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Zhang T, Liu W, Li L, Jue Z, Xu C. Evaluation of serum and pleural levels tumor M2-pyruvate kinase in lung cancer patients with pleural effusion. BMC Pulm Med 2022; 22:307. [PMID: 35948914 PMCID: PMC9364574 DOI: 10.1186/s12890-022-02103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/04/2022] [Indexed: 11/14/2022] Open
Abstract
Objective To evaluate the diagnostic value of tumor M2-pyruvate kinase (TuM2-PK) and carcinoembryonic antigen (CEA) levels in both pleural effusion and serum in the differential diagnosis of benign and malignant pleural effusion. Methods This prospective study was conducted among 80 patients with benign pleural effusion (BPE group) and 125 patients with malignant pleural effusion associated with lung cancer (MPE group). The levels of TuM2-PK and CEA were measured by using sandwich enzyme-linked immunosorbent assay and electrochemiluminescence. The receiver-operating characteristic curve (ROC) analysis was used to confirm the cutoff value to evaluate the diagnostic efficiency of TuM2-PK and CEA. Results The TuM2-PK and CEA levels in pleural effusion and serum, and their ratio (P/S) were higher in MPE group than that in BPE group (P < 0.05). In pleural effusion and serum, the diagnostic efficiency of combined TuM2-PK and CEA for MPE was superior to either single detection. Conclusions The combined detection of TuM2-PK and CEA has a high sensitivity for diagnosis of MPE and might provide method for rapid and accurate diagnosis of patients.
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Affiliation(s)
- Tiantian Zhang
- Department of Respiratory Medicine, Affiliated Nanjing Brain Hospital, Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029, Jiangsu, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, Jiangsu, China
| | - Wei Liu
- Department of Respiratory Medicine, Affiliated Nanjing Brain Hospital, Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029, Jiangsu, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, Jiangsu, China
| | - Li Li
- Department of Respiratory Medicine, Affiliated Nanjing Brain Hospital, Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029, Jiangsu, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, Jiangsu, China
| | - Zou Jue
- Department of Pathology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029, China.
| | - Chunhua Xu
- Department of Respiratory Medicine, Affiliated Nanjing Brain Hospital, Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029, Jiangsu, China. .,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, Jiangsu, China.
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2
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Pleural Fluid Soluble Interleukin-2 Receptor as a Biomarker for the Diagnosis of Tuberculosis Pleural Effusion: A Systematic Review and Meta-Analysis. J Trop Med 2022; 2022:4348063. [PMID: 35356490 PMCID: PMC8958078 DOI: 10.1155/2022/4348063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2022] [Accepted: 02/28/2022] [Indexed: 02/01/2023] Open
Abstract
Background Several studies have assessed the diagnostic accuracy of pleural fluid soluble interleukin-2 receptor (sIL-2R) for tuberculous pleural effusion (TPE) but with varied results. Therefore, we conducted this systematic review and meta-analysis to evaluate the accuracy of sIL-2R for TPE. Methods PubMed, Ovid, and Web of Science databases were searched from inception to 23 March 2021 to identify eligible studies concerning the diagnostic accuracy of fluid sIL-2R for TPE. The sensitivity and specificity of sIL-2R for TPE were pooled with a bivariate model. We estimated the global diagnostic accuracy of PE sIL-2R with a summary receiver operating characteristic (sROC) curve. The revised Quality Assessment for Diagnostic Accuracy Studies tool (QUADAS-2) was used to assess the quality of eligible studies. Results A total of nine studies with 270 TPEs and 586 non-TPEs were included in the final analysis. The pooled sensitivity and specificity were 0.81 (95% CI: 0.76–0.86) and 0.92 (95% CI: 0.77–0.98), respectively. The area under the sROC curve (AUC) was 0.82 (95% CI: 0.79–0.86). No significant publication bias was observed. Conclusions Pleural fluid sIL-2R is a useful diagnostic marker for TPE. However, the diagnostic accuracies of already available biomarkers such as pleural fluid adenosine deaminase, interferon-γ, and interleukin-27 appear to be superior relative to sIL-2R. Therefore, it might not be preferable to use sIL-2R for diagnosing TPE.
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3
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Zhang M, Li D, Hu ZD, Huang YL. The diagnostic utility of pleural markers for tuberculosis pleural effusion. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:607. [PMID: 32566633 PMCID: PMC7290547 DOI: 10.21037/atm.2019.09.110] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tuberculosis pleural effusion (TPE) is common in clinical practice, and its diagnosis remains a challenge for clinicians. Ziehl-Neelsen staining, PE Mycobacterium tuberculosis culture, and biopsy are the gold standards for TPE diagnosis; however, they are time-consuming, invasive, observer-dependent, and insensitive. PE markers represent a rapid, low-cost, and non-invasive objective diagnostic tool for TPE. In the past decades, several PE biomarkers have been developed, and their diagnostic accuracy has been evaluated in many studies. Here, we reviewed the literature to summarize the diagnostic accuracy of these biomarkers, especially using the evidence from systematic review and meta-analysis. The current research strongly suggests that adenosine deaminase (ADA), interferon-gamma (IFN-γ), and interleukin 27 (IL-27) have extremely higher diagnostic accuracy for TPE, while the diagnostic accuracy of interferon gamma release assays (IGRAs), tumor necrosis factor-α (TNF-α), and interferon-γ-induced protein 10 kDa (IP-10) is moderate. Although some evidence supports C-X-C motif chemokine ligand 9 (CXCL9), CXCL11, CXCL12, sFas ligand, angiotensin-converting enzyme (ACE), calpain-1, spectrin breakdown products (SBDP), matrix metalloproteinase-1 (MMP-1), soluble CD26 (sCD26), soluble interleukin 2 receptor (sIL-2R) as useful diagnostic markers for TPE, more support is needed to validate their diagnostic accuracy. Finally, nucleic acid amplification tests (NAATs) have extremely high diagnostic specificity, but their sensitivity is low. Taken together, ADA is the preferred marker for TPE because its low cost and suitability for standardization.
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Affiliation(s)
- Man Zhang
- Department of Thoracic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Dan Li
- Department of Special Food and Equipment, Naval Special Medical Center, The Naval Military Medical University, Shanghai 200433, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Yuan-Lan Huang
- Department of Laboratory Medicine, Naval Special Medical Center, The Naval Military Medical University, Shanghai 200433, China
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4
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Antonangelo L, Faria CS, Sales RK. Tuberculous pleural effusion: diagnosis & management. Expert Rev Respir Med 2019; 13:747-759. [PMID: 31246102 DOI: 10.1080/17476348.2019.1637737] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Background: Tuberculosis (TB) is the world's leading cause of death from infectious disease. The World Health Organization (WHO) recognized 6.3 million new TB cases in 2017, 16% corresponding to extrapulmonary forms; pleural tuberculosis (PT) is the most common extrapulmonary form in adults. PT diagnosis is often challenging because the scarcity of bacilli in pleural fluid (PF), sometimes requiring invasive procedures to obtain pleural tissue for histological, microbiological or molecular examination. In regions of medium and high disease prevalence, adenosine deaminase (ADA), interferon gamma (IFN-γ) and interleukin 27 (IL-27) dosages are useful to establish presumptive diagnosis in patients with compatible clinical/radiological picture who present with lymphocytic pleural effusion. PT treatment is similar to the pulmonary TB treatment regimen recommended by WHO. Area covered: In this update, we present a PT review, including epidemiology, pathogenesis, clinical features, diagnosis, and therapy. Expert opinion: There is no PF test alone accurate for PT diagnosis, despite the evolution in clinical laboratory. ADA, IFN-γ and IL-27 are valuable laboratory biomarkers; however, IFN-γ and IL-27 are quite expensive. Molecular tests present low sensitivity in PF, being useful for diagnostic confirmation. Multidrug therapy remains the PT treatment choice. Advancing research in immunotherapy may bring benefits to PT patients.
