Browse > Article

Sensitivity of Polymerase Chain Reaction for Pleural Tuberculosis according to the Amount of Pleural Effusion Specimens  

Moon, Jin Wook (Department of Internal Medicine, Ewha Womans University College of Medicine)
Publication Information
Tuberculosis and Respiratory Diseases / v.62, no.3, 2007 , pp. 184-191 More about this Journal
Abstract
Background: For the diagnosis of pleural tuberculosis, polymerase chain reaction (PCR) of pleural effusion specimens has shown very low sensitivity, which might be due to the small number of bacilli in the samples. The purpose of this investigation is to determine whether the sensitivity of PCR testing can be improved when increasing the amount of pleural effusion specimens. Methods: We prospectively analyzed pleural effusion specimens obtained from 53 patients for whom the exclusion of the possibility of tuberculous pleural effusion was necessary. We performed Mycobacterium tuberculosis PCR testing using the Cobas Amplicor MTB test (Roche Diagnostic Systems) with three different amounts (10ml, 25ml, and 50ml) of pleural effusion specimen in each patient. Pleural tuberculosis was defined as having one of the following: culture-positive pleural fluid sample, histopathologic finding consistent with tuberculosis on pleural biopsy, culture-positive sputum specimen, and/or positive response to anti-tuberculous medication without other possible causes of pleural effusion. Results: Of the 53 patients, 26 received the diagnosis of pleural tuberculosis. The sensitivities of AFB smearing, Mycobacterium tuberculosis culture of pleural effusion specimen, pleural biopsy, and measurement of ADA were 3.8%, 15.4%, 84.6%, and 88.5%, respectively. The results of PCR testing were positive for 3 (11.5%), 4 (15.4%), and 3 (11.5%) of the 26 patients when using 10ml, 25ml, and 50ml of pleural effusion specimens, respectively. These results did not show a statistically significant difference in the sensitivity of PCR testing when increasing the amount of pleural effusion samples (p>0.05, symmetry exact test). Conclusion: For specimens such as pleural effusion, in which the bacillary load is very low, the clinical utility of PCR testing seems highly limited with the kits designed for the diagnosis of pulmonary tuberculosis. An increased amount of pleural effusion sample does not improve the sensitivity of PCR testing.
Keywords
Amplicor; Pleural effusion; Polymerase chain reaction (PCR); Sensitivity; Tuberculosis;
Citations & Related Records

