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Wen XH, Han YL, Cao XS, Zhao W, Yan Z, Yan L, Wen JX, Hu ZD, Zheng WQ. Diagnostic value of nucleic acid amplification tests for tuberculous pleural effusion. Future Microbiol 2023; 18:971-983. [PMID: 37702019 DOI: 10.2217/fmb-2023-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Diagnosing tuberculous pleural effusion (TPE) is challenging for pulmonologists and laboratory scientists. The gold standards for TPE diagnosis are pleural fluid Ziehl-Neelsen staining, Mycobacterium tuberculosis (Mtb) culture and pleural biopsy. These tools have limitations, including low sensitivity, long turnaround time and invasiveness. The nucleic acid amplification test (NAAT) is a rapid and minimally invasive tool for diagnosing TPE. This review summarizes the diagnostic accuracy of available NAATs for TPE, with a focus on the evidence from systematic reviews and meta-analyses. The NAATs summarized in this review include in-house NAATs, GeneXpert-MTB/RIF, GeneXpert-MTB/RIF Ultra, simultaneous amplification and testing-tuberculosis, FluoroType MTB and loop-mediated isothermal amplification.
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Affiliation(s)
- Xu-Hui Wen
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010, China
- Department of Parasitology, Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, 010050, China
| | - Yu-Ling Han
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010, China
- Department of Parasitology, Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, 010050, China
| | - Xi-Shan Cao
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010, China
| | - Wen Zhao
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010, China
| | - Zhi Yan
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010, China
- Department of Parasitology, Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, 010050, China
| | - Li Yan
- Department of Respiratory & Critical Care Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010, China
| | - Jian-Xun Wen
- Department of Medical Experiment Center, Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, 010050, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010, China
| | - Wen-Qi Zheng
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010, China
- Department of Parasitology, Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, 010050, China
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Binjomah AZ, Alnimr AM, Zareah SM, Alharbi SF, Alasmari KS, Aldosari KM, Alduealej IM. The diagnostic impact of implementing a molecular-based algorithm to standard mycobacterial screening at a reference laboratory with an intermediate prevalence for non-respiratory samples. Saudi J Biol Sci 2021; 28:4103-4108. [PMID: 34354388 PMCID: PMC8324989 DOI: 10.1016/j.sjbs.2021.05.080] [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: 03/17/2021] [Revised: 05/29/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022] Open
Abstract
Rapid, reliable results can be given by molecular, direct detection and identification of the Mycobacterium tuberculosis (MTB/Mtb) complex from clinical samples. The Xpert MTB/RIF assay is an assay that has been availablefor more than a decade for identification of Mycobacterium tuberculosis and resistance to rifampicin. However, there is minimal evidence on its clinical usefulness in paucibacillary, non-respiratory samples. The Xpert MTB/RIF assay clinical utility index, its diagnostic characteristics and the number required to diagnose 2935 non-respiratory specimens submitted for routine mycobacterial work-up in a reference laboratory in an intermediate prevalence setting per specimen form were evaluated. The Xpert MTB/RIF assay showed a variable clinical utility index and number required to diagnose (NND) depending on the type of specimen, which was moderate in tissue biopsies (NND = 1.8) and excellent in pus and urine samples, compared to acid-fast microscopy and culture as a gold standard technique (NND = 1.1 and 1.2). Microscopy, on the other hand, consistently showed a weak to fair index of clinical usefulness in all specimen forms, with in NND of 2.3-12.5. The NND for detecting tuberculous infection in the cerebrospinal fluid by the Xpert MTB/RIF assay was noted to be 1.2, with a moderate clinical utility index of 0.8. The evidence presented indicates that the overall appropriate diagnostic utility of the Xpert MTB/RIF assay is clinically successful in most non-respiratory samples. To check the cost-effectiveness and prognostic effect of integrating this completely automated molecular-based assay into the routine testing algorithm for non-respiratory mycobacterial specimens, further data must be collected.
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Affiliation(s)
- Abdulwahab Z. Binjomah
- Riyadh Regional Laboratory and Blood Bank, Mycobacteriology Reference Laboratory, Imam Abdulaziz Bin Mohammed Bin Saud Street, Ulaishah, 3485, Riyadh 12746, Saudi Arabia
- College of Medicine, Alfaisal University, Takhassusi Street, Riyadh 11533, Saudi Arabia
| | - Amani M. Alnimr
- Department of Microbiology, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, King Faisal Road, Dammam 34212, Saudi Arabia
| | - Suzan M. Zareah
- Riyadh Regional Laboratory and Blood Bank, Mycobacteriology Reference Laboratory, Imam Abdulaziz Bin Mohammed Bin Saud Street, Ulaishah, 3485, Riyadh 12746, Saudi Arabia
| | - Shafi F. Alharbi
- Riyadh Regional Laboratory and Blood Bank, Mycobacteriology Reference Laboratory, Imam Abdulaziz Bin Mohammed Bin Saud Street, Ulaishah, 3485, Riyadh 12746, Saudi Arabia
| | - Khalid S. Alasmari
- Riyadh Regional Laboratory and Blood Bank, Mycobacteriology Reference Laboratory, Imam Abdulaziz Bin Mohammed Bin Saud Street, Ulaishah, 3485, Riyadh 12746, Saudi Arabia
| | - Kamel M. Aldosari
- Riyadh Regional Laboratory and Blood Bank, Mycobacteriology Reference Laboratory, Imam Abdulaziz Bin Mohammed Bin Saud Street, Ulaishah, 3485, Riyadh 12746, Saudi Arabia
| | - Ibrahim M. Alduealej
- Riyadh Regional Laboratory and Blood Bank, Mycobacteriology Reference Laboratory, Imam Abdulaziz Bin Mohammed Bin Saud Street, Ulaishah, 3485, Riyadh 12746, Saudi Arabia
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Diagnostic value of Xpert MTB/RIF assay on pleural tissue obtained via closed pleural biopsy among persons with presumptive tuberculous pleuritis. Afr J Thorac Crit Care Med 2021; 27. [PMID: 34240047 PMCID: PMC8203088 DOI: 10.7196/ajtccm.2021.v27i1.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background
Tuberculous pleuritis (TBP) is a common extrapulmonary tuberculosis that contributes to the tuberculosis burden. Xpert
MTB/RIF assay is a promising method for rapid diagnosis of TBP. The diagnostic value of Xpert MTB/RIF assay in pleural tissue obtained
via closed pleural biopsy among sputum acid-fast bacilli (AFB) smear-negative persons is not well studied.
