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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

Baba, Kamaldeen MD* † ‡; Dyrhol-Riise, Anne Margarita MD, PhD* §; Sviland, Lisbet MD, PhD† ∥; Langeland, Nina MD, PhD* §; Hoosen, Anwar A. MD; Wiker, Harald G. MD, PhD; Mustafa, Tehmina MD, PhD† ¶

Applied Immunohistochemistry & Molecular Morphology: December 2008 - Volume 16 - Issue 6 - p 554-561
doi: 10.1097/PAI.0b013e31816c3f79
Research Articles

Aim The aim of the study was to evaluate the diagnostic potential of immunohistochemistry using an antibody to the secreted mycobacterial antigen MPT64, specific for Mycobacterium tuberculosis complex organisms, on formalin-fixed biopsies from patients with pleural tuberculosis (TB) from a high TB and HIV endemic area.

Methods and Results Pleural biopsies from 25 TB cases and 11 non-TB cases were studied. Ziehl-Neelsen staining for acid-fast bacilli and immunohistochemistry with anti-MPT64 and anti-Bacille Calmette-Guérin (BCG) antibodies was performed. Nested polymerase chain reaction (N-PCR) for IS6110 was performed for comparison. Acid-fast bacilli were detected in only 2 cases and 3 biopsies showed granulomas with caseous necrosis. Immunostaining with anti-MPT64, anti-BCG, and N-PCR were positive in 20 (80%), 12 (48%), and 16 (64%) of the cases, and 0, 3 (27%), and 2 (18%) of the non-TB controls, respectively. The diagnostic validity of immunohistochemistry was calculated by comparison with N-PCR–positive TB cases and N-PCR–negative non-TB controls. The sensitivity of immunohistochemistry with anti-MPT64 and anti-BCG were 81% and 56% respectively, and the corresponding specificities were 100% and 78%.

Conclusions Detection of the MPT64 antigen by immunohistochemistry improves the diagnosis of TB pleuritis caused by M. tuberculosis complex organisms in patients living in HIV-endemic areas with atypical histology and negative staining for acid-fast bacilli.

*Institute of Medicine

Center for International Health

Section of Microbiology and Immunology, The Gade Institute, University of Bergen

§Department of Medicine

Department of Pathology, Haukeland University Hospital, Bergen, Norway

Department of Microbiological Pathology, University of Limpopo (Medunsa Campus), South Africa

Competing interests: None of the authors have competing interests.

Reprints: Tehmina Mustafa, MD, PhD, Section of Microbiology and Immunology, The Gade Institute, Armauer Hansens Building, Haukeland University Hospital, Bergen N-5021, Norway (e-mail:

Received for publication November 21, 2007; accepted February 6, 2008

© 2008 Lippincott Williams & Wilkins, Inc.