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Affiliation(s)
- Leila Antonangelo
- a Divisao de Patologia Clinica - Departamento de Patologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , BR.,b Laboratorio de Investigacao Medica - LIM 03, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , BR
| | - Caroline S Faria
- b Laboratorio de Investigacao Medica - LIM 03, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , BR
| | - Roberta K Sales
- c Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , BR
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5
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Abstract
PURPOSE OF REVIEW This article summarizes current data regarding the accuracy of pleural fluid tests assisting the diagnosis of tuberculous pleuritis (TBP). RECENT FINDINGS No pleural fluid test reliably rules-in TBP in settings with low TBP prevalence. Interferon-γ) alone or in combination with adenosine deaminase (ADA) is more reliable than ADA for this purpose in nonlow prevalences. ADA can reliably rule-out TBP in prevalences of less than 40% although in higher prevalences the product of interleukin-27 and ADA is the most accurate rule-out test. SUMMARY The definite diagnosis of TBP requires the isolation of Mycobacterium tuberculosis from pleural fluid or biopsies. Because of the low sensitivity of pleural fluid cultures and the invasiveness of pleural biopsy techniques, the concept of a pleural fluid test that accurately establishes or excludes TBP diagnosis has been proposed. Numerous pleural fluid tests have been evaluated for this purpose with ADA being the most widely accepted one. During the last years, it has been demonstrated that the ability of ADA to rule-in or rule-out TBP is affected by the prevalence of TBP in the setting where the test is used. The complementary use of interferon-γ or interleukin-27 increases the ability of ADA to rule-in or rule-out the disease, respectively.
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6
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Yang J, Zhu Y, Wu L, Zhu W, Zhang X, Yang Y, Xu C. Diagnostic and prognostic significance of receptor-binding cancer antigen expressed on SiSo cells in lung-cancer-associated pleural effusion. CLINICAL RESPIRATORY JOURNAL 2016; 12:279-284. [PMID: 27402224 DOI: 10.1111/crj.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/19/2016] [Accepted: 07/10/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aimed to evaluate the diagnostic and prognostic value of pleural effusion levels of soluble receptor-binding cancer antigen expressed on SiSo cells (sRCAS1) in lung cancer patients with malignant pleural effusion (MPE). METHODS Pleural effusion samples were collected from 78 patients with MPE, and from 48 patients with benign pleural effusion (BPE). Pleural effusion sRCAS1 concentrations were measured by enzyme-linked immunosorbent assay. RESULTS MPE has significantly higher sRCAS1 levels than that of BPE (P < .01). With a cutoff value of 18.7 U/mL, sRCAS1 showed a good diagnostic performance for MPE. Univariate and multivariate analysis indicated that elevated sRCAS1 levels were an independent predictor of overall survival (OS) and disease-free survival (DFS). Kaplan-Meier survival curves further confirmed that patients with high sRCAS1 have shorter DFS and OS (P = .026 and P = .032, respectively). CONCLUSION In conclusion, measurement of sRCAS1 might be a useful diagnostic and prognostic marker for MPE.
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Affiliation(s)
- Jian Yang
- Department of Respiratory Medicine, Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, 211100, China
| | - Ying Zhu
- Department of Respiratory Medicine, Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, 211100, China
| | - Liangquan Wu
- Department of Respiratory Medicine, Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, 211100, China
| | - Wenyan Zhu
- Department of Respiratory Medicine, Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, 211100, China
| | - Xiuwei Zhang
- Department of Respiratory Medicine, Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, 211100, China
| | - Yang Yang
- Department of Respiratory Medicine, Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, 211100, China
| | - Chunhua Xu
- Endoscopic Center of Nanjing Chest Hospital, Nanjing, Jiangsu, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, Jiangsu, 210029, China
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Yari S, Hadizadeh Tasbiti A, Ghanei M, Shokrgozar MA, Fateh A, Yari F, Bahrmand A. Modified TB rapid test by proteinase K for rapid diagnosis of pleural tuberculosis. APMIS 2016; 124:201-207. [PMID: 26693840 DOI: 10.1111/apm.12490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 11/02/2015] [Indexed: 11/27/2022]
Abstract
The diagnosis of pleural tuberculosis continues to be a challenge due to the low sensitivity of traditional diagnostic methods. Better and more rapid tests are needed for diagnosis of pleural TB. In this study, pleural fluids were tested with rapid test to determine Mycobacterium tuberculosis (MTB antigen). Affinity chromatography was used to purify specific polyclonal antibodies against MTB antigen. Pleural samples after decontamination were treated with proteinase K. Rapid test for pleural fluids was prepared by specific antibody. Rapid test was performed on 85 pleural fluid patients. The patients had a mean age of 46.55 ± 15.96 years and 38 were men. The performance of rapid test, using proteinase K, was found to be the most impressive: sensitivity 93%, specificity 94%, PPV 90%, and NPV 96% compared with adenosine deaminase test (ADA), PCR, smear, and culture. The present study did demonstrate that modified TB rapid test can substantially improve the diagnosis of extrapulmonary TB.
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Affiliation(s)
- Shamsi Yari
- Tuberculosis Department, Pasteur Institute of Iran, Tehran, Iran
| | | | - Mostafa Ghanei
- Tuberculosis Department, Pasteur Institute of Iran, Tehran, Iran
- Chemical Injury Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Abolfazl Fateh
- Tuberculosis Department, Pasteur Institute of Iran, Tehran, Iran
| | - Fatemeh Yari
- Blood transfusion research center, High Institute for research and education in transfusion medicine, Tehran, Iran
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8
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Michot JM, Madec Y, Bulifon S, Thorette-Tcherniak C, Fortineau N, Noël N, Lambotte O, El Jahiri Y, Delacour H, Delfraissy JF, Blanc FX. Adenosine deaminase is a useful biomarker to diagnose pleural tuberculosis in low to medium prevalence settings. Diagn Microbiol Infect Dis 2015; 84:215-20. [PMID: 26707067 DOI: 10.1016/j.diagmicrobio.2015.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 11/02/2015] [Accepted: 11/07/2015] [Indexed: 11/17/2022]
Abstract
Adenosine deaminase (ADA) activity measurement in pleural fluid is a relevant test to diagnose pleural tuberculosis (pTB) in high tuberculosis prevalence settings. We investigated the diagnostic utility of pleural ADA using a retrospective analysis of patients admitted with newly diagnosed pleural effusion without identified etiology between 2001 and 2008 in Paris suburb, a low to medium tuberculosis prevalence area. 104 adults (mean age 55 years; 34 with pTB, 70 with other diagnoses) were analyzed. Median follow-up was 15.6 months. Mean [interquartile range] pleural ADA was 119 U/L [IQR: 83-143] in pTB and 24 U/L [IQR: 15-31] in non-tuberculous effusions (P<0.001). With an optimal pleural ADA cut-off value of 41.5 U/L for pTB diagnosis, sensitivity and specificity were 97.1% and 92.9%, while positive and negative predictive values were 86.8% and 98.5%, respectively. We conclude that pleural ADA activity could be integrated in the diagnostic procedures of pTB in low to medium tuberculosis prevalence settings.