Objectives
To evaluate the diagnostic value of Xpert MTB/RIF assay on diagnosis of TB in pleural tissue obtained via blind closed
pleural biopsy.
Methods
Closed pleural biopsy using Cope needle was performed on adult patients who presented with lymphocyte predominant exudative
pleural effusion. Xpert MTB/RIF assay was performed in parallel to pathology and mycobacterial culture of the pleural tissue specimen
to determine its sensitivity and specificity. Final clinical diagnosis of TBP was determined by improvement in 2-months follow-up of
anti-tuberculous treatment.
Results
A total of 33 patients were included in the study. The median (interquartile range (IQR)) age was 27 (25 - 42) years. The sensitivity
and specificity of Xpert MTB/RIF assay was 30% and 100% compared with Mycobacterium tuberculosis culture as the gold standard, and
20% and 95.7% compared with histopathology as the gold standard.
Conclusion
Xpert MTB/RIF assay in pleural tissue obtained by closed pleural biopsy did not increase diagnostic yield, but it shortens time
for diagnosis compared with conventional methods.
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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: 31] [Impact Index Per Article: 6.2] [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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Li L, Wang Y, Zhang R, Liu D, Li Y, Zhou Y, Song J, Li W, Tian P. Diagnostic value of polymerase chain reaction/acid-fast bacilli in conjunction with computed tomography-guided pleural biopsy in tuberculous pleurisy: A diagnostic accuracy study. Medicine (Baltimore) 2019; 98:e15992. [PMID: 31335667 PMCID: PMC6709139 DOI: 10.1097/md.0000000000015992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Patients with tuberculous pleurisy often remain undiagnosed even after blind thoracentesis and closed pleural biopsy (PB). In this study, we assessed the value of computed tomography (CT)-guided core needle biopsy of pleural lesion and evaluated the diagnostic accuracy of polymerase chain reaction (PCR)/staining for acid-fast bacilli (AFB) in suspicious tuberculous pleurisy undiagnosed in blind thoracentesis.Patients with exudative pleural effusion (PE) without specific etiology after blind thoracentesis and closed PB were enrolled in this study. PB specimens were obtained through CT-guided core needle biopsy of pleural lesion, then underwent PCR, AFB, histopathological examination, and some routine tests. Diagnostic values were evaluated through sensitivity, specificity, negative predictive value, positive predictive value, and accuracy.A total of 261 participants (TB group: 241, non-TB group: 20) were recruited. In this cohort, the sensitivity, specificity, and accuracy were 56.0%, 95.0%, and 59.0%, respectively for PCR, whereas 57.3%, 95.0%, and 60.2%, respectively for AFB. Their parallel test achieved an improved sensitivity (76.8%) and accuracy (77.8%), with a slight decrease in specificity (90.0%). In histopathological examination, granuloma was the most common finding in TB group (88.4%, 213/241), but also observed in non-TB group (10.0%, 2/20). In addition, pleural lymphocyte percentage in TB group was significantly higher than that of non-TB group (92% vs 61%, respectively; P = .003). However, no significant differences were found for other biomarkers.CT-guided core needle PB is essential for patients with exudative PE but undiagnosed after blind thoracentesis. Combining with PCR and AFB, it strongly improves the diagnosis of tuberculous pleurisy.
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Affiliation(s)
- Lei Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Genetics, Stanford University School of Medicine, Stanford, CA
| | - Ye Wang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui Zhang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dan Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yalun Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yongzhao Zhou
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Juan Song
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Panwen Tian
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Kumari P, Lavania S, Tyagi S, Dhiman A, Rath D, Anthwal D, Gupta RK, Sharma N, Gadpayle AK, Taneja RS, Sharma L, Ahmad Y, Sharma TK, Haldar S, Tyagi JS. A novel aptamer-based test for the rapid and accurate diagnosis of pleural tuberculosis. Anal Biochem 2018; 564-565:80-87. [PMID: 30352198 DOI: 10.1016/j.ab.2018.10.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 12/30/2022]
Abstract
Pleural tuberculosis (pTB) is diagnosed by using a composite reference standard (CRS) since microbiological methods are grossly inadequate and an accurate diagnostic test remains an unmet need. The present study aimed to evaluate the utility of Mycobacterium tuberculosis (Mtb) antigen and DNA-based tests for pTB diagnosis. Patients were classified as 'Definite TB', 'Probable TB' and 'Non-TB' disease according to the CRS. We assessed the performance of in-house antigen detection assays, namely antibody-based Enzyme-Linked ImmunoSorbent Assay (ELISA) and aptamer-based Aptamer-Linked Immobilized Sorbent Assay (ALISA), targeting Mtb HspX protein and DNA-based tests namely, Xpert MTB/RIF and in-house devR-qPCR. ROC curves were generated for the combined group of 'Definite TB' and 'Probable TB' vs. 'Non-TB' disease group and cut-off values were derived to provide specificity of ≥98%. The sensitivity of ALISA was ∼93% vs. ∼24% of ELISA (p-value ≤0.0001). devR-qPCR exhibited a sensitivity of 50% vs. ∼22% of Xpert (p-value ≤0.01). This novel aptamer-based ALISA test surpasses the sensitivity criterion and matches the specificity requirement spelt out in the 'Target product profile' for extrapulmonary tuberculosis samples by Unitaid (Sensitivity ≥80%, Specificity 98%). The superior performance of the aptamer-based ALISA test indicates its translational potential to bridge the existing gap in pTB diagnosis.
