Abstract
An elevated level of adenosine deaminase (ADA) in pleural liquid has been considered as a supplemental diagnostic marker for tuberculous pleurisy. However, this is complicated by false-positives and -negatives. Recently, it has been revealed that various cytokines are intimately involved in the pathognomonic physiology of tuberculosis. In this study, interleukin-8 (IL-8), tumour necrosis factor α (TNF α) and interferon γ (IFN γ ) were compared with ADA in pleural liquid of patients with inflammatory (21 cases), malignant (28 cases) and tuberculous (21 cases) disease. The pleural ADA, IL-8, TNF α and IFN γ levels in the tuberculous group were higher than in the other three groups. Analysis of receiver operating characteristic (ROC) curves, to evaluate the utility of the various parameters, demonstrates values for the area under the curve (AUC) of 0·770, 0·875, 0·892 and 0·987, respectively for IL-8, TNF α, ADA and IFN γ,. No false-positives were encountered with IFN γ and only one case with a small volume of pleural liquid was a false-negative. This indicates that IFN γ is a very reliable marker of tuberculous pleurisy.
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