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Affiliation(s)
- Jean-Marie Michot
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, 94275 Le Kremlin-Bicêtre, France; Université Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Gustave Roussy, Département de Médecine Oncologique, 94805 Villejuif, France
| | - Yoann Madec
- Institut Pasteur, Unité d'Epidémiologie des Maladies Emergentes, 75015 Paris, France
| | - Sophie Bulifon
- AP-HP, Hôpital Bicêtre, Service de Pneumologie, 94275 Le Kremlin-Bicêtre, France
| | | | - Nicolas Fortineau
- AP-HP, Hôpital Bicêtre, Département de Microbiologie, 94275 Le Kremlin-Bicêtre, France
| | - Nicolas Noël
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, 94275 Le Kremlin-Bicêtre, France; Université Paris-Sud, 94275 Le Kremlin-Bicêtre, France
| | - Olivier Lambotte
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, 94275 Le Kremlin-Bicêtre, France; Université Paris-Sud, 94275 Le Kremlin-Bicêtre, France
| | - Younes El Jahiri
- Service de Santé des Armées, Hôpital Bégin, Département de Biochimie, 94160 Saint-Mandé, France
| | - Hervé Delacour
- Service de Santé des Armées, Hôpital Bégin, Département de Biochimie, 94160 Saint-Mandé, France
| | - Jean-François Delfraissy
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, 94275 Le Kremlin-Bicêtre, France; Université Paris-Sud, 94275 Le Kremlin-Bicêtre, France
| | - François-Xavier Blanc
- Université de Nantes, Inserm UMR 1087/CNRS UMR 6291, 44007 Nantes, France; L'institut du thorax, Service de Pneumologie, Hôpital G. et R. Laënnec, CHU de Nantes, 44093 Nantes cedex 1, France.
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9
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Hassan WA, Alkarn AF, Kamel M. Can chest ultrasonography differentiate between benign and malignant effusions? THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2015. [DOI: 10.4103/1687-8426.158061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Xu CH, Cao L, Zhang XW, Yan J, Yu LK. Prognostic value of soluble H7-B4 in pleural effusion associated with lung cancer. Tumour Biol 2015; 36:4397-403. [PMID: 25636447 DOI: 10.1007/s13277-015-3079-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/08/2015] [Indexed: 11/29/2022] Open
Abstract
B7-H4, a member of the inhibitory B7 family, can restrain T cell proliferation, activation, and cytokine secretion and may be involved in immune evasion in cancer patients. This study aimed to evaluate the diagnostic and prognostic value of pleural effusion levels of soluble B7-H4 (sB7-H4) in lung cancer patients with malignant pleural effusion (MPE). Pleural effusion samples were collected from 98 lung cancer patients with malignant effusion and from 60 patients with nonmalignant pleural effusion. Pleural effusion concentrations of sB7-H4 were measured using sandwich enzyme-linked immunosorbent assay. Malignant effusion exhibited higher sB7-H4 levels than those in nonmalignant effusion (P < 0.01). Lung cancer patients with pleural effusion sB7-H4 levels below 35.8 ng/ml had a longer overall survival than those with higher levels (P < 0.05). By multivariate analysis, pleural effusion sB7-H4 was an independent prognostic factor in patients with MPE. In conclusion, measurement of sB7-H4 might be a useful diagnostic and prognostic value for MPE patients.
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Affiliation(s)
- Chun-Hua Xu
- Department of Respiratory Medicine, Nanjing Chest Hospital, 215 Guangzhou Road, Nanjing, 210029, China
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11
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Tural Önür S, Sökücü SN, Dalar L, Seyhan EC, Akbaş A, Altin S. Are soluble IL-2 receptor and IL-12p40 levels useful markers for diagnosis of tuberculous pleurisy? Infect Dis (Lond) 2014; 47:150-5. [PMID: 25549699 DOI: 10.3109/00365548.2014.975278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The differential diagnostic utilities of the levels of soluble interleukin (IL)-12p40 and the IL-2 receptor in sera and pleural effusions were evaluated in patients with exudative pleural effusions. METHODS We enrolled a total of 120 patients with exudative pleural effusions. The clinical, radiological, and histopathological diagnoses were tuberculous pleurisy in 52, malignant pleurisy in 39, and parapneumonic effusions in 29 patients. RESULTS We measured serum IL-12p40 and adenosine deaminase (ADA) levels in patients with tuberculous pleurisy and in a control group treated for pleural effusion to determine if such levels were useful in the diagnosis of pleural effusion (p < 0.005). Definite microbiological or histopathological diagnoses of tuberculous pleurisy or pleural effusion were recorded, and we found that ADA and serum soluble IL-2 receptor levels aided in diagnosis (p < 0.001). The levels of ADA and soluble IL-2 in pleural effusions afforded sensitivities and specificities of 84.62% and 82.69% and of 70.59% and 80.88%, respectively. The soluble IL-2 receptor level afforded a sensitivity and specificity of 82.69% and 52.9%. IL-12p40 levels in pleural effusions and sera afforded sensitivities and specificities of 80.77% and 80.77% and of 60.29% and 39.71%, respectively. CONCLUSION Soluble IL-2 receptor levels in patients with tuberculous pleurisy serve as markers of disease in non-endemic countries, similarly to ADA levels.
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Affiliation(s)
- Seda Tural Önür
- Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Chest Disease
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12
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13
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Xu C, Yu L, Zhan P, Zhang Y. Elevated pleural effusion IL-17 is a diagnostic marker and outcome predictor in lung cancer patients. Eur J Med Res 2014; 19:23. [PMID: 24887477 PMCID: PMC4041345 DOI: 10.1186/2047-783x-19-23] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/02/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Interleukin 17 (IL-17) is a proinflammatory cytokine produced mainly by CD4(+) T-lymphocytes and may be important in tumor cell growth and progression. In this study, we aimed to evaluate the diagnostic and prognostic value of pleural effusion levels of IL-17 in lung cancer patients with malignant pleural effusion (MPE). METHODS Pleural effusion samples were collected from 78 lung cancer patients with MPE and from 45 patients with nonmalignant pleural effusion. Pleural fluid concentrations of IL-17 were measured by using enzyme-linked immunosorbent assays. RESULTS Malignant effusion exhibited higher IL-17 levels than nonmalignant effusion (20.49 ± 5.27 pg/ml vs. 13.16 ± 2.25 pg/ml; P < 0.01). Lung cancer patients with pleural fluid IL-17 levels below 15 pg/ml had longer overall survival than those patients with higher levels (10.8 months vs. 4.7 months; P < 0.05). On the basis of multivariate analysis, we found that pleural fluid IL-17 level was an independent prognostic factor in lung cancer patients with MPE. CONCLUSIONS Measurement of IL-17 levels might be a useful diagnostic and prognostic test for lung cancer patients with MPE.
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Affiliation(s)
| | - LiKe Yu
- First Department of Respiratory Medicine, Nanjing Chest Hospital, 215 Guangzhou Road, Nanjing 210029, China.
