title: Validity of tuberculous pleuritis diagnosed in a resource-constrained setting in Dindigul district of Tamil Nadu.
abstract: BACKGROUND
  Majority of the Indians live in rural areas where resource constrained settings depend on cheaper and less invasive tests to diagnose extrapulmonary tuberculosis (TB). The decline in prevalence of TB in the country could affect the validity of the diagnosis. The aim was to measure validity of the pleural fluid study of proteins, lactate dehydrogenase (LDH), and cell counts in diagnosis of tuberculous pleuritis.
  
  
  METHODS
  This was a cross-sectional study conducted in a 300 bedded secondary care hospital in rural Tamil Nadu. Exhaustive sampling was performed during April 2013 to March 2014. Pleural fluid study of 54 patients with exudative pleural effusion was conducted. Diagnosis was established by closed needle pleural biopsy. Receiver operator curves were plotted and area under curve (AUC) was calculated for various parameters. Sensitivity, specificity, and predictive values were calculated for different cut-off values of the parameter with significant AUC.
  
  
  RESULTS
  Prevalence of tuberculous pleural effusion was 56% (95% confidence interval [95% CI] - 42.5-69.5%). Lymphocyte predominance in pleural fluid was the only valid test, and cut-off >80% had sensitivity of 70.0% (95% CI - 53.3-86.7%) and specificity of 70.8% (95% CI - 52.2-89.4%). Pleural fluid pH, protein or its ratio with serum protein, sugar, total leukocyte count, LDH or its ratio with serum LDH; erythrocyte sedimentation rate were not valid screening tests.
  
  
  CONCLUSIONS
  Lymphocyte predominance > 80% can be used as a marker of tuberculous pleuritis. Since the prevalence of tuberculous pleuritis in India has come down considerably, newer tests need to be included to make a valid diagnosis.
authors.affiliation: Department of General Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India.
authors.forename: Baranidharan
authors.initials: B
authors.lastname: Chennaiyan
authors.affiliation: Department of Community Medicine, MOSC Medical College, Ernakulam, Kerala, India.
authors.forename: Arun N
authors.initials: AN
authors.lastname: Bhatt
authors.affiliation: Department of Pulmonary Medicine, PSG Hospital, Coimbatore, India.
authors.forename: Roopa
authors.initials: R
authors.lastname: Kancherla
authors.affiliation: Department of Medicine, Christian Medical College, Vellore, India.
authors.forename: Cijoy K
authors.initials: CK
authors.lastname: Kuriakose
authors.affiliation: Department of Medicine, Christian Fellowship Hospital, Oddanchatram, Dindigul, Tamil Nadu, India.
authors.forename: Anand Vimal
authors.initials: AV
authors.lastname: Dev
authors.affiliation: Department of Medicine, Christian Fellowship Hospital, Oddanchatram, Dindigul, Tamil Nadu, India.
authors.forename: George A
authors.initials: GA
authors.lastname: Philip
keywords: Extrapulmonary tuberculosis; pleural tuberculosis; tuberculosis; tuberculous pleuritis