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Affiliation(s)
- Pooja Kumari
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Surabhi Lavania
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Shaifali Tyagi
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India
| | - Abhijeet Dhiman
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India; Faculty of Pharmacy, Uttarakhand Technical University, Dehradun, Uttarakhand, India
| | - Deepak Rath
- Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Divya Anthwal
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India
| | - Rakesh Kumar Gupta
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India
| | - Neera Sharma
- Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - A K Gadpayle
- Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - R S Taneja
- Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Lokesh Sharma
- Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Yusra Ahmad
- Faculty of Pharmacy, Uttarakhand Technical University, Dehradun, Uttarakhand, India
| | - Tarun Kumar Sharma
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India; AptaBharat Innovation Pvt. Ltd., Translational Health Science and Technology Institute Incubator, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India.
| | - Sagarika Haldar
- Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India.
| | - Jaya Sivaswami Tyagi
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India; Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad, Gurgaon Expressway, PO box #04, Faridabad, 121001, India.
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Tyagi S, Sharma N, Tyagi JS, Haldar S. Challenges in pleural tuberculosis diagnosis: existing reference standards and nucleic acid tests. Future Microbiol 2017; 12:1201-1218. [PMID: 28972418 DOI: 10.2217/fmb-2017-0028] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pleural tuberculosis (pTB) is a grave form of extrapulmonary tuberculosis. Microbiological tests are usually found to be inadequate for pTB diagnosis. The absence of a uniform 'composite reference standard' is challenging; therefore, diagnosis is usually performed using a combination of diversified criteria. Nucleic acid tests vary in diagnostic accuracy and have not yet been integrated into clinical decision making. This review assesses the varied criteria used for pTB classification and the challenges afflicting pleural fluid-based DNA diagnostic tests, namely, PCR and Xpert® MTB/RIF. In the 58 studies (PCR: n = 33; Xpert: n = 25) analyzed, reference standards were heterogeneous and PCR/Xpert pooled sensitivity values (range: 0-100%) were inadequate. However, the consistent high specificity of Xpert (range: 90-100%) indicated its utility as a 'rule-in' test. There is an urgent need to evaluate existing and new molecular tests in well-designed studies to accurately assess their utility for pTB diagnosis. To conclude, rapid and accurate tests are warranted for pTB diagnosis.
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Affiliation(s)
- Shaifali Tyagi
- Center for Bio-design & Diagnostics, Translational Health Science & Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad - Gurgaon Expressway, PO Box No 04, Faridabad 121001, India
| | - Neera Sharma
- Department of Biochemistry, Dr RML Hospital, New Delhi 110001, India
| | - Jaya Sivaswami Tyagi
- Center for Bio-design & Diagnostics, Translational Health Science & Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad - Gurgaon Expressway, PO Box No 04, Faridabad 121001, India.,Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sagarika Haldar
- Center for Bio-design & Diagnostics, Translational Health Science & Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad - Gurgaon Expressway, PO Box No 04, Faridabad 121001, India
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Evaluation of different laboratory methods for rapid diagnosis of tuberculous pleurisy. Int J Mycobacteriol 2016; 5:437-445. [DOI: 10.1016/j.ijmyco.2016.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/21/2016] [Accepted: 07/03/2016] [Indexed: 11/17/2022] Open
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Abstract
Pleural effusion management is a common clinical situation associated with numerous pulmonary, pleural or extra-pulmonary diseases. A systematic approach is needed to enable a rapid diagnosis and an appropriate treatment. Pleural fluid analysis is the first step to perform which allows a presumptive diagnosis in most cases. Otherwise, further analysis of the pleural fluid or thoracic imaging or pleural biopsy may be necessary. This review aims at highlighting the important elements of the work-up required by a pleural effusion.
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Tadele A, Beyene D, Hussein J, Gemechu T, Birhanu A, Mustafa T, Tsegaye A, Aseffa A, Sviland L. Immunocytochemical detection of Mycobacterium Tuberculosis complex specific antigen, MPT64, improves diagnosis of tuberculous lymphadenitis and tuberculous pleuritis. BMC Infect Dis 2014; 14:585. [PMID: 25421972 PMCID: PMC4262190 DOI: 10.1186/s12879-014-0585-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 10/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A rapid, sensitive and accurate laboratory diagnosis is of prime importance in suspected extrapulmonary tuberculosis (EPTB) cases. However, traditional techniques for the detection of acid-fast bacilli have limitations. The aim of the study was to evaluate the diagnostic value of immunocytochemical staining for detection of Mycobacterium tuberculosis complex specific antigen, MPT64, in aspirates from pleural effusions and lymph nodes, the most common presentations of EPTB. METHOD A cross-sectional study was conducted by including patients at Tikur Anbessa Specialized Hospital and the United Vision Medical Services from December 2011 to June 2012. Lymph node aspirates and pleural fluid samples were collected and analyzed from a total of 51 cases (26 tuberculous (TB) pleuritis and 25 TB lymphadenitis) and 67 non-TB controls. Each specimen was subjected to Ziehl-Neelsen (ZN) staining, culture on Lowenstein- Jensen (LJ) medium, cytological examination, Polymerase Chain Reaction (PCR) using IS1081gene sequence as a primer and immunocytochemistry (ICC) with polyclonal anti-MPT64 antibody. All patients were screened for HIV. RESULT ICC was positive in 38 of 51 cases and in the 7 of 67 controls giving an overall sensitivity and specificity of 74.5% and 89.5%, respectively. Using IS1081-PCR as a reference method, the sensitivity and specificity, positive and negative predictive value of ICC was 88.1%, 89.5%, 82.2% and 93.2%, respectively. The case detection rate increased from 13.7% by ZN stain to 19.6% by LJ culture, to 66.7% by cytology and 74.5% by ICC. CONCLUSION Immunocytochemistry with anti-MPT64 antigen improved detection of TB in pleural effusion and lymph node aspirates. Further studies using monoclonal antibodies on samples from other sites of EPTB is recommended to validate this relatively simple diagnostic method for EPTB.