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14
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Xu CH, Hao KK, Yu LK, Zhang XW. Diagnostic value of soluble receptor-binding cancer antigen expressed on SiSo cells and carcinoembryonic antigen in malignant pleural effusion in patients with lung cancer. Asia Pac J Clin Oncol 2014; 11:28-33. [PMID: 24720371 DOI: 10.1111/ajco.12195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Chun-hua Xu
- First Department of Respiratory Medicine; Nanjing Chest Hospital; Nanjing China
| | - Ke-ke Hao
- First Department of Respiratory Medicine; Nanjing Chest Hospital; Nanjing China
| | - Li-ke Yu
- First Department of Respiratory Medicine; Nanjing Chest Hospital; Nanjing China
| | - Xiu-wei Zhang
- Department of Respiratory Medicine; Nanjing Jiangning Hospital; Nanjing China
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15
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Comparison of same day diagnostic tools including Gene Xpert and unstimulated IFN-γ for the evaluation of pleural tuberculosis: a prospective cohort study. BMC Pulm Med 2014; 14:58. [PMID: 24708530 PMCID: PMC4108018 DOI: 10.1186/1471-2466-14-58] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The accuracy of currently available same-day diagnostic tools (smear microscopy and conventional nucleic acid amplification tests) for pleural tuberculosis (TB) is sub-optimal. Newer technologies may offer improved detection. METHODS Smear-microscopy, adenosine deaminase (ADA), interferon gamma (IFN-γ), and Xpert MTB/RIF [using an unprocessed (1 ml) and centrifuged (~20 ml) sample] test accuracy was evaluated in pleural fluid from 103 consecutive patients with suspected pleural TB. Culture for M.tuberculosis and/or histopathology (pleural biopsy) served as the reference standard. Patients were followed prospectively to determine their diagnostic categorisation. RESULTS Of 93 evaluable participants, 40 had definite-TB (reference positive), 5 probable-TB (not definite but treated for TB) and 48 non-TB (culture and histology negative, and not treated for TB). Xpert MTB/RIF sensitivity and specificity (95% CI) was 22.5% (12.4 - 37.6) and 98% (89.2 - 99.7), respectively, and centrifugation did not improve sensitivity (23.7%). The Xpert MTB/RIF internal positive control showed no evidence of inhibition. Biomarker specific sensitivity, specificity, PPV, and NPVs were: ADA (48.85 IU/L; rule-in cut-point) 55.3% (39.8 - 69.9), 95.2% (83.9 - 98.7), 91.4 (73.4 - 95.4), 69.7% (56.7 - 80.1); ADA (30 IU/L; clinically used cut-point) 79% (63.7 - 89), 92.7% (80.6 - 97.5), 91.0 (73.4 - 95.4), 82.7% (69.3 - 90.1); and IFN-γ (107.7 pg/ml; rule-in cut-point) 92.5% (80.2 - 97.5), 95.9% (86.1 - 98.9), 94.9% (83.2 - 98.6), 93.9% (83.5 - 97.9), respectively (IFN-γ sensitivity and NPV better than Xpert [p < 0.05] and rule-in ADA [p < 0.05]). CONCLUSION The usefulness of Xpert MTB/RIF to diagnose pleural TB is limited by its poor sensitivity. IFN-γ is an excellent rule-in test and, compared to ADA, has significantly better sensitivity and rule-out value in a TB-endemic setting.
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Ferreiro L, San José E, Valdés L. Tuberculous pleural effusion. Arch Bronconeumol 2014; 50:435-43. [PMID: 24721286 DOI: 10.1016/j.arbres.2013.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 12/28/2022]
Abstract
Tuberculous pleural effusion (TBPE) is the most common form of extrapulmonary tuberculosis (TB) in Spain, and is one of the most frequent causes of pleural effusion. Although the incidence has steadily declined (4.8 cases/100,000population in 2009), the percentage of TBPE remains steady with respect to the total number of TB cases (14.3%-19.3%). Almost two thirds are men, more than 60% are aged between 15-44years, and it is more common in patients with human immunodeficiency virus. The pathogenesis is usually a delayed hypersensitivity reaction. Symptoms vary depending on the population (more acute in young people and more prolonged in the elderly). The effusion is almost invariably a unilateral exudate (according to Light's criteria), more often on the right side, and the tuberculin test is negative in one third of cases. There are limitations in making a definitive diagnosis, so various pleural fluid biomarkers have been used for this. The combination of adenosine deaminase and lymphocyte percentage may be useful in this respect. Treatment is the same as for any TB. The addition of corticosteroids is not advisable, and chest drainage could help to improve symptoms more rapidly in large effusions.
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Affiliation(s)
- Lucía Ferreiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - Esther San José
- Servicio de Análisis Clínicos, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, España
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, España.
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Kopcinovic LM, Culej J. Pleural, peritoneal and pericardial effusions - a biochemical approach. Biochem Med (Zagreb) 2014; 24:123-37. [PMID: 24627721 PMCID: PMC3936968 DOI: 10.11613/bm.2014.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/14/2014] [Indexed: 12/23/2022] Open
Abstract
The pathological accumulation of serous fluids in the pleural, peritoneal and pericardial space occurs in a variety of conditions. Since patient management depends on right and timely diagnosis, biochemical analysis of extravascular body fluids is considered a valuable tool in the patient management process. The biochemical evaluation of serous fluids includes the determination of gross appearance, differentiation of transudative from exudative effusions and additional specific biochemical testing to assess the effusion etiology. This article summarized data from the most relevant literature concerning practice with special emphasis on usefulness of biochemical tests used for the investigation of pleural, peritoneal and pericardial effusions. Additionally, preanalytical issues concerning serous fluid analysis were addressed and recommendations concerning acceptable analytical practice in serous fluid analysis were presented.
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Affiliation(s)
- Lara Milevoj Kopcinovic
- Medical School University Hospital Sestre Milosrdnice, University Department of Chemistry, Zagreb, Croatia
| | - Jelena Culej
- Medical School University Hospital Sestre Milosrdnice, Department of Transfusiology and Hemostasis, Zagreb, Croatia
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Chegou NN, Hoek KGP, Kriel M, Warren RM, Victor TC, Walzl G. Tuberculosis assays: past, present and future. Expert Rev Anti Infect Ther 2014; 9:457-69. [DOI: 10.1586/eri.11.23] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Diagnostic value of pleural interleukin 17 and carcinoembryonic antigen in lung cancer patients with malignant pleural effusions. Tumour Biol 2013; 35:1599-603. [PMID: 24072496 DOI: 10.1007/s13277-013-1220-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/16/2013] [Indexed: 12/27/2022] Open
Abstract
Interleukin 17 (IL-17) has been found to be increased in some human cancers; however, the possible implication of IL-17 in regulating antitumor responses in lung cancer patients with malignant pleural effusions (MPE) remains to be elucidated. This study aimed to investigate the diagnostic value of pleural IL-17 and carcinoembryonic antigen (CEA) in MPE and benign pleural effusions (BPE). Pleural effusion samples from 108 patients were classified on the basis of diagnosis as MPE (n = 56) and BPE (n = 52). The concentration of IL-17 was determined by enzyme-linked immunosorbent assay (ELISA). The CEA levels were also determined in all patients. A significant difference was observed in the levels of CEA (P < 0.01) between MPE and BPE. The concentration of IL-17 in MPE was significantly higher compared to that in BPE (P < 0.01). With a cutoff point of 15.7 pg/ml, IL-17 had a sensitivity of 76.8 % and a specificity of 80.8 % for differential diagnosis. The combined detection of IL-17 and CEA had a sensitivity of 96.4 % and a specificity of 92.3 % to distinguish MPE from BPE. The combined detection of IL-17 and CEA may be more valuable in the differential diagnosis between MPE and BPE.
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D'Attilio L, Díaz A, Santucci N, Bongiovanni B, Gardeñez W, Marchesini M, Bogué C, Dídoli G, Bottasso O, Bay ML. Levels of inflammatory cytokines, adrenal steroids, and mRNA for GRα, GRβ and 11βHSD1 in TB pleurisy. Tuberculosis (Edinb) 2013; 93:635-41. [PMID: 23988280 DOI: 10.1016/j.tube.2013.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/12/2013] [Accepted: 07/30/2013] [Indexed: 12/25/2022]
Abstract
Our previous work on the immune-endocrine features of patients with pulmonary tuberculosis (TB) showed markedly decreased plasma levels of dehydroepiandrosterone (DHEA) together with augmented concentrations of Cortisol and pro- and anti-inflammatory cytokines. Studies in peripheral blood mononuclear cells (PBMC) indicated a lower mRNA α/β ratio of glucocorticoid receptors -GR- together with a higher 11β-hydroxysteroid dehydrogenase type 1 (11βHSD1) mRNA expression in cases with severe pulmonary TB. Since Pleural TB (PLTB) is a rather benign manifestation of TB, we now analyzed the systemic and local immune-endocrine profile as well as the GRα, GRβ, 11βHSD1 and 11βHSD2 transcripts in PBMC and pleural effusion mononuclear cells (PEMC) of patients with PLTB. PLTB patients had increased levels of IL-1β, IL-6 and IFNγ together with reduced Cortisol and DHEA concentrations in pleural fluids. Also, a significantly increased expression of 11βHSD1 and GRα was found in PEMC compared to PBMC. Findings point out to an appropriate immune response and a substantial inflammatory reaction, wherein the low Cortisol concentrations may be equally effective, because of the increased expression of GRα and 11βHSD1 transcripts which may optimize the immunomodulatory properties of Cortisol.
