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Evaluation of Polymerase Chain Reaction, Adenosine Deaminase, and Interferon- in Pleural Fluid for the Differential Diagnosis of Pleural Tuberculosis^*

^* From the Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali, Colombia.

Correspondence to: Nancy Gore Saravia, MSc, PhD, Centro Internacional de Entrenamiento e Investigaciones Médicas- CIDEIM, Apartado Aereo 5390, Av 1N No. 3–03, Cali, Colombia; e-mail: cideim{at}cali.cetcol.net.co

Study objectives: Pleural tuberculosis (TB) is a diagnostic challenge because of its nonspecific clinical presentation and paucibacillary nature. The inefficiency of conventional laboratory methods and the reliance on pleural biopsy have motivated the evaluation of alternative diagnostic strategies. We have evaluated polymerase chain reaction (PCR) directed to the IS6110 sequence of Mycobacterium tuberculosis, the determination of adenosine deaminase (ADA) activity, and measurement of interferon (IFN)- levels in pleural fluid in the diagnosis of pleural TB.

Patients: ADA activity, IFN- levels, and PCR were evaluated in 140 cases of pleural effusion, 42 with confirmed pleural TB, 19 with probable pleural TB, 70 with a nontuberculous etiology, and 9 having an undetermined etiology.

Results: ADA activity, IFN- levels, and PCR were 88%, 85.7%, and 73.8% sensitive, respectively, and 85.7%, 97.1%, and 90% specific, respectively, for pleural TB that had been confirmed by either culture or pleural biopsy specimens. The combination of PCR, IFN- measurement, and ADA activity determination allowed the selective increase of sensitivity and specificity for probable and confirmed cases compared to individual methods. Positive and negative predictive values for these individual or combined methods were maintained over a wide range of prevalence of pleural TB in the patient population presenting with pleural effusions. Fever and younger age were associated with tuberculous pleural effusion (p < 0.0001), while blood in sputum and older age were associated with malignant etiology (p < 0.008).

Conclusions: These clinical variables together with the use of ADA activity determination, PCR, and measurement of IFN- levels provide the basis for the rapid and efficient diagnosis of pleural TB in different clinical settings.

Key Words: adenosine deaminase • diagnosis • interferon- • pleural effusion • polymerase chain reaction • positive and negative predictive values • tuberculosis

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