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Affiliation(s)
- Agerie Tadele
- />University of Gondar, Gondar, Ethiopia
- />Addis Ababa University, Addis Ababa, Ethiopia
- />Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Jemal Hussein
- />Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Tuffa Gemechu
- />Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
- />United Vision Medical Services, Addis Ababa, Ethiopia
| | | | - Tehmina Mustafa
- />Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- />Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Abraham Aseffa
- />Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Lisbet Sviland
- />Department of Pathology, Haukeland University Hospital, Bergen, Norway
- />Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Seo AN, Park HJ, Lee HS, Park JO, Chang HE, Nam KH, Choe G, Park KU. Performance characteristics of nested polymerase chain reaction vs real-time polymerase chain reaction methods for detecting Mycobacterium tuberculosis complex in paraffin-embedded human tissues. Am J Clin Pathol 2014; 142:384-90. [PMID: 25125630 DOI: 10.1309/ajcp2qzrh4znprdd] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Nucleic acid amplification tests on formalin-fixed, paraffin-embedded (FFPE) tissue specimens enable Mycobacterium tuberculosis complex (MTB) detection and rapid tuberculosis diagnosis in the absence of microbiologic culture tests. We aimed to evaluate the efficacy of different polymerase chain reaction (PCR) methods for detecting Mycobacterium species in FFPE tissues. METHODS We examined 110 FFPE specimens (56 nonmycobacterial cases, 32 MTB, and 22 nontuberculous mycobacteria [NTM] determined by acid-fast bacilli [AFB] culture) to assess five PCR methods: nested PCR (N-PCR) (Seeplex MTB Nested ACE Detection; Seegene, Seoul, South Korea), an in-house real-time PCR (RT-PCR) method, and three commercial RT-PCR methods (AccuPower MTB RT-PCR [Bioneer, Seoul, Korea], artus M tuberculosis TM PCR [Qiagen, Hilden, Germany], and AdvanSure tuberculosis/NTM RT-PCR [LG Life Sciences, Seoul, Korea]). RESULTS The results of N-PCR, in-house RT-PCR, and AdvanSure RT-PCR correlated well with AFB culture results (concordance rates, 94.3%, 87.5%, and 89.5%, respectively). The sensitivity of N-PCR (87.5%) was higher than that of the RT-PCR methods, although these differences were not statistically significant between N-PCR and the in-house and AdvanSure RT-PCR methods (68.8% and 80.0%, respectively). All the PCR methods had high specificities, ranging from 98.2% to 100%. Only two NTM cases were detected by AdvanSure RT-PCR, implying a very low sensitivity. CONCLUSIONS Well-designed RT-PCR and N-PCR can effectively identify MTB in FFPE specimens.
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Affiliation(s)
- An Na Seo
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Republic of Korea
- Department of Pathology, Kyungpook National University School of Medicine, Jung-gu, Daegu, Republic of Korea
| | - Hyo Jin Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Republic of Korea
| | - Jung Ok Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Republic of Korea
| | - Ho Eun Chang
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Republic of Korea
| | - Kyung Han Nam
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Republic of Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Republic of Korea
- Department of Pathology, Seoul National University College of Medicine, Jongnogu, Seoul, Republic of Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Republic of Korea
- Department of Laboratory Medicine, Seoul National University College of Medicine, Jongnogu, Seoul, Republic of Korea
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14
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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: 2.0] [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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15
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Gao Y, Ou Q, Huang F, Wang S, Shen L, Shen Y, Wu J, Zheng J, Weng X, Zhang W, Shao L. Improved diagnostic power by combined interferon-gamma release assay and nested-PCR in tuberculous pleurisy in high tuberculosis prevalence area. ACTA ACUST UNITED AC 2012; 66:393-8. [DOI: 10.1111/1574-695x.12006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/21/2012] [Accepted: 08/29/2012] [Indexed: 11/28/2022]
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16
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Dil-Afroze, Sharma D, Dhobi GN, Shah S, Eachkoti R, Hussain I, Shah ZA, Siddiqi MA. Evaluation of polymerase chain reaction for rapid diagnosis of clinically suspected tuberculous pleurisy. Indian J Clin Biochem 2012; 21:76-9. [PMID: 23105619 DOI: 10.1007/bf02912917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pleural effusion is one of the commonest presentations of tuberculosis, the clinical manifestations being typically abrupt resembling bacterial pneumonia. Since delayed hypersensitivity is the underlying immune response, bacterial load is very low. Owing to these facts, tuberculous pleurisy as an extra-pulmonary disease poses a diagnostic dilemma. The conventional bacteriological methods rarely detect Mycobacterium tuberculosis in pleural fluid and are of limited use in diagnosis of tuberculous pleurisy. We evaluated the efficacy of polymerase chain reaction (PCR) in the diagnosis of tuberculous pleurisy by targeting the gene segment coding for MPB64 protein specific forMycobacterium tuberculosis. Based on the clinical criteria, 82 patients with lymphocytic exudative pleural effusion were included in the study. Patients were analyzed in two groups; one group consisting of 48 patients of tubercular pleural effusion confimed by various diagnostic procedures and another group of 34 patients comprising of non-tubercular pleural effusion. There were no false positive results by PCR and the specificity worked out to be 100%. Twenty two patients tested positive for Mantoux with a sensitivity of 45%. ZN-staining for AFB was found in samples from 15 patients (20% sensitivity). ADA was positive for 28 patients with a sensitivity of 53%. PCR was positive for 32/48 patients (67% sensitivity). Thus, PCR was found to be more sensitive than any other conventional method in diagnosis of clinically suspected tubercular pleurisy.