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Affiliation(s)
- Luciano D'Attilio
- Institute of Immunology, School of Medical Sciences, National University of Rosario, Santa Fe 3100, CUAS IV 2° Flor, Rosario 2000, Argentina.
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Khan FY, Hamza M, Omran AH, Saleh M, Lingawi M, Alnaqdy A, Rahman MOA, Ahmedullah HS, Hamza A, Ani AA, Errayes M, Almaslamani M, Mahmood AA. Diagnostic value of pleural fluid interferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar. Int J Gen Med 2013; 6:13-8. [PMID: 23378780 PMCID: PMC3553648 DOI: 10.2147/ijgm.s39345] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the diagnostic utility of interferon-gamma (IFN-γ) and adenosine deaminase (ADA) in tuberculous pleural effusions by determining the best cutoff levels of these two markers for pleural tuberculosis, in the context of the local epidemiological settings in Qatar. Methods We prospectively studied IFN-γ and ADA levels in the pleural fluid of patients presenting to Hamad General Hospital between June 1, 2009 and May 31, 2010. Results We studied 103 patients with pleural effusions, 72 (69.9%) with pleural tuberculosis, and 31 (30.1%) with nontuberculous etiologies. The mean IFN-γ concentration for the group with tuberculous effusions was significantly higher than that in the group with nontuberculous effusions (1.98 ± 81 vs 0.26 ± 10 pg/mL [P < 0.0001]). The mean ADA activity for the tuberculous effusions group was significantly higher than that in group with nontuberculous effusions (41.30 ± 20.09 vs 14.93 ± 14.87 U/L [P < 0.0001]). By analysis of receiver operating characteristic (ROC) curves, the best cutoff values for IFN-γ and ADA were 0.5 pg/mL and 16.65 U/L, respectively. The results for IFN-γ vs ADA were: for sensitivity, 100% vs 86%, respectively; for specificity, 100% vs 74%, respectively; for positive predictive value, 100% vs 88.5%, respectively; and for negative predictive value, 100% vs 69.7%, respectively. Conclusion IFN-γ and ADA could be used as valuable parameters for the differentiation of tuberculous from nontuberculous effusion, and IFN-γ was more sensitive and specific for tuberculous effusion than ADA.
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Eldin EN, Omar A, Khairy M, Mekawy AHM, Ghanem MK. Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusion. Ann Thorac Med 2012. [PMID: 23189099 PMCID: PMC3506102 DOI: 10.4103/1817-1737.102181] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Noninvasive diagnosis of pleural tuberculosis (TB) remains a challenge due to the paucibacillary nature of the disease. As Mycobacterium tuberculosis (MTB)-specific T cells are recruited into pleural space in TB effusion; their indirect detection may provide useful clinical information. OBJECTIVES: Evaluation of pleural fluid interferon (INF)-γ levels vs Quantiferon–TB Gold In tube assay (QFT- IT) in blood and its adapted variants, using pleural fluid or isolated pleural fluid cells in the diagnosis of pleural TB. METHODS: Thirty-eight patients with pleural effusion of unknown etiology presented at Assiut University Hospital, Egypt, were recruited. Blood and pleural fluid were collected at presentation for INF-γ assays. Ex vivo pleural fluid INF-γ levels, QFT-IT in blood and its adapted variants were compared with final diagnosis as confirmed by other tools including blind and/or thoracoscopic pleural biopsy. RESULTS: The final clinical diagnosis was TB in 20 (53%), malignancy in 10 (26%), and effusion due to other causes in eight patients (21%). Ex vivo pleural fluid INF-γ levels accurately identified TB in all patients and were superior to the QFT-IT assays using blood or pleural fluid (70 and 78% sensitivity, with 60 and 83% specificity, respectively). QFT-IT assay applied to isolated pleural fluid cells had 100% sensitivity and 72% specificity. The optimal cut-off obtained with ROC analysis was 0.73 for TB Gold assay in blood assay, 0.82 IU/ml for the cultured pleural fluid assay, and 0.94 for isolated pleural cells assay. CONCLUSION: The ex vivo pleural fluid INF-γ level is an accurate marker for the diagnosis of pleural TB. QFT- IT assay in peripheral blood or its adapted versions of the assay using pleural fluid and/or washed pleural fluid cells had no diagnostic advantage over pleural fluid INF-γ in the diagnosis of pleural TB.
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Affiliation(s)
- Eman N Eldin
- Department of Clinical Pathology, Assiut University Hospital, Egypt
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23
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Shouman W, El-Gammal M, Shaker A, El-Shoura A, Marei A, El-Ahmady M, Boghdadi G. ESAT-6-ELISpot and interferon γ in the diagnosis of pleural tuberculosis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2012. [DOI: 10.1016/j.ejcdt.2012.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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CXCL12 as a biological marker for the diagnosis of tuberculous pleurisy. Tuberculosis (Edinb) 2012; 92:248-52. [DOI: 10.1016/j.tube.2012.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 12/21/2011] [Accepted: 01/05/2012] [Indexed: 11/17/2022]
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Talwar S, Agarwala S, Mittal CM, Choudhary SK, Airan B. Pleural effusions in children undergoing cardiac surgery. Ann Pediatr Cardiol 2011; 3:58-64. [PMID: 20814477 PMCID: PMC2921519 DOI: 10.4103/0974-2069.64368] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Persistent pleural effusions are a source of significant morbidity and mortality following surgery in congenital heart disease. In this review, we discuss the etiology, pathophysiology, and management of this common complication.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Center and Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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26
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Liu YC, Shin-Jung Lee S, Chen YS, Tu HZ, Chen BC, Huang TS. Differential diagnosis of tuberculous and malignant pleurisy using pleural fluid adenosine deaminase and interferon gamma in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 44:88-94. [DOI: 10.1016/j.jmii.2010.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 04/22/2010] [Indexed: 10/18/2022]
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McGrath EE, Warriner D, Anderson PB. Pleural fluid characteristics of tuberculous pleural effusions. Heart Lung 2010; 39:540-3. [PMID: 20561884 DOI: 10.1016/j.hrtlng.2009.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 11/03/2009] [Accepted: 12/10/2009] [Indexed: 11/17/2022]
Abstract
Mycobacterium tuberculosis (TB) infection of the pleural space is an important cause of pleural effusion in areas of high TB prevalence. Microbiological analyses of pleural fluid in the acute setting may be negative. Consequently, investigations may proceed to more invasive techniques, such as pleural biopsy or thoracoscopy. Ongoing research has led to implementing a number of additional fluid analyses that may lead to a diagnosis without a need for further invasive procedures. In this review, we discuss the characteristics of tuberculous pleural fluid that may assist in this important diagnosis, and we highlight the benefits of specific biomarker analyses. English-language publications from a MEDLINE search and references from relevant articles from January 1, 1990 to September 1, 2009 were reviewed. The key words searched included tuberculosis, pleural fluid, effusion, diagnosis, adenosine deaminase, and interferon.
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Affiliation(s)
- Emmet E McGrath
- Department of Respiratory Medicine, Northern General Hospital, Sheffield, United Kingdom.
