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IP Indian Journal of Immunology and Respiratory Medicine


Clinico-radiological profile and diagnostic yield of various procedures in analysis of tubercular pleural effusion


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Author Details: Chaina Ram Choudhary, Laxman Kumar Soni, Shrawan Ram, Gopal Purohit, Sunil Vyas, Priyanka Soni

Volume : 1

Issue : 3

Online ISSN : 2581-4222

Print ISSN : 2581-4214

Article First Page : 63

Article End Page : 66


Abstract

Background: Tuberculosis is the leading cause of pleural effusion in developing countries. Early diagnosis and treatment of this condition is imperative as it is associated with high morbidity and mortality. Pleural biopsy has been considered the gold standard in diagnosis of TPE but it is invasive, so that pleural fluid markers of TPE have been extensively evaluated as an alternative to pleural biopsy.
Methods: Prospective study included 100 cases with Detailed clinical history, Radiological examination and NAATs i.e. MTB DNA PCR with other conventional diagnostic techniques like pleural fluid biochemistry, ADA, cytology and culture for mycobacterium tuberculosis was carried out in all patients.
Results: Out of total 100 cases, 09% cases were sputum positive for AFB, 3% pleural fluid positive for AFB, 28% were culture positive, 74% were DNA PCR positive, and 85% cases had ADA >40 units/liter, 87% cases had a LN Ratio greater than 0.75. Sensitivity, specificity, PPV & NPV of PCR for MTB was observed 92.86%, 33.33%, 35.13% & 92.30% respectively (p<0.01). ATT response was observed in 78% cases in 2 weeks, 98% cases in 4 weeks and 100% cases at the end of 6 weeks.
Conclusions: Delay in diagnosis of TPE leads to sequelae as well as spread of infection to other organs. More than one diagnostic procedure is often needed for confirmation of TPE. PCR targeting IS6110 is the simple, rapid and highly sensitive test used in the early diagnosis of TPE.

Keywords:
ADA; MTB DNA PCR; Tuberculous pleural effusion