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Affiliation(s)
- Dil-Afroze
- Department of Immunology & Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, J&K-190011 Soura, India
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17
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Balasingham SV, Davidsen T, Szpinda I, Frye SA, Tønjum T. Molecular Diagnostics in Tuberculosis. Mol Diagn Ther 2012; 13:137-51. [DOI: 10.1007/bf03256322] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Rapid molecular detection of extrapulmonary tuberculosis by the automated GeneXpert MTB/RIF system. J Clin Microbiol 2011; 49:1202-5. [PMID: 21270230 DOI: 10.1128/jcm.02268-10] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In total, 521 nonrespiratory specimens (91 urine, 30 gastric aspirate, 245 tissue, 113 pleural fluid, 19 cerebrospinal fluid [CSF], and 23 stool specimens) submitted to the German National Reference Laboratory for Mycobacteria (NRL) from May 2009 to August 2010 were comparatively investigated with the new molecular-based GeneXpert MTB/RIF (Xpert) assay system and conventional liquid and solid culture methods. Twenty (3.8%) of the 521 specimens gave no interpretable result. Whereas the sensitivity of the Xpert assay with tissue specimens was 69.0% (20 out of 29 culture-positive cases detected), 100% sensitivity was found with the urine and stool specimens. The combined sensitivity and specificity of the Xpert assay were calculated to be 77.3% and 98.2%, respectively.
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19
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Sumi S, Radhakrishnan VV. Diagnostic significance of humoral immune responses to recombinant antigens of Mycobacterium tuberculosis in patients with pleural tuberculosis. J Clin Lab Anal 2011; 24:283-8. [PMID: 20872560 DOI: 10.1002/jcla.20401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mycobacterium tuberculosis bacilli are seldom demonstrated in tuberculous pleural effusion (TPE) by conventional bacteriological methods. In this study, an indirect enzyme-linked immunosorbent assay (ELISA) was developed to detect IgG against four mycobacterial recombinant antigens (ESAT-6, PlcA, HspX and Tb8.4) in 69 pleural fluids of patients with TPE and 71 patients with malignant pleural effusion. To increase the sensitivity of the assay, a multi-antigen cocktail containing all the above antigens were also used. IgG positivity in ELISA for PlcA, HspX, Tb8.4, ESAT-6 antigens and multi-antigen complex were 49.3, 60.8, 49.3, 53.6 and 75.4% respectively. Each one of the above four antigens and their multi-antigen cocktail were highly specific in distinguishing tuberculous and malignant pleural effusion. This new generation immunoassay will serve as a useful marker for the diagnosis of pleural tuberculosis patients in whom M. tuberculosis bacilli were not demonstrated by bacteriological methods.
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Affiliation(s)
- S Sumi
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
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20
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Maurya AK, Kant S, Kushwaha RAS, Nag VL, Kumar M, Dhole TN. The advantage of using IS6110-PCR vs. BACTEC culture for rapid detection of Mycobacterium tuberculosis from pleural fluid in northern India. Biosci Trends 2011; 5:159-64. [DOI: 10.5582/bst.2011.v5.4.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anand K. Maurya
- Department of Pulmonary Medicine, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George Medical College)
| | - Surya Kant
- Department of Pulmonary Medicine, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George Medical College)
| | - Ram Awadh Singh Kushwaha
- Department of Pulmonary Medicine, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George Medical College)
| | - Vijaya Lakshmi Nag
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences
| | - Manoj Kumar
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences
| | - T. N. Dhole
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences
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21
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Abstract
Tuberculosis of the breast is an uncommon disease even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is high. Clinical presentation is usually of a solitary, ill-defined, unilateral hard lump situated in the upper outer quadrant of the breast. This disease can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed. Incorporating a highly sensitive technique like polymerase chain reaction (PCR) may be helpful in establishing the usefulness of such technology and can aid in conforming the diagnosis early. The disease is curable with antitubercular drugs, and surgery is rarely required
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Affiliation(s)
- Salim Baharoon
- Department of Medicine, Division of Infectious Diseases, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.