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Moreno-Pérez D, Andrés Martín A, Altet Gómez N, Baquero-Artigao F, Escribano Montaner A, Gómez-Pastrana Durán D, González Montero R, Mellado Peña MJ, Rodrigo-Gonzalo-de-Liria C, Ruiz Serrano MJ. [Diagnosis of tuberculosis in pediatrics. Consensus document of the Spanish Society of Pediatric Infectology (SEIP) and the Spanish Society of Pediatric Pneumology (SENP)]. An Pediatr (Barc) 2010; 73:143.e1-143.14. [PMID: 20335081 DOI: 10.1016/j.anpedi.2009.12.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 12/14/2009] [Indexed: 11/19/2022] Open
Abstract
Tuberculosis is one of the most important health problems worldwide. There are an increased number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration coming from high endemic areas. Measures to optimize early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Pediatric Association (Spanish Society of Pediatric Infectology and Spanish Society of Pediatric Pneumology) have agreed this Consensus Document in order to homogenize diagnostic criteria in pediatric patients.
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Affiliation(s)
- D Moreno-Pérez
- Hospital Materno-Infantil Carlos Haya, Universidad de Málaga, España.
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Fujimoto N, Gemba K, Asano M, Wada S, Ono K, Ozaki S, Kishimoto T. Soluble mesothelin-related protein in pleural effusion from patients with malignant pleural mesothelioma. Exp Ther Med 2010; 1:313-317. [PMID: 22993544 DOI: 10.3892/etm_00000048] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 12/08/2009] [Indexed: 12/12/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a highly aggressive neoplasm primarily arising from surface serosal cells of the pleura and is strongly associated with asbestos exposure. Patients with MPM often develop pleural fluid as initial presentation. However, cytological diagnosis using pleural fluid is usually difficult and has limited utility. A useful molecular marker for differential diagnosis particularly with lung cancer (LC) is urgently needed. The aim of the present study was to investigate the diagnostic value of soluble mesothelin-related protein (SMRP) in pleural fluid. Pleural fluids were collected from 23 patients with MPM, 38 with LC, 26 with benign asbestos pleurisy (BAP), 5 with tuberculosis pleurisy (TP) and 4 with chronic heart failure (CHF), and the SMRP concentration was determined. All data were analyzed by using non-parametric two-sided statistical tests. The median concentration of SMRP in MPM, LC, BAP, TP and CHF were 11.5 (range 0.90-82.80), 5.20 (0.05-36.40), 6.65 (1.45-11.25), 3.20 (1.65-6.50) and 2.03 (1.35-2.80) nmol/l, respectively. The SMRP concentration was significantly higher in MPM than in the other diseases (P=0.001). The area under the ROC curve (AUC) values of the MPM diagnosis was 0.75 for the differential diagnosis from the other groups. Based on the cut-off value of 8 nmol/l, the sensitivity and specificity for diagnosis of MPM were 70.0 and 68.4%, respectively. These results indicate that the SMRP concentration in pleural fluid is a useful marker for the diagnosis of MPM.
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Affiliation(s)
- Nobukazu Fujimoto
- Department of Respiratory Medicine, Okayama Rosai Hospital, Okayama 7028055, Japan
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Kobashi Y, Shimizu H, Mouri K, Obase Y, Miyashita N, Oka M. Rapid diagnosis of tuberculous pleuritis by a T-cell interferon-γ release assay. ACTA ACUST UNITED AC 2009; 41:232-6. [DOI: 10.1080/00365540802635197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Seiscento M, Vargas FS, Rujula MJP, Bombarda S, Uip DE, Galesi VMN. Aspectos epidemiológicos da tuberculose pleural no estado de São Paulo (1998-2005). J Bras Pneumol 2009; 35:548-54. [DOI: 10.1590/s1806-37132009000600008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 04/01/2009] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar as características epidemiológicas e tendências quanto à incidência de TB pleural. MÉTODOS: Estudo descritivo, retrospectivo dos casos de TB reportados entre 1998 e 2005 e coletados do banco de dados do Sistema de Notificação de Tuberculose (Epi-TB) da Secretaria de Saúde do Estado de São Paulo. RESULTADOS: Foram notificados 144.347 casos novos de TB durante o período estudado. A forma pulmonar foi predominante (118.575 casos; 82,2%). Das formas extrapulmonares (25.773 casos; 17,8%), a pleural foi a mais referida (12.545 casos; 48,7%). A incidência (por 100.000 habitantes) de todas as formas diminuiu, (49,7 em 1998 e 44,6 em 2005; R² = 0,898; p < 0,001), enquanto a incidência de TB pleural permaneceu estável (4,1 em 1998 e 3,8 em 2005; R² = 0,433; p = 0,076). A maior incidência de TB pleural ocorreu em pacientes do sexo masculino (2:1) entre 30 e 59 anos de idade. Dos 12.545 pacientes com TB pleural, 4.018 (32,0%) apresentaram comorbidades: alcoolismo (9,5%); HIV (8,0%); diabetes (3,3%); e doença mental (1,2%). O diagnóstico referido fundamentou-se em métodos bacteriológicos (14,2%) e histológicos (30,2%), assim como outros não especificados (55,6%). CONCLUSÕES: No estado de São Paulo, a TB pleural foi a forma extrapulmonar predominante, apresentando incidência estável no período entre 1998 e 2005, apesar da tendência de diminuição das formas pulmonares. A histologia e a bacteriologia definiram o diagnóstico em 44,4% dos casos.
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Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: a meta-analysis. Respir Med 2008; 102:744-54. [PMID: 18222681 DOI: 10.1016/j.rmed.2007.12.007] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 11/16/2007] [Accepted: 12/13/2007] [Indexed: 12/20/2022]
Abstract
BACKGROUND Conventional tests are not always helpful in making a diagnosis of tuberculous pleurisy. Many studies have investigated the usefulness of adenosine deaminase (ADA) in pleural fluid for the early diagnosis of tuberculous pleurisy. We conducted a meta-analysis to determine the accuracy of ADA measurements in the diagnosis of tuberculous pleurisy. METHODS After a systematic review of English language studies, sensitivity, specificity, and other measures of accuracy of ADA concentration in the diagnosis of pleural effusion were pooled using random effects models. Summary receiver operating characteristic curves were used to summarize overall test performance. RESULTS Sixty-three studies met our inclusion criteria. The summary estimates for ADA in the diagnosis of tuberculous pleurisy in the studies included were sensitivity 0.92 (95% confidence interval 0.90-0.93), specificity 0.90 (95% confidence interval 0.89-0.91), positive likelihood ratio 9.03 (95% confidence interval 7.19-11.35), negative likelihood ratio 0.10 (95% confidence interval 0.07-0.14), and diagnostic odds ratio 110.08 (95% confidence interval 69.96-173.20). CONCLUSIONS ADA determination is a relative sensitive and specific test for the diagnosis of tuberculous pleurisy. Measurement of ADA in pleural effusion is thus likely to be a useful diagnostic tool for tuberculous pleurisy. The results of ADA assays should be interpreted in parallel with clinical findings and the results of conventional tests.
