Abstract
Abstract Rapid, accurate, affordable, point-of-care tuberculosis (TB) diagnostic tests are essential for controlling TB. We aimed evaluate the diagnostic performance of tuberculous pleural effusion by combining medical thoracoscopy with blood interferon-gamma release assay (IGRA) and pleural fluid adenosine deaminase (ADA). Patients with undiagnosed pleural effusion measured by chest X-ray or ultrasound were prospectively enrolled in this study. Medical thoracoscopy, blood IGRA and pleural fluid ADA were conducted.A total of 154 patients with undiagnosed pleural effusion were enrolled. Among them, 98 patients (63.6%) were diagnosed as TPE. Patients in TPE+ groups were significantly younger. The diagnostic thresholds obtained via receiver operating characteristic curve analysis were: ADA 23.4 U/L with AUC 0.91 (95% CI: 0.85-0.97, Figure 2) and IFN-γ 6.9 pg/mL with AUC 0.87 (95% CI: 0.82-0.93). By combining all three test together, we achieved sensitivity of 0.92, perfect specificity and NLR of 0.082. The AUC of the combination test was 0.96 (0.93-0.99), which was significant higher than any individual test (p < 0.001). The combination of medical thoracoscopy with Interferon-Gamma release assay and adenosine deaminase performs better than individual test in diagnosis TPE. The combination diagnosis has very high diagnostic rate, can be easily and safely carried out.
Highlights
Tuberculosis (TB) has long plagued human beings and was declared a global emergency in 1993 by WHO (World Health Organization, 1993)
We aimed to evaluate the diagnostic performance of Tuberculous pleural effusion (TPE) by combining medical thoracoscopy with interferon-gamma release assay (IGRA) and adenosine deaminase (ADA)
A total of 154 patients with undiagnosed pleural effusion measured by chest X-ray or ultrasound were enrolled
Summary
Tuberculosis (TB) has long plagued human beings and was declared a global emergency in 1993 by WHO (World Health Organization, 1993). TB is a major public health problem in developing countries, especially in Asia and Africa, TB continues to be of concern in high-income nations (Pareek et al, 2016). In high-income countries, the overall changes in TB showed an important disparity, especially in foreign-born immigrants: in some developed countries, foreign-born cases has even increased (Jelastopulu et al, 2009). Drug-resistant TB emerged as one of the main challenges: about 630,000 cases of multidrug-resistant (MDR) TB occur worldwide, and extensively drug-resistant (XDR) was reported in more than 80 countries (World Health Organization, 2013). On top of the aforementioned challenges, nowadays, insufficient rapid and accurate TB diagnostic test remain one essential barrier to global TB control activities (Zumla et al, 2013). Accurate, affordable, point-of-care TB diagnostic tests that are easy to use and implement are needed
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