Myanmar Health Sciences Research Journal
Volume 27, Number 1
TITLE: Role of Polymerase chain reaction in the diagnosis of tuberculosis pleural effusion
AUTHOR: in Thein, Myat Mon; Myint Myint Nyein; Nyo Mee May Thyn; Yee Yee Naing; Khin Saw Aye
SOURCE: Myanmar Health Sciences Research Journal. 2015; 27(1): 36-41
ABSTRACT: Diagnosis of tuberculous pleural effusion (TPE) is based on the demonstration of tubercle bacilli in the pleural fluid or that of caseous tubercle by histopathological examination. However, to reach a definitive diagnosis of tuberculous pleural effusion is still a challenge because of its nonspecific clinical presentations and inefficiency of conventional laboratory methods due to its paucibacillary nature. The aim of this study was to identify the role of polymerase chain reaction (PCR) method in the diagnosis of TPE. A total of 47 patients with clinically suspected TPE were subjected for pleural aspiration and closed pleural biopsy. Routine examination, cytological and PCR analysis of mycobacterium in pleural fluid were performed. Histopathological examination of pleural biopsy tissue was also done. Pleural fluid AFB staining and cytology showed no definitive diagnosis of TPE in all cases. Twenty-four cases (51.5%) reached the definitive diagnosis of tuberculosis by histopathology of pleural tissue while the remaining 23 cases (48.9%) were diagnosed as chronic nonspecific pleuritis. PCR analysis of pleural fluid revealed that 33 cases (70.2%) were positive and 14 cases (29.8%) were negative for tuberculosis. According to Receiver Operating Characteristic (ROC) curve, protein concentration and lymphocyte count at the levels of =5100 mg/dl and 85% were the best cut-off values where the sensitivities and specificities of TPE were 81.8%, 71.4% and 75.8%, 71.4%, respectively. Association and 95% confident interval between histopathology and PCR analysis showed sensitivity 69.7%, specificity 92.9%, positive predictive value 95.8% and negative predictive value 56.5%. PCR analysis of pleural fluid has a gain over conventional methods. This study pointed out that pleural tissue histopathology in combination with total protein concentration and lymphocyte count can be a useful tool in diagnosis of TPE.
SUBJECT HEADINGS: PCR, Tuberculous pleural effusion