Tuberc Respir Dis.  2012 Sep;73(3):143-150. 10.4046/trd.2012.73.3.143.

Clinical Utility of Two Interferon-gamma Release Assays on Pleural Fluid for the Diagnosis of Tuberculous Pleurisy

• Kang JY
• Rhee CK
• Kang NH
• Kim JS
• Yoon HK
• Song JS

• KMID: 1842909
• DOI: http://doi.org/10.4046/trd.2012.73.3.143

Abstract

BACKGROUND
The release of interferon-gamma (IFN-gamma) by T lymphocytes increases after rechallenge with Mycobacterium tuberculosis antigen, especially, at a localized site of tuberculosis (TB) infection. We aimed to compare the clincial efficacy of two commercial IFN-gamma release assays from pleural fluid for the diagnosis in tuberculous pleurisy.
METHODS
We performed T-SPOT.TB and QuantiFERON-TB Gold tests simultaneously on pleural fluid and peripheral blood samples from patients with pleural effusion, in South Korea, an area with intermediate TB burden.
RESULTS
Thirty-six patients were enrolled prospectively, and tuberculous pleurisy was found in 21 patients. Both the numbers of IFN-gamma secreting T cells and the concentration of IFN-gamma were greater in the pleural tuberculous group, comparing with the non-tuberculous group. Moreover, in the tuberculous group, there was a significant difference in IFN-gamma producing spot-forming cells using the T-SPOT.TB method between pleural fluid and peripheral blood. The receiver operating characteristic (ROC) curve, was the greatest for pleural fluid T-SPOT.TB test, followed by peripheral blood T-SPOT.TB test, peripheral blood QuantiFERON-TB Gold test, and pleural fluid QuantiFERON-TB Gold test (area under the ROC curve of 0.956, 0.890, 0.743, and 0.721, respectively). The T-SPOT.TB assay produced less indeterminate results than did QuantiFERON-TB Gold assay in both pleural fluid and peripheral blood.
CONCLUSION
These findings