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22
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Calabrese F, Carturan E, Thiene G. Cardiac infections: focus on molecular diagnosis. Cardiovasc Pathol 2010; 19:171-82. [DOI: 10.1016/j.carpath.2009.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/24/2009] [Accepted: 09/28/2009] [Indexed: 01/09/2023] Open
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Kumar P, Sen MK, Chauhan DS, Katoch VM, Singh S, Prasad HK. Assessment of the N-PCR assay in diagnosis of pleural tuberculosis: detection of M. tuberculosis in pleural fluid and sputum collected in tandem. PLoS One 2010; 5:e10220. [PMID: 20419090 PMCID: PMC2856669 DOI: 10.1371/journal.pone.0010220] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 03/21/2010] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The nonspecific clinical presentation and paucibacillary nature of tuberculous pleuritis remains a challenge for diagnosis. Diagnosis of tuberculous pleural effusion depends on the demonstration of the presence of tubercle bacilli in the sputum, pleural fluid, or pleural biopsy specimen, or demonstration of granuloma in pleura by histological examination. We examined the clinical utility of the diagnosis of pleural tuberculosis using the in house N-PCR assay, AFB smear microscopy and culture. Besides pleural fluid the inclusion of sputum in the efficacy of diagnosis of pleural tuberculosis was scrutinized. METHODOLOGY/PRINCIPAL FINDINGS Pleural fluid and sputum samples of 58 tuberculous and 42 non-tuberculous pleural effusion patients were processed for AFB smear microscopy, culture and the N-PCR assay. Mycobacteria were detected exclusively in tuberculous pleural effusion samples. None of the non-tuberculous pleural effusion samples were positive for mycobacteria. Comparative analysis showed that the N-PCR assay had the highest sensitivity. Inclusion of sputum along with pleural fluid increased N-PCR sensitivity from 51.7 to 70.6% (p<0.0001).This improved sensitivity was reflected in AFB smear microscopy and isolation by culture. The sensitivity enhanced on inclusion of sputum from 3.4 (p = 0.50) to 10.3% (p = 0.038) for AFB smear microscopy and for isolation of mycobacteria from 10.3(p = 0.03) to 22.4% (p = 0.0005). Thirteen isolates were obtained from 58 pleural tuberculosis patients. Eleven mycobacterial isolates were identified as M. tuberculosis and two as M. fortuitum and M. chelonae. Complete concordance was seen between the biochemical identification of isolates and the N-PCR identification of mycobacterial species prior to isolation. CONCLUSIONS/SIGNIFICANCE To the best of our knowledge this is the first PCR based report on utility of sputum for diagnosis of pleural tuberculosis. The present study demonstrates that a combination of pleural fluid with sputum sample and N-PCR improved the diagnosis of pleural tuberculosis.
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Affiliation(s)
- Parameet Kumar
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Manas K. Sen
- Department of Pulmonary Critical Care and Sleep Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
| | - Devendra S. Chauhan
- National JALMA Institute of Leprosy and Other Mycobacterial Diseases, Tajganj, Agra, India
| | - Vishwa M. Katoch
- Department of Health Research (Ministry of Health & Family Welfare) and Indian Council of Medial Research, Ramalingaswami Bhawan, Ansari Nagar, New Delhi, India
| | - Sarman Singh
- Division of Clinical Microbiology, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Hanumanthappa K. Prasad
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
- * E-mail:
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Affiliation(s)
- Christoph Lange
- Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
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25
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Kumar P, Nath K, Rath B, Sen MK, Vishalakshi P, Chauhan DS, Katoch VM, Singh S, Tyagi S, Sreenivas V, Prasad HK. Visual format for detection of Mycobacterium tuberculosis and M. bovis in clinical samples using molecular beacons. J Mol Diagn 2009; 11:430-8. [PMID: 19661384 PMCID: PMC2729840 DOI: 10.2353/jmoldx.2009.080135] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A real-time polymerase chain reaction (PCR) assay for the direct identification of Mycobacterium tuberculosis and M. bovis using molecular beacons was developed. The assay was modified for use in regular thermal cyclers. Molecular beacons that were specific for M. tuberculosis (Tb-B) and M. bovis (Bo-B) were designed. The fluorescence of the target PCR product-molecular beacon probe complex was detected visually using a transilluminator. The results were then compared with those of conventional multiplex PCR (CM-PCR) assays and biochemical identification. The detection limit of Tb-B and Bo-B beacons was 500 fg and 50 fg by the visual format and real-time PCR assay, respectively, compared with 5 pg by CM-PCR assay. Pulmonary and extrapulmonary samples were examined. The agreement between culture and the two assays was very good in sputum samples and fair in extrapulmonary samples. The agreement between clinical diagnoses with the two assays was moderate in extrapulmonary samples. There was very good agreement between CM-PCR and visual format assays for all samples used in the study. Concordance in the identification of isolates by the visual, CM-PCR assay, and biochemical identification was seen. Hence, the use of molecular beacon detection of M. tuberculosis and M. bovis in clinical samples is feasible by setting up two asymmetric PCRs concurrently. The assay is sensitive, specific, simple to interpret, and takes less than 3 hours to complete.
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Affiliation(s)
- Parameet Kumar
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi-110029, India.
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26
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Abstract
Tuberculous pleural effusion is one of the most common forms of extrapulmonary tuberculosis (TB). The immediate cause of the effusion is a delayed hypersensitivity response to mycobacterial antigens in the pleural space. For this reason microbiological analyses are often negative and limited by the lengthy delay in obtaining results. In areas with high TB prevalence, pleural fluid adenosine deaminase (ADA) levels greater than 40 U/l argue strongly for TB; in contrast, low levels of pleural ADA have high negative predictive value in low-prevalence countries. The specificity of this enzyme increases if only lymphocytic exudates are considered. The shortcoming of the ADA test is its inability to provide culture and drug sensitivity information, which is paramount in countries with a high degree of resistance to anti-TB drugs. Sputum induction (in addition to pleural fluid) for acid-fast bacilli and culture is a recommended procedure in all patients with TB pleurisy. The microscopic-observation drug-susceptibility assay performed on pleural fluid or pleural tissue increases by two to three times the detection of TB over conventional cultures, and it allows for the identification of multidrug-resistant TB. A reasonable management strategy for pleural TB would be to initiate a four-drug regimen and perform a therapeutic thoracentesis in patients with large, symptomatic effusions.
