerous pleural fluid tests have been evaluated for this purpose with ADA being the most widely accepted one. During the last years, it has been demonstrated that the ability of ADA to rule-in or rule-out TBP is affected by the prevalence of TBP in the setting where the test is used. The complementary use of interferon-γ or interleukin-27 increases the ability of ADA to rule-in or rule-out the disease, respectively.