KEYWORDS: Tuberculous pleuritis
, Central venous catheter based closed thoracic drainage, Conventional thoracentesis and drainage.
Increased specificity for the diagnosis of tuberculous pleuritis
. Chest 1996;109(2):414-9.
Mycobacterium tuberculosis is isolated in culture in only 20% to 40% of cases of confirmed tuberculous pleuritis
, the diagnostic yield of the culture being low in pleural fluid, but may be increased if a sample of pleural tissue is also cultured (6,8,9).
Several studies have suggested that an elevated pleural fluid ADA level predicts tuberculous pleuritis
with a sensitivity of 80-100% and a specificity of 80-92% when the Giusti method is used (20).
Adenosine deaminase activity is a sensitive marker for the diagnosis of tuberculous pleuritis
in patients with very low CD4 counts.
Combined use of pleural adenosine deaminasse with lymphocyte/neutrophil ratio: increased specificity for the diagnosis of tuberculous pleuritis
Keywords: Public Health Mycobacteria Tuberculous pleuritis
The patients included those with; pleural effusion of indeterminate origin, suspected tuberculous pleuritis
not responding to the antituberculous therapy after two months, fibrinopurulent or chronic empyema, suspected malignant effusion, interstitial lung disease not responding to the treatment, pulmonary nodule(s) suspected of malignant origin, myasthenia gravis and paratracheal/mediastinal mass.
It is because there are few bacilli in the effusion and tuberculous pleuritis
is due to hypersensitivity to tuberculo-protein rather than actual infection and is well documented in the literature.34 Thoracentesis is said to be a safe procedure with minimum complications, four (4%) patients had iatrogenic pneumothorax in this study.
Focussing on the utility of the antibody response in tuberculous pleuritis
according to specific reactivity, there is a recent study, reporting that a specific IgA-ELISA method using MPT-64 and MT-10.3 antigens showed a sensitivity of 78% (14).
Tumour necrosis factor-alpha in comparison to adenosine deaminase in tuberculous pleuritis
In this issue Prabha et al (15) have studied the role of leptin in tuberculous pleuritis
by measuring the leptin and cytokine levels in serum and pleural fluid by ELISA.