Evaluation of molecular and immunological methods for diagnosis of tuberculosis pleurisy  

作　　者：Maysaa El Sayed Zaki 

机构地区：[1]Clinical Pathology,Faculty of Medicine,Mansoura University,Egypt

出　　处：《Asian Pacific Journal of Tropical Medicine》2008年第4期14-19,共6页亚太热带医药杂志（英文版）

摘　　要：Objective:The inefficiency of conventional laboratory methods for diagnosis of Pleural tuberculosis(TBP) and the reliance on pleural biopsy have motivated the evaluation of alternative diagnostic strategies.Our goal was to evaluate different laboratory techniques Ziehl Neelsen,Mantoux skin test,determination of interferon gamma in serum and pleural fluid,polymerase chain reaction and serological study of specific IgG,IgM and IgA beside bacteriological culture by BACTEC 460 TB for rapid and accurate diagnosis of tuberculosis pleurisy. Methods:Patients presented with pleural effusions were subjected to study by ZN,PCR,serological study By specific IgG,IgM and IgA for A60 of tuberculosis compared to culture by BACTEC460 TB.Interferon gamma was determined both in serum and pleural fluid.Results:Mantoux skin test was positive in 19 TBP patients and four patients with exudative pleural effusion.Z.N staining results of pleural biopsy specimens were positive in only 1 of 23 patients(4.3%) in the tuberculous pleural effusion group.PCR was positive in 20 cases of group 1(87%).Serum and pleural fluid interferon had significantly elevated levels(P【0.000 1) in TBP and both measurements had significant correlation in TBP(P【0.000 1).The serum IgA ELISA test was positive in 7/23(30.4%),IgM was positive in 17/23(73.9%) patients and IgG was positive in 16/23(69%) patients.Non of the non TBP had either ZN,PCR or positive serum IgA,IgG,or IgM.When the positive results for IgG and IgM were combined together the serological tests correcdy identified 20/23(87%) of patients. Conclusion:We suggest that in TBP serological diagnosis by combined use of IgG and IgM for A60 antigen with serum determination of interferon gamma can provide rapid and non invasive diagnostic tool that can justify the starting of chemotherapy while awaiting the results of culture.Objective:The inefficiency of conventional laboratory methods for diagnosis of Pleural tuberculosis(TBP) and the reliance on pleural biopsy have motivated the evaluation of alternative diagnostic strategies.Our goal was to evaluate different laboratory techniques Ziehl Neelsen,Mantoux skin test,determination of interferon gamma in serum and pleural fluid,polymerase chain reaction and serological study of specific IgG,IgM and IgA beside bacteriological culture by BACTEC 460 TB for rapid and accurate diagnosis of tuberculosis pleurisy. Methods:Patients presented with pleural effusions were subjected to study by ZN,PCR,serological study By specific IgG,IgM and IgA for A60 of tuberculosis compared to culture by BACTEC460 TB.Interferon gamma was determined both in serum and pleural fluid.Results:Mantoux skin test was positive in 19 TBP patients and four patients with exudative pleural effusion.Z.N staining results of pleural biopsy specimens were positive in only 1 of 23 patients(4.3%) in the tuberculous pleural effusion group.PCR was positive in 20 cases of group 1(87%).Serum and pleural fluid interferon had significantly elevated levels(P<0.000 1) in TBP and both measurements had significant correlation in TBP(P<0.000 1).The serum IgA ELISA test was positive in 7/23(30.4%),IgM was positive in 17/23(73.9%) patients and IgG was positive in 16/23(69%) patients.Non of the non TBP had either ZN,PCR or positive serum IgA,IgG,or IgM.When the positive results for IgG and IgM were combined together the serological tests correcdy identified 20/23(87%) of patients. Conclusion:We suggest that in TBP serological diagnosis by combined use of IgG and IgM for A60 antigen with serum determination of interferon gamma can provide rapid and non invasive diagnostic tool that can justify the starting of chemotherapy while awaiting the results of culture.

关 键 词：TUBERCULOUS PLEURISY MOLECULAR DIAGNOSIS TUBERCULIN SEROLOGY Interferon gamma 

分 类 号：R521.7[医药卫生—内科学]