Evaluating pleural ADA, ADA2, IFN-gamma and IGRA for diagnosing tuberculous pleurisy
Resource
J. Infect., 67(4), 294-302
Journal
J. Infect.
Journal Volume
67
Journal Issue
4
Pages
294-302
Date Issued
2013
Date
2013
Author(s)
Keng, Li-Ta
Shu, Chin-Chung
Chen, Jason Yao-Ping
Liang, Sheng-Kai
Lin, Ching-Kai
Chang, Lih-Yu
Chang, Chia-Hao
Wang, Jann-Yuan
Yu, Chong-Jen
Lee, Li-Na
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.
Subjects
Adenosine deaminase
Adenosine deaminase 2
Interferon-gamma
Interferon-gamma release assay
Tuberculous pleurisy
T-SPOT.TB assay
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