Times Cited By SCOPUS : 0
연도 인용수 순위
  • Reference
1 Ogawa K, Koga H, Hirakata Y, Tomono K, Tashiro T, Kohno S. Differential diagnosis of tuberculous pleurisy by measurement of cytokine concentrations in pleural effusion. Tuber Lung Dis 1997;78:29-34   DOI   ScienceOn
2 Nagesh BS, Sehgal S, Jindal SK, Arora SK. Evaluation of polymerase chain reaction for detection of Mycobacterium tuberculosis in pleural fluid. Chest 2001;119:1737-41   DOI   ScienceOn
3 Light RW. Pleural diseases. Philadelphia, PA: Lea & Febiger; 1983
4 Vlaspolder F, Singer P, Roggeveen C. Diagnostic value of an amplification method (Gen-Probe) compared with that of culture for diagnosis of tuberculosis. J Clin Microbiol 1995;33:2699-703
5 Ruiz-Manzano J, Manterola JM, Gamboa F. Detection of Mycobacterium tuberculosis in paraffin-embedded pleural biopsy specimens by commercial ribosomal RNA and DNA amplification kits. Chest 2000;118: 648-55   DOI   ScienceOn
6 Menzies D. Issues in the management of contacts of patients with active pulmonary tuberculosis. Can J Public Health 1997;88:197-201
7 Ellner JJ. Pleural fluid and peripheral blood lymphocyte function in tuberculosis. Ann Intern Med 1978;89:932-3
8 Iseman MD. A clinician's guide to tuberculosis. Philadelphia, PA: Lippincott Williams & Wilkins; 2000
9 Querol JM, Minguez J, Garcia-Sanchez E, Farga MA, Gimeno C, Garcia-de-Lomas J. Rapid diagnosis of pleural tuberculosis by polymerase chain reaction. Am J Respir Crit Care Med 1995;152:1977-81   DOI   ScienceOn
10 Stead WW, Eichenholz A, Stauss HK. Operative and pathologic findings in twenty-four patients with syndrome of idiopathic pleurisy with effusion, presumably tuberculous. Am Rev Tuberc 1955;71: 473-502
11 de Wit D, Maartens G, Steyn L. A comparative study of the polymerase chain reaction and conventional procedures for the diagnosis of tuberculous pleural effusion. Tuber Lung Dis 1992;73:262-7   DOI   ScienceOn
12 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   DOI   ScienceOn
13 Shah S, Miller A, Mastellone A. Rapid diagnosis of tuberculosis in various biopsy and body fluid specimens by the AMPLICOR Mycobacterium tuberculosis polymerase chain reaction test. Chest 1998;113:1190-4   DOI   ScienceOn
14 Centers for Disease Control and Prevention. From the Centers for Disease Control and Prevention. Update: Nucleic acid amplification tests for tuberculosis. JAMA 2000;284:826   DOI   ScienceOn
15 Kolk AH, Schuitema AR, Kuijper S, van Leeuwen J, Hermans PW, van Embden JD, et al. Detection of Mycobacterium tuberculosis in clinical samples by using polymerase chain reaction and a nonradioactive detection system. J Clin Microbiol 1992;30:2567-75
16 American thoracic society. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000;161:1376-95   DOI   ScienceOn
17 World Health Organization. Laboratory Services in Tuberculosis Control. Part III: Culture WHO/TB/ 98.258. Geneva, Switzerland: World Health Organization; 1998
18 Ehlers S, Ignatius R, Regnath T, Hahn H. Diagnosis of extrapulmonary tuberculosis by Gen-Probe amplified Mycobacterium tuberculosis direct test. J Clin Microbiol 1996;34:2275-9
19 Giusti G, Galanti B. Methods of enzyme analysis. New York, NY: Academic Press; 1983
20 Nightingale SL. From the Food and Drug Administration. JAMA 1996;275:585   DOI   ScienceOn
21 Levidiotou S, Vrioni G, Galanakis E, Gesouli E, Pappa C, Stefanou D. Four-year experience of use of the Cobas Amplicor system for rapid detection of Mycobacterium tuberculosis complex in respiratory and nonrespiratory specimens in Greece. Eur J Clin Microbiol Infect Dis 2003;22:349-56   DOI   ScienceOn
22 Pfyffer GE, Kissling P, Jahn EM, Welscher HM, Salfinger M, Weber R. Diagnostic performance of amplified Mycobacterium tuberculosis direct test with cerebrospinal fluid, other nonrespiratory, and respiratory specimens. J Clin Microbiol 1996;34:834-41
23 Al Zahrani K, Al Jahdali H, Poirier L, Rene P, Gennaro ML, Menzies D. Accuracy and utility of commercially available amplification and serologic tests for the diagnosis of minimal pulmonary tuberculosis. Am J Respir Crit Care Med 2000; 162:1323-9   DOI
24 Reischl U, Lehn N, Wolf H, Naumann L. Clinical evaluation of the automated COBAS AMPLICOR MTB assay for testing respiratory and nonrespiratory specimens. J Clin Microbiol 1998;36:2853-60
25 Toman K. Tuberculosis case-finding and chemotherapy: questions and answers. Geneva, Switzerland: World health organization; 1979
26 Moon JW, Chang YS, Kim SK, Kim YS, Lee HM, Kim SK, et al. The clinical utility of polymerase chain reaction for the diagnosis of pleural tuberculosis. Clin Infect Dis 2005;41:660-6   DOI   ScienceOn
27 de Lassence A, Lecossier D, Pierre C, Cadranel J, Stern M, Hance AJ. Detection of mycobacterial DNA in pleural fluid from patients with tuberculous pleurisy by means of the polymerase chain reaction: comparison of two protocols. Thorax 1992;47:265-9   DOI   ScienceOn
28 Berger HW, Mejia E. Tuberculous pleurisy. Chest 1973;63:88-92   DOI   ScienceOn
29 Carpentier E, Drouillard B, Dailloux M. Diagnosis of tuberculosis by Amplicor Mycobacterium tuberculosis test: a multicenter study. J Clin Microbiol 1995; 33:3106-10
30 Villegas MV, Labrada LA, Saravia NG. Evaluation of polymerase chain reaction, adenosine deaminase, and interferon-gamma in pleural fluid for the differential diagnosis of pleural tuberculosis. Chest 2000;118: 1355-64   DOI   ScienceOn
31 Behr MA, Warren SA, Salamon H, Hopewell PC, Ponce de Leon A, Daley CL, et al. Transmission of Mycobacterium tuberculosis from patients smearnegative for acid-fast bacilli. Lancet 1999;353:444-9   DOI   ScienceOn