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Chegou NN, Walzl G, Bolliger CT, Diacon AH, van den Heuvel MM. Evaluation of Adapted Whole-Blood Interferon-γ Release Assays for the Diagnosis of Pleural Tuberculosis. Respiration 2008; 76:131-8. [DOI: 10.1159/000128575] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Accepted: 01/23/2008] [Indexed: 11/19/2022] Open
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Chan MC, Chang KM, Chao WC, Lin LY, Kuo BIT, Hsu JY, Wu CL. Evaluation of a new inflammatory molecule (triggering receptor expressed on myeloid cells-1) in the diagnosis of pleural effusion. Respirology 2007; 12:333-8. [PMID: 17539835 DOI: 10.1111/j.1440-1843.2007.01056.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The triggering receptor expressed on myeloid cell-1 (TREM-1) is a newly discovered molecule that is associated with the inflammatory response to microorganisms. We investigated the role of surface and soluble TREM-1 in differentiating different disease entities in pleural effusion formation. METHODS Sixty-seven patients with pleural effusion due to transudate (14), malignancy (15), tuberculous pleuritis (16), para-pneumonic effusion (10) and empyaema (12) were included in this study. Surface TREM-1 was measured by flow cytometry and was expressed as mean fluorescence intensity and soluble TREM-1 was measured by ELISA and expressed as pg/mL. Results are given as mean levels +/- SEM. RESULTS Surface TREM-1 was measured in 24 patients and the levels were highest in para-pneumonic effusion (30.0 +/- 8.4) and lowest in malignant pleural effusion (5.2 +/- 1.1) and tuberculous pleuritis (5.2 +/- 2.4). Soluble TREM-1 was highest in effusions of infectious aetiology (para-pneumonic effusion (979.4 +/- 229.6) and empyaema (1712.6 +/- 299.5)) and lowest in non-infectious effusions (transudate (81.2 +/- 4.5 pg/mL) and malignancy (111.3 +/- 20.7). At a cut-off value of 114 pg/mL, soluble TREM-1 yielded a sensitivity of 87.5% and a specificity of 89.7% in differentiating non-infectious effusion from tuberculous pleuritis. At a cut-off value of 374 pg/mL, sTREM-1 yielded a sensitivity of 93.8% and a specificity of 90.9 in differentiating tuberculous pleuritis from bacterial pleural effusion. CONCLUSION Soluble and surface TREM-1 are valuable markers in establishing the aetiology of pleural effusions.
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Affiliation(s)
- Ming-Cheng Chan
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, and Central Taiwan University of Science and Technology, Taipei, Taiwan
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Gopi A, Madhavan SM, Sharma SK, Sahn SA. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest 2007; 131:880-889. [PMID: 17356108 DOI: 10.1378/chest.06-2063] [Citation(s) in RCA: 257] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Tuberculous (TB) pleural effusion occurs in approximately 5% of patients with Mycobacterium tuberculosis infection. The HIV pandemic has been associated with a doubling of the incidence of extrapulmonary TB, which has resulted in increased recognition of TB pleural effusions even in developed nations. Recent studies have provided insights into the immunopathogenesis of pleural TB, including memory T-cell homing and chemokine activation. The definitive diagnosis of TB pleural effusions depends on the demonstration of acid-fast bacilli in the sputum, pleural fluid, or pleural biopsy specimens. The diagnosis can be established in a majority of patients from the clinical features, pleural fluid examination, including cytology, biochemistry, and bacteriology, and pleural biopsy. Measurement of adenosine deaminase and interferon-gamma in the pleural fluid and polymerase chain reaction for M tuberculosis has gained wide acceptance in the diagnosis of TB pleural effusions. Although promising, these tests require further evaluation before their routine use can be recommended. The treatment of TB pleural effusions in patients with HIV/AIDS is essentially similar to that in HIV-negative patients. At present, evidence regarding the use of corticosteroids in the treatment of TB pleural effusion is not clear-cut.
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Affiliation(s)
- Arun Gopi
- The Division of Pulmonary and Critical Care Medicine, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sethu M Madhavan
- The Division of Pulmonary and Critical Care Medicine, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surendra K Sharma
- The Division of Pulmonary and Critical Care Medicine, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Steven A Sahn
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC.
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Jiang J, Shi HZ, Liang QL, Qin SM, Qin XJ. Diagnostic Value of Interferon-γ in Tuberculous Pleurisy. Chest 2007; 131:1133-41. [PMID: 17426220 DOI: 10.1378/chest.06-2273] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Conventional tests are not always helpful in making a diagnosis of tuberculous pleurisy. Many studies have investigated the usefulness of interferon (IFN)-gamma measurements in pleural fluid for the early diagnosis of tuberculous pleurisy. We conducted a metaanalysis to determine the accuracy of IFN-gamma measurements in the diagnosis of tuberculous pleurisy. METHODS After a systematic review of English-language studies, sensitivity, specificity, and other measures of accuracy of IFN-gamma concentrations in the diagnosis of pleural effusion were pooled using random-effects models. Summary receiver operating characteristic curves were used to summarize overall test performance. RESULTS Twenty-two studies met our inclusion criteria. The summary estimates for IFN-gamma in the diagnosis of tuberculous pleurisy in the studies included were as follows: sensitivity, 0.89 (95% confidence interval [CI], 0.87 to 0.91); specificity, 0.97 (95% CI, 0.96 to 0.98); positive likelihood ratio, 23.45 (95% CI, 17.31 to 31.78); negative likelihood ratio, 0.11 (95% CI, 0.07 to 0.16); and diagnostic odds ratio, 272.7 (95% CI, 147.5 to 504.2). CONCLUSIONS IFN-gamma determination is a sensitive and specific test for the diagnosis of tuberculous pleurisy. The measurement of IFN-gamma levels in pleural effusions is thus likely to be a useful tool for diagnosing tuberculous pleurisy. The results of IFN-gamma assays should be interpreted in parallel with clinical findings and the results of conventional tests.
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Affiliation(s)
- Jing Jiang
- Institute of Respiratory Diseases, First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
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Katayama H, Hiraki A, Aoe K, Fujiwara K, Matsuo K, Maeda T, Murakami T, Toyooka S, Sugi K, Ueoka H, Tanimoto M. Aberrant promoter methylation in pleural fluid DNA for diagnosis of malignant pleural effusion. Int J Cancer 2007; 120:2191-5. [PMID: 17285579 DOI: 10.1002/ijc.22576] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Accumulating evidence implicates epigenetic changes such as hypermethylation in carcinogenesis. We investigated whether DNA methylation of 5 tumor suppressor genes in pleural fluid samples could aid in diagnosis of malignant effusion. In samples from 47 patients with malignant pleural effusions and 34 with nonmalignant effusions, we used a methylation-specific polymerase chain reaction to detect aberrant hypermethylation of the promoters of the DNA repair gene O(6)-methylguanine-DNA methyltransferase (MGMT), p16(INK4a), ras association domain family 1A (RASSF1A), apoptosis-related genes, death-associated protein kinase (DAPK), and retinoic acid receptor beta (RARbeta). Promoter hypermethylation was associated with malignant effusion for MGMT (Odds ratio (OR) = infinity), p16(INK4a) (OR = infinity), RASSF1A (OR = 13.8; CI, 1.71-112), and RARbeta (OR = 3.17; CI, 1.10-9.11), but not for DAPK. Instead, DAPK methylation was associated with the length of smoking (p < 0.05). Patients with hypermethylation of MGMT, p16(INK4a), RASSF1A or RARbeta were 5.68 times more likely to have malignant effusions than patients without methylation (p = 0.008). Methylations per patient were more numerous for lung cancer than nonmalignant pulmonary disease (0.915 vs. 0.206, p < 0.001). Sensitivity, specificity, and positive predictive value of methylation in one or more genes for diagnosis of malignant effusion were 59.6%, 79.4%, and 80.0% respectively. In conclusion, aberrant promoter methylation of tumor suppressor genes in pleural fluid DNA could be a valuable diagnostic marker for malignant pleural effusion.
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Affiliation(s)
- Hideki Katayama
- Department of Respiratory Medicine and Clinical Research, NHO Sanyo National Hospital, Respiratory Disease Center, 685 Higashi-Kiwa, Ube, Yamaguchi 755-0241, Japan
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Il versamento pleurico: aspetti eziologici, diagnostici e clinici. PNEUMOLOGIA INTERVENTISTICA 2007. [PMCID: PMC7121191 DOI: 10.1007/978-88-470-0556-3_45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Il coinvolgimento della pleura puÒ comparire nel corso di molteplici e differenti patologie. Le cause che sottendono un versamento pleurico possono essere intra-toraciche o sistemiche e, se in alcuni casi queste appaiono facilmente individuabili grazie a segni clinici patognomonici, in altri casi l’inquadramento nosografico di un versamento puÒ risultare complesso, dovendosi basare su elementi clinici e reperti laboratoristico-strumentali spesso aspecifici.
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Kim SH, Park JY, Park HS, Seo HS, Kim ST, Kim CW, Lee BG, Lee SJ, Lee SN, Noh JK, Lee MS, Lee WY, Yong SJ, Shin KC. Diagnostic Value of Procalcitonin and C-Reactive Protein in Differentiation of Pleural Effusions. Tuberc Respir Dis (Seoul) 2007. [DOI: 10.4046/trd.2007.63.4.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joo Young Park
- Department of Microbiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Sook Park
- Department of Microbiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hee Seok Seo
- Department of Microbiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Shin Tae Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chong Whan Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Bu Ghil Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Shun Nyung Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Kyu Noh
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Su Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Won Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Suk Joong Yong
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kye Chul Shin
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Chen HJ, Hsu WH, Tu CY, Yu YH, Chiu KL, Hang LW, Hsia TC, Shih CM. Sonographic septation in lymphocyte-rich exudative pleural effusions: a useful diagnostic predictor for tuberculosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:857-63. [PMID: 16798896 DOI: 10.7863/jum.2006.25.7.857] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the role of the sonographic features of lymphocyte-rich exudative pleural effusions in the differential diagnosis of tuberculosis and lung cancer in an area with a high incidence of tuberculosis. METHODS Medical records of patients undergoing chest sonography between January 2003 and June 2005 (30 months) were reviewed retrospectively. The enrolled patients included 73 with lung cancer-related pleural effusions and 93 with tuberculous pleural effusions. The sonographic appearances of the pleural effusions were defined in terms of 4 patterns: anechoic, homogeneously echogenic, complex septated, and complex nonseptated. RESULTS Among the 73 lung cancer-related pleural effusions, there were sonographic appearances of an anechoic pattern in 11% (8/73), a complex septated pattern in 4% (3/73), and a complex nonseptated pattern in 85% (62/73). In 93 tuberculous pleural effusions, there were sonographic appearances of an anechoic pattern in 12% (11/93), a complex septated pattern in 47% (44/93), and a complex non-septated pattern in 41% (38/93). Apparently, a complex septated pattern in the sonographic appearance of lymphocyte-rich pleural effusions is a useful diagnostic predictor for differentiating tuberculosis from lung cancer (95% confidence interval, -0.57 to -0.29). If we define the complex septated pattern in the sonographic appearance of lymphocyte-rich exudative pleural effusions as a predictor for tuberculous pleural effusions, we can achieve sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio values of 47%, 96%, 94%, 59%, and 12, respectively. CONCLUSIONS A complex septated pattern in the sonographic appearance is a useful predictor of tuberculosis in lymphocyte-rich exudative pleural effusions.
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Affiliation(s)
- Hung-Jen Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
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Juan RS, Sánchez-Suárez C, Rebollo MJ, Folgueira D, Palenque E, Ortuño B, Lumbreras C, Aguado JM. Interferon γ quantification in cerebrospinal fluid compared with PCR for the diagnosis of tuberculous meningitis. J Neurol 2006; 253:1323-30. [PMID: 16786212 DOI: 10.1007/s00415-006-0215-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the utility of interferon gamma (INF-gamma) levels in cerebrospinal fluid (CSF), for the diagnosis of tuberculous meningitis (TBM), and compare these results with aPCR technique. METHODS We studied CSF samples from patients with proven or probable TBM and a control group, composed by patients with other causes of meningitis and without meningitis. INFgamma levels were measured by radioimmunoassay. A PCR technique was performed using IS6110 primers. RESULTS Of the 127 patients studied, 20 (15.6%) had TBM, 59 (46%) had meningitis of another aetiology and 49 (38.4%) had were HIV and non-HIV patients with normal CSF. The area below the ROC curve for interferon gamma levels in the diagnosis of TBM was 0.94. A cut-off of 6.4 IU/mL yielded a sensitivity of 70% and a specificity of 94%. False positive results were observed in 7 of the 59 patients (11.8%) with non-TB meningitis, (patients with herpetic meningoencephalitis and meningitis due to intracellular microorganisms). INF-gamma sensitivity was higher than PCR (70% vs. 65%). Both tests performed together showed higher sensitivity (80%) and specificity (92.6%). CONCLUSION CSF INF-gamma levels (> 6.4 IU/mL) are very valuable in TBM diagnosis. PCR and INF-gamma could be simultaneously used to increase the diagnostic yield.
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MESH Headings
- Adolescent
- Adult
- Aged
- Area Under Curve
- Diagnosis, Differential
- False Positive Reactions
- Female
- Humans
- Interferon-gamma/cerebrospinal fluid
- Interferon-gamma/genetics
- Male
- Meningitis, Aseptic/cerebrospinal fluid
- Meningitis, Bacterial/cerebrospinal fluid
- Meningitis, Bacterial/genetics
- Meningitis, Bacterial/microbiology
- Meningitis, Viral/cerebrospinal fluid
- Meningitis, Viral/genetics
- Meningitis, Viral/virology
- Middle Aged
- Mycobacterium tuberculosis/growth & development
- Prospective Studies
- ROC Curve
- Radioimmunoassay
- Reproducibility of Results
- Reverse Transcriptase Polymerase Chain Reaction
- Tuberculosis, Meningeal/cerebrospinal fluid
- Tuberculosis, Meningeal/diagnosis
- Tuberculosis, Meningeal/genetics
- Tuberculosis, Meningeal/microbiology
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Affiliation(s)
- Rafael San Juan
- Infectious Diseases Unit, Hospital General Universitario "Doce de Octubre", Carretera de Andalucía Km. 5.4., 28041, Madrid, Spain.
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Attallah AM, Osman S, Saad A, Omran M, Ismail H, Ibrahim G, Abo-Naglla A. Application of a circulating antigen detection immunoassay for laboratory diagnosis of extra-pulmonary and pulmonary tuberculosis. Clin Chim Acta 2005; 356:58-66. [PMID: 15936303 DOI: 10.1016/j.cccn.2004.11.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 11/29/2004] [Accepted: 11/29/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diagnosis of extra-pulmonary tuberculosis is often difficult to establish using standard methods. Recently, a 55-kDa mycobacterial antigen was identified in sera of individuals with pulmonary TB using a simple and rapid dot-ELISA based on monoclonal antibody (TB-55 mAb). Here, we have evaluated the application of the dot-ELISA for the detection of target antigen in sera of individuals with extra-pulmonary TB. METHODS The Western blot and indirect immunoperoxidase staining was used to identify the target TB antigen using the TB-55 mAb. The dot-ELISA was used to detect the target antigen in serum samples. RESULTS The target antigen was identified at 55-kDa molecular weight in serum, ascitic fluid and CSF samples from individuals with extra-pulmonary TB. The purified antigen from these samples showed similar biochemical properties to the previously described antigen. The target antigen was localized in areas without caseous necrosis in lymph tissues. The dot-ELISA detected the target antigen in 90% sera of individuals with extra-pulmonary TB and in 87% sera of individuals with pulmonary TB with a specificity of 97% among control individuals. CONCLUSION The detection of the 55-kDa antigen using dot-ELISA can be routinely employed to support clinical diagnosis of extra-pulmonary TB and pulmonary TB.
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Affiliation(s)
- Abdelfattah M Attallah
- R&D Department, Biotechnology Research Center, P.O. Box 14, 23 July St., Industrial Zone, 34517 New Damietta City, Egypt.
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