Pleural fluid tumor necrosis factor for diagnosis of pleural tuberculosis: A systematic review and meta-analysis

Interleukin-6 and -27 as potential novel biomarkers for human pleural tuberculosis regardless of the immunological status

Tuberculosis (TB) is the leading cause of pleural exudative effusions. Inflammatory markers, such as IFNγ and ADA, have been used as proxies for its diagnosis. We evaluated ex vivo levels of several cytokines in 83 pleural effusion specimens from patients with TB (including 10 with HIV co-infection) and 26 patients with other pleuritis using multiplex and ELISA assays. IL-6 and IL-27 levels were higher (p ≤ 0.04) in TB patients, regardless of the HIV status and the approach. IL-2, IL-4, IL-8, IFNγ, TNF and G-CSF showed variable results depending on the assay. This warranty these markers to be further validated.

Diagnostic value of soluble biomarkers for parapneumonic pleural effusion

Parapneumonic pleural effusion (PPE) is a common complication in patients with pneumonia. Timely and accurate diagnosis of PPE is of great value for its management. Measurement of biomarkers in circulating and pleural fluid have the advantages of easy accessibility, short turn-around time, objectiveness and low cost and thus have utility for PPE diagnosis and stratification. To date, many biomarkers have been reported to be of value for the management of PPE. Here, we review the values of pleural fluid and circulating biomarkers for the diagnosis and stratification PPE. The biomarkers discussed are C-reactive protein, procalcitonin, presepsin, soluble triggering receptor expressed on myeloid cells 1, lipopolysaccharide-binding protein, inflammatory markers, serum amyloid A, soluble urokinase plasminogen activator receptor, matrix metalloproteinases, pentraxin-3 and cell-free DNA. We found that none of the available biomarkers has adequate performance for diagnosing and stratifying PPE. Therefore, further work is needed to identify and validate novel biomarkers, and their combinations, for the management of PPE.

The Diagnostic Value of Medical Thoracoscopy Pleural Biopsy, Ultrasound-guided Pleural Biopsy, and Closed Pleural Biopsy in Tuberculous Pleurisy: A propensity score matching analysis.. [DOI: 10.21203/rs.3.rs-2099835/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background and objective For diagnosis of exudative pleural effusion in tuberculous pleurisy, medical thoracoscopic pleural biopsy (MTPB) enables direct vision and is most widely applied, although ultrasound-guided pleural biopsy (USPB) and closed pleural biopsy (CPB) are also viable. This retrospective study compared the diagnostic efficiencies and safety of USPB, CPB, and MTPB. Methods Patients enrolled from 2014 through 2020 underwent USPB, CPB, or MTPB (n = 69, 69, and 110, respectively). Propensity score matching (PSM) analysis was used to compare the diagnostic sensitivities of CPB, MTPB, and USPB. The secondary outcomes were postoperative complications and hospitalization stay. Results PSM analysis resulted in 40 (USPB vs. CPB), 47 (USPB vs. MTPB), and 52 (CPB vs. MTPB) matched pairs. The diagnostic sensitivities of the USPB and CPB groups were 72.5% and 55.0% (P = 0.162); that of USPB and MTPB were 70.2% and 80.9% (P = 0.337); the CPB and MTPB groups were comparable(P = 0.152). The rates of associated pain and subcutaneous emphysema of the MTPB group were higher than that of the USPB or CPB (P = 0.000, both).Hospitalization time of the MTPB group was longest, and significantly longer than that of the USPB (P = 0.029). Conclusions While the three techniques were similarly effective in diagnosing tuberculous pleurisy, USPB and CPB showed fewer associated complications and shorter hospital stays compared with MTPB. The image guidance offered by USPB benefited reduction in postoperative complications.

Insight into diagnosis of pleural tuberculosis with special focus on nucleic acid amplification tests

INTRODUCTION

Pleural tuberculosis (TB) is the archetype of extrapulmonary TB (EPTB), which mainly affects the pleural space and leads to exudative pleural effusion. Diagnosis of pleural TB is a difficult task predominantly due to atypical clinical presentations and sparse bacillary load in clinical specimens.

AREA COVERED

We reviewed the current literature on the globally existing conventional/latest modalities for diagnosing pleural TB. Bacteriological examination (smear/culture), tuberculin skin testing/interferon-γ release assays, biochemical testing, imaging and histopathological/cytological examination are the main modalities. Moreover, nucleic acid amplification tests (NAATs), i.e. loop-mediated isothermal amplification, PCR/multiplex-PCR, nested-PCR, real-time PCR and GeneXpert® MTB/RIF are being utilized. Currently, GeneXpert Ultra, Truenat MTB^TM, detection of circulating Mycobacterium tuberculosis (Mtb) cell-free DNA by NAATs, aptamer-linked immobilized sorbent assay and immuno-PCR (I-PCR) have also been exploited.

EXPERT OPINION

Routine tests are not adequate for effective pleural TB diagnosis. The latest molecular/immunological tests as discussed above, and the other tools, i.e. real-time I-PCR/nanoparticle-based I-PCR and identification of Mtb biomarkers within urinary/serum extracellular vesicles being utilized for pulmonary TB and other EPTB types may also be exploited to diagnose pleural TB. Reliable diagnosis and early therapy would reduce the serious complications associated with pleural TB, i.e. TB empyema, pleural fibrosis, etc.

Diagnosis of tuberculous pleural effusions: A review

Tuberculous pleural effusion (TPE) is the second most common presentation of extrapulmonary tuberculosis. The paucibacillary nature of the effusion poses diagnostic challenges. Biomarkers like adenosine deaminase and interferon-γ have some utility for diagnosing TPEs, as do cartridge-based polymerase chain reaction (PCR) methods. When these fluid studies remain indeterminate, pleural biopsies must be performed to confirm the diagnosis. This review article elaborates on the scientific evidence available for various diagnostic tests and presents a practical approach to the diagnosis of TPEs.