title: Pleural fluid ADA, IgA-ELISA and PCR sensitivities for the diagnosis of pleural tuberculosis.
abstract: The diagnosis of pleural tuberculosis (pTB) is difficult, and more sensitive and specific techniques are needed. In the period August 1998 to November 2002, we evaluated 132 patients with a pleural effusion submitted to a thoracentesis and pleural biopsy in a tertiary care hospital in Rio de Janeiro, Brazil. Three tests were performed and compared in the pleural fluid: ADA activity measurement, IgA-ELISA for two combined specific Mycobacterium tuberculosis antigens, and polymerase chain reaction (PCR) for detection of M. tuberculosis DNA. Ninety-five patients (72%) were given a final diagnosis of pTB. Overall histopathologic sensitivity was 77%. The sensitivities of pleural fluid culture and AFB smear were 42% and 1%, respectively. Twenty-one (22%) additional patients had a clinical diagnosis of pTB. Median follow-up time of all TB patients after the completion of antituberculous treatment was 13 months. Sensitivities of ADA, IgA-ELISA and PCR were 91%, 78% and 82%, while specificities were 93%, 96% and 85%, respectively. Only ADA sensitivity was significantly higher than the histopathologic examination (McNemar chi2 test; p = 0.002) and also significantly higher than ELISA (p = 0.049), but not higher than PCR (p = 0.143). We conclude that the routine use of ADA activity measurement in pleural fluid can obviate the need for a pleural biopsy in the initial diagnostic approach to pleural effusions, while IgA-ELISA and PCR techniques, potentially more specific tests, need further refinement to improve their accuracy.
authors.affiliation: Universidade Gama Filho, Rio de Janeiro, Brazil. atrajman@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Trajman
authors.forename: C
authors.initials: C
authors.lastname: Kaisermann
authors.forename: R R
authors.initials: RR
authors.lastname: Luiz
authors.forename: R D
authors.initials: RD
authors.lastname: Sperhacke
authors.forename: M L
authors.initials: ML
authors.lastname: Rossetti
authors.forename: M H
authors.initials: MH
authors.lastname: Féres Saad
authors.forename: I G
authors.initials: IG
authors.lastname: Sardella
authors.forename: N
authors.initials: N
authors.lastname: Spector
authors.forename: A L
authors.initials: AL
authors.lastname: Kritski
mesh_terms: D000243:Adenosine Deaminase / Q000032:analysis* / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004269:DNA, Bacterial / Q000032:analysis / Q000235:genetics; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D035422:Pleural Cavity / Q000201:enzymology* / Q000473:pathology; D016133:Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D014396:Tuberculosis, Pleural / Q000175:diagnosis* / Q000201:enzymology*
chemical_list: D004269:DNA, Bacterial; D007070:Immunoglobulin A; D000243:Adenosine Deaminase