title: Evaluation of adapted whole-blood interferon-gamma release assays for the diagnosis of pleural tuberculosis.
abstract: BACKGROUND
  Pleural tuberculosis (TB) remains difficult to diagnose despite numerous diagnostic tools. Recently, in vitro interferon (IFN)-gamma-based assays have been introduced in the diagnosis of latent TB, but these techniques have not been established in the diagnosis of active TB disease, including pleural TB.
  
  
  OBJECTIVE
  It was the aim of this study to assess the accuracy of the commercially available QuantiFERON TB Gold assay and adapted variants of the assay, using pleural fluid or isolated pleural fluid cells for the diagnosis of pleural TB.
  
  
  METHODS
  We recruited 66 consecutive patients with a pleural effusion of unknown cause presenting at a tertiary academic health care centre in Cape Town, South Africa, a high prevalence area of TB. Blood and pleural fluid were collected at presentation for IFN-gamma assays and the results evaluated for diagnostic accuracy.
  
  
  RESULTS
  The clinical diagnosis was TB in 30 (46%), malignancy in 20 (30%), parapneumonic effusion/empyema in 8 (12%) and effusion due to other causes in 8 patients (12%). Ex vivo pleural fluid IFN-gamma levels accurately identified TB in all patients and were superior to the QuantiFERON In Tube assay using blood and pleural fluid (73 and 57% sensitivity, with 71 and 87% specificity, respectively) and the QuantiFERON Gold assay applied to isolated pleural fluid cells (100% sensitivity and 67% specificity).
  
  
  CONCLUSIONS
  The ex vivo pleural fluid interferon-gamma level is an accurate marker for the diagnosis of pleural TB, and the QuantiFERON TB Gold assay performed with peripheral blood or adapted for pleural fluid cells does not add diagnostic value.
authors.affiliation: Department of Biomedical Sciences, Division of Molecular Biology and Human Genetics, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, US/MRC Centre for Molecular and Cellular Biology, Stellenbosch University, Cape Town, South Africa.
authors.forename: Novel N
authors.initials: NN
authors.lastname: Chegou
authors.forename: Gerhard
authors.initials: G
authors.lastname: Walzl
authors.forename: Chris T
authors.initials: CT
authors.lastname: Bolliger
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Diacon
authors.forename: Michel M
authors.initials: MM
authors.lastname: van den Heuvel
mesh_terms: D000328:Adult; D000368:Aged; D045604:Extracellular Fluid / Q000166:cytology; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology* / Q000276:immunology / Q000378:metabolism; D013601:T-Lymphocytes / Q000378:metabolism*; D014396:Tuberculosis, Pleural / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000378:metabolism
chemical_list: D007371:Interferon-gamma