|Title:||Evaluating pleural ADA, ADA2, IFN-gamma and IGRA for diagnosing tuberculous pleurisy||Authors:||Keng, Li-Ta
Chen, Jason Yao-Ping
|Keywords:||Adenosine deaminase;Adenosine deaminase 2;Interferon-gamma;Interferon-gamma release assay;Tuberculous pleurisy;T-SPOT.TB assay||Issue Date:||2013||Journal Volume:||67||Journal Issue:||4||Start page/Pages:||294-302||Source:||J. Infect.||Abstract:||
Objective: Conventional methods for diagnosing tuberculous pleurisy (TB pleurisy) are either invasive or have a long turn-around-time. Performances of pleural adenosine deaminase (ADA), ADA2, interferon-gamma (IFN-gamma), and interferon-gamma release assays (IGRA) as diagnostic tools for TB pleurisy were evaluated.
Methods: Eighty-eight patients with lymphocyte-predominant pleural exudates between June 2010 and March 2011, including 31 with clinically diagnosed TB pleurisy, were prospectively studied. Pleural ADA and ADA2 activity were measured by colorimetric method, IFN-gamma levels by enzyme-linked immuno-sorbent assay, and IGRA by enzyme-linked immuno-spot (T-SPOT.TB) assay.
Results: Pleural ADA, ADA2, and IFN-gamma levels, but not the proportion of positive T-SPOT.TB assay, were significantly higher in patients with TB pleurisy than in those without TB pleurisy. The area under the receiver-operating-characteristic (ROC) curve was 0.920, 0.893, 0.875, and 0.544 for IFN-gamma, ADA2, ADA, and T-SPOT.TB assay, respectively. The combination of ADA >= 40 IU/L and IFN-gamma >= 75 pg/mL yielded a specificity of 100%.
Conclusions: Pleural ADA, ADA2 and IFN-gamma, but not T-SPOT.TB assay, are all sensitive and specific for TB pleurisy. In patients with lymphocyte-predominant pleural exudates, ADA >= 40 IU/L and IFN-gamma >= 75 pg/mL in pleural effusion imply a very high probability of TB pleurisy. (C) 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
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