Interferon-Gamma Release Assay Performance of Pleural Fluid and Peripheral Blood in Pleural Tuberculosis

Fei Liu,Zitong Wang,Xinting Yang,Xia Zhang,Liqun Zhang,Liping Ma,Li Xie,Mengqiu Gao,Fengjiao Du,Xiaoguang Wu,Hongyan Jia,Zongde Zhang,Robert J Wilkinson

doi:10.1371/journal.pone.0083857

Fei Liu, Zitong Wang + Show 11 more

Open Access

https://doi.org/10.1371/journal.pone.0083857

Copy DOI

Journal: PloS one	Publication Date: Dec 27, 2013
Citations: 31	License type: CC BY 4.0

Affiliation: Beijing Chest Hospital, Capital Medical University

Abstract

BackgroundThe diagnosis of pleural tuberculosis (TB) remains to be difficult. Interferon-gamma release assay (IGRA) is a promising method for diagnosing TB in low TB burden countries. The release of interferon-gamma (IFN-γ) by T lymphocytes increases at a localized site of infection with Mycobacterium tuberculosis antigen. This study aimed to examine the clinical accuracy of T-SPOT.TB on pleural fluid and peripheral blood for the diagnosis of pleural TB in high TB burden country.Methods168 subjects with pleural effusion were enrolled prospectively and examined with T-SPOT.TB on pleural fluid and peripheral blood samples simultaneously.ResultsThe receiver operating characteristic (ROC) curve and cut-off value of pleural fluid T-SPOT.TB was established according to spot forming cells (SFC) between culture/biopsy-confirmed pleural TB group and no pleural TB group. The sensitivity of pleural fluid T-SPOT.TB and peripheral blood T-SPOT.TB was similar (96.3% and 92.7%, respectively) (P= 0.691). In contrast, the specificity of pleural fluid T-SPOT.TB (94.5%) was significantly higher than that of peripheral blood T-SPOT.TB (76.1%) (P=0.002). 2% (2/98) of pleural fluid T-SPOT.TB results were indeterminate.ConclusionThe diagnostic accuracy of peripheral blood T-SPOT.TB is low in high TB burden countries due to latent tuberculosis infection. Pleural fluid T-SPOT.TB is a relatively useful and supplementary test to explore pleural TB in high TB burden countries, but its diagnostic accuracy needs to be validated in further large scale research.

Highlights

Tuberculosis (TB) is the leading cause of death from a curable infectious disease
We investigated ELISPOT based Interferon-gamma release assay (IGRA) (TSPOT.TB) applied to both pleural fluids (PF) and peripheral Blood (PB) obtained from patients with pleural effusion in order to evaluate the diagnostic performance of this assay for the diagnosis of pleural TB in China
We prospectively investigated possible clinical utilization of the T-SPOT.TB assay applied to PF and PB for the diagnosis of pleural TB in high TB burden area

Summary

Introduction

Eight to ten million of new TB cases are reported each year in high burden developing countries (Who, 2011). This study aimed to examine the clinical accuracy of T-SPOT.TB on pleural fluid and peripheral blood for the diagnosis of pleural TB in high TB burden country. Methods: 168 subjects with pleural effusion were enrolled prospectively and examined with T-SPOT.TB on pleural fluid and peripheral blood samples simultaneously. The specificity of pleural fluid T-SPOT.TB (94.5%) was significantly higher than that of peripheral blood T-SPOT.TB (76.1%) (P=0.002). Conclusion: The diagnostic accuracy of peripheral blood T-SPOT.TB is low in high TB burden countries due to latent tuberculosis infection. Pleural fluid T-SPOT.TB is a relatively useful and supplementary test to explore pleural TB in high TB burden countries, but its diagnostic accuracy needs to be validated in further large scale research

Objectives

Results

Conclusion