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Affiliation(s)
- José M Porcel
- Department of Internal Medicine, Pleural Diseases Unit, Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA), Avda Alcalde Rovira Roure 80, 25198, Lleida, Spain.
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27
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Queipo-Ortuño MI, Colmenero JD, Bermudez P, Bravo MJ, Morata P. Rapid differential diagnosis between extrapulmonary tuberculosis and focal complications of brucellosis using a multiplex real-time PCR assay. PLoS One 2009; 4:e4526. [PMID: 19225565 PMCID: PMC2639699 DOI: 10.1371/journal.pone.0004526] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 01/05/2009] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Arduous to differ clinically, extrapulmonary tuberculosis and focal complications of brucellosis remain important causes of morbidity and mortality in many countries. We developed and applied a multiplex real-time PCR assay (M RT-PCR) for the simultaneous detection of Mycobacterium tuberculosis complex and Brucella spp. METHODOLOGY Conventional microbiological techniques and M RT-PCR for M. tuberculosis complex and Brucella spp were performed on 45 clinical specimens from patients with focal complications of brucellosis or extrapulmonary tuberculosis and 26 control samples. Fragments of 207 bp and 164 bp from the conserved region of the genes coding for an immunogenic membrane protein of 31 kDa of B. abortus (BCSP31) and the intergenic region SenX3-RegX3 were used for the identification of Brucella and M. tuberculosis complex, respectively. CONCLUSIONS The detection limit of the M RT-PCR was 2 genomes per reaction for both pathogens and the intra- and inter-assay coefficients of variation were 0.44% and 0.93% for Brucella and 0.58% and 1.12% for Mycobacterium. M RT-PCR correctly identified 42 of the 45 samples from patients with tuberculosis or brucellosis and was negative in all the controls. Thus, the overall sensitivity, specificity, PPV and NPV values of the M RT PCR assay were 93.3%, 100%, 100% and 89.7%, respectively, with an accuracy of 95.8% (95% CI, 91.1%-100%). Since M RT-PCR is highly reproducible and more rapid and sensitive than conventional microbiological tests, this technique could be a promising and practical approach for the differential diagnosis between extrapulmonary tuberculosis and focal complications of brucellosis.
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Affiliation(s)
- María Isabel Queipo-Ortuño
- Biochemistry and Molecular Biology Department, Faculty of Medicine, University of Malaga, Malaga, Spain.
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28
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Lee LN, Chou CH, Wang JY, Hsu HL, Tsai TH, Jan IS, Hsueh PR, Yang PC. Enzyme-linked immunospot assay for interferon-gamma in the diagnosis of tuberculous pleurisy. Clin Microbiol Infect 2009; 15:173-9. [DOI: 10.1111/j.1469-0691.2008.02655.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rapid and Specific Diagnosis of Tuberculous Pleuritis With Immunohistochemistry by Detecting Mycobacterium Tuberculosis Complex Specific Antigen MPT64 in Patients From a HIV Endemic Area. Appl Immunohistochem Mol Morphol 2008; 16:554-61. [DOI: 10.1097/pai.0b013e31816c3f79] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Real-time Quantitative PCR in the Diagnosis of Tuberculosis in Formalin-fixed Paraffin-embedded Pleural Tissue in Patients From a High HIV Endemic Area. ACTA ACUST UNITED AC 2008; 17:112-7. [DOI: 10.1097/pdm.0b013e31814ceac3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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: 15.1] [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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Affiliation(s)
- Angeline A Lazarus
- Uniformed Services, University of Health Sciences, Division of Pulmonary Medicine, National Navy Medical Cneter, Betheada, Maryland, USA
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Abstract
Molecular diagnostics in tuberculosis has enabled rapid detection of Mycobacterium tuberculosis complex in clinical specimens, identification of mycobacterial species, detection of drug resistance, and typing for epidemiological investigation. In the laboratory diagnosis of tuberculosis, the nucleic acid amplification (NAA) test is rapid and specific but not as sensitive as culture of mycobacteria. The primary determinant of successful NAA testing for tuberculosis depends on the shedding of mycobacterial DNA in secretions from caseating granulomas and its dissemination into sterile body fluids or tissue biopsies. In multibacillary diseases with a high mycobacterial load, a positive Ziehl-Neelsen smear with a positive NAA test is diagnostic of active tuberculosis, whereas a positive Ziehl-Neelsen smear with a negative NAA test in the absence of inhibitors would indicate nontuberculous mycobacterial disease. The role of the NAA test is more important in paucibacillary diseases with low mycobacterial loads. The presence of polymerase chain reaction (PCR) inhibitors, however, especially in extrapulmonary specimens, may produce false-negative results. Although this problem can be overcome to some extent by extra extraction steps, the additional processing invariably leads to the loss of mycobacterial DNA. To circumvent this problem, a brief culture augmentation step is carried out before the NAA test is performed, which can enhance the mycobacterial load while concomitantly diluting inhibitors, thereby maintaining the sensitivity of the test without excessively increasing turnaround time.
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Affiliation(s)
- V C C Cheng
- Centre of Infection and Immunology, University of Hong Kong, Hong Kong Special Administrative Region, China
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Zimmerman RL. Effusion cytology: Keeping researchers and journals in business for the past 20 years—and it is not over yet. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cdip.2005.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Barnes TW, Olson EJ, Morgenthaler TI, Edson RS, Decker PA, Ryu JH. Low Yield of Microbiologic Studies on Pleural Fluid Specimens. Chest 2005; 127:916-21. [PMID: 15764776 DOI: 10.1378/chest.127.3.916] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND It is generally recommended that pleural fluid samples from pleural effusions of unknown cause be cultured for bacteria, mycobacteria, and fungi. However, the utility of this practice has been not been adequately assessed. DESIGN Retrospective review. SETTING Tertiary care, referral medical center. PATIENTS Five hundred twenty-five patients undergoing diagnostic thoracentesis at Mayo Medical Center, Rochester, MN, over a 12-month period from July 1, 2001, to June 30, 2002. INTERVENTIONS None. MEASUREMENTS AND RESULTS Among 525 patients undergoing diagnostic thoracenteses, 476 patients (91%) had one or more cultures performed on their pleural fluid specimens. Thirty-nine positive results (3.0% of 1,320 cultures) occurred in 35 of these 476 patients (7.4%). After excluding likely contaminants, true pathogens were identified in only 19 of 1,320 pleural fluid cultures (1.4%) belonging to 15 patients (3.2% of those who had cultures performed on their pleural fluid specimen). These positive results included 2.3% of aerobic bacterial, 1.2% of anaerobic bacterial, 1.4% of fungal, and 0% of mycobacterial cultures. Microbiologic smears performed on these pleural fluid samples included 357 Gram stains, 109 fungal smears (potassium hydroxide), and 232 acid-fast smears with positive yields of 2.5%, 0%, and 0%, respectively. These positive findings represented 1.3% of all smears performed. Of the specimens obtained from outpatient thoracenteses, only one had a true-positive result (0.8%). Only 1.1% (four specimens) of the cultures performed on free-flowing effusions demonstrated true pathogens; three of these four specimens grew fungi. CONCLUSIONS The positive yield of microbiologic smears and cultures on pleural fluid specimens is low, particularly in the outpatient setting and in patients with free-flowing effusions. Microbiologic testing of pleural fluid specimens should be ordered more selectively.
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Affiliation(s)
- Terrance W Barnes
- Division of Pulmonary and Critical Care Medicine, Desk East 18, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Abstract
Management of patients with tuberculous pleuritis can be improved by establishing early diagnosis accurately, administering effective chemotherapy, and close monitoring of progress for early detection and prompt management of severe pleural inflammation in the hope of preventing or reducing subsequent residual pleural fibrosis. In addition to the conventional diagnostic tools, chemical markers, especially pleural fluid adenosine deaminase and interferon-gamma levels and new microbiological tests such as polymerase chain reaction and BACTEC culture of pleural biopsy specimens for Mycobacterium tuberculosis, can increase the diagnostic yield for tuberculous pleuritis. Indicators of the severity of pleural inflammation, including high pleural fluid tumour necrosis factor-alpha and lysozyme levels, and low pleural fluid glucose and pH, can help to predict residual pleural fibrosis. It is likely that patients will require surgery: (i) complete drainage of pleural fluid for prevention; and (ii) pleurectomy for the treatment of residual pleural fibrosis.
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Affiliation(s)
- Poon-Chuen Wong
- Tuberculosis & Chest Unit, Grantham Hospital, Aberdeen, Hong Kong, China.
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Tuberculosis in the Intensive Care Unit: The North American Perspective. TROPICAL AND PARASITIC INFECTIONS IN THE INTENSIVE CARE UNIT 2005. [PMCID: PMC7121205 DOI: 10.1007/0-387-23380-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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38
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Gray JW. Childhood tuberculosis and its early diagnosis. Clin Biochem 2004; 37:450-5. [PMID: 15183293 DOI: 10.1016/j.clinbiochem.2004.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2003] [Revised: 03/09/2004] [Accepted: 03/09/2004] [Indexed: 10/26/2022]
Abstract
Traditional methods for laboratory diagnosis of tuberculosis are unsatisfactory, especially for children, in whose specimens mycobacteria are usually sparse. Recent changes in tuberculosis epidemiology in developed countries, including a large increase in incidence in children from certain ethnic minorities, have prompted interest in newer diagnostic methods. Liquid-based culture detection systems offer improved sensitivity and speed of diagnosis, although the time taken for detection of growth is still upwards of 1 week. Nucleic acid amplification techniques offer more rapid results, but perform best on smear-positive samples; sensitivities may be as low as 50% in smear-negative specimens. Although these newer techniques are widely used in some developed countries, in others, they are not perceived as offering sufficient benefit to justify their routine use. The diagnostic accuracy of mycobacteriophage and serologic methods is insufficient to justify their wide use even in developing countries. Despite recent developments, there is still no panacea for diagnosis of childhood tuberculosis.
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Affiliation(s)
- James W Gray
- Department of Microbiology, Birmingham Children's Hospital, B4 6NH, UK.
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Shamputa IC, Rigouts And L, Portaels F. Molecular genetic methods for diagnosis and antibiotic resistance detection of mycobacteria from clinical specimens. APMIS 2004; 112:728-52. [PMID: 15638836 DOI: 10.1111/j.1600-0463.2004.apm11211-1203.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mycobacteria comprise a diverse group of bacteria that are widespread in nature, some of which cause significant disease in humans. Members of the Mycobacterium tuberculosis complex (MTBC) are the most important human pathogens of the genus Mycobacterium. Traditional methods for detection and identification of mycobacteria include microscopy, culture and phenotypic tests. These methods either lack sensitivity, specificity, or are time consuming. Advances in the field of molecular biology have provided rapid diagnostic tools that have reduced the turnaround times for detecting MTBC and drug resistance in cultures and directly in clinical specimens from weeks to days. This review discusses the molecular genetic techniques for detecting and identifying MTBC as well as drug resistance of mycobacteria in clinical specimens.
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Affiliation(s)
- I C Shamputa
- Mycobacteriology Unit, Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium
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