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Pleural fluid tests to diagnose tuberculous pleuritis

Skouras, Vasileios S.; Kalomenidis, Ioannis

Current Opinion in Pulmonary Medicine: July 2016 - Volume 22 - Issue 4 - p 367–377
doi: 10.1097/MCP.0000000000000277
DISEASES OF THE PLEURA: Edited by Richard Light
Editor's Choice

Purpose of review This article summarizes current data regarding the accuracy of pleural fluid tests assisting the diagnosis of tuberculous pleuritis (TBP).

Recent findings No pleural fluid test reliably rules-in TBP in settings with low TBP prevalence. Interferon-γ) alone or in combination with adenosine deaminase (ADA) is more reliable than ADA for this purpose in nonlow prevalences. ADA can reliably rule-out TBP in prevalences of less than 40% although in higher prevalences the product of interleukin-27 and ADA is the most accurate rule-out test.

Summary The definite diagnosis of TBP requires the isolation of Mycobacterium tuberculosis from pleural fluid or biopsies. Because of the low sensitivity of pleural fluid cultures and the invasiveness of pleural biopsy techniques, the concept of a pleural fluid test that accurately establishes or excludes TBP diagnosis has been proposed. Numerous pleural fluid tests have been evaluated for this purpose with ADA being the most widely accepted one. During the last years, it has been demonstrated that the ability of ADA to rule-in or rule-out TBP is affected by the prevalence of TBP in the setting where the test is used. The complementary use of interferon-γ or interleukin-27 increases the ability of ADA to rule-in or rule-out the disease, respectively.

aDepartment of Pulmonary Medicine, 401 General Army Hospital

b1st Department of Pulmonary Medicine, Hygeia Hospital

c1st Department of Critical Care & Pulmonary Medicine, Medical School of Athens University, ‘Evangelismos’ General Hospital, Athens, Greece

Correspondence to Vasileios S. Skouras, MD, PhD, Department of Pulmonary Medicine, 401 General Army Hospital of Athens, 1 Kanellopoulou Str, 11526, Athens, Greece. Tel: +30 6973380282; e-mail:

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