Evaluation of real-time PCR of patient pleural effusion for diagnosis of tuberculosis

• Main Authors: Zaha Arnaldo, Guerra Renata L, Conde Marcus B, Olival Liliane, Verza Mirela, Sperhacke Rosa D, Michelon Candice T, Rosso Franciele, Rossetti Maria LR
• Format: Article
• Language: English
• Published: BMC 2011-08-01
• Series: BMC Research Notes
• Online Access: http://www.biomedcentral.com/1756-0500/4/279

<p>Abstract</p> <p>Background</p> <p>Pleural tuberculosis (TB) diagnosis often requires invasive procedures such as pleural biopsy. The aim of this study was to evaluate the role of real-time polymerase chain reaction (PCR) for the <it>IS</it>6110 sequence of <it>M. tuberculosis </it>in pleural fluid specimens as a rapid and non-invasive test for pleural TB diagnosis.</p> <p>Findings</p> <p>For this cross-sectional study, 150 consecutive patients with pleural effusion diagnosed by chest radiography, who were referred for diagnostic thoracocentesis and pleural biopsy and met eligibility criteria, had a pleural fluid specimen submitted for real-time PCR testing. Overall, 98 patients had pleural TB and 52 had pleural effusion secondary to other disease. TB diagnosis was obtained using acid-fast bacilli (AFB) smear or culture for mycobacteria and/or histopathologic examination in 94 cases and by clinical findings in 4 cases. Sensitivity, specificity, positive and negative predictive values of PCR testing for pleural TB diagnosis were 42.8% (95% CI 38.4 - 44.8), 94.2% (95% CI 85.8 - 98.0), 93.3% (95% CI 83.6 - 97.7), and 48.5% (95% CI 44.2 - 50.4), respectively. The real-time PCR test improved TB detection from 30.6% to 42.9% when compared to AFB smear and culture methods performed on pleural fluid specimens, although the best sensitivity was achieved by combining the results of culture and histopathology of pleural tissue specimens.</p> <p>Conclusion</p> <p>The real-time PCR test of pleural fluid specimens is a useful and non-invasive additional assay for fast diagnosis of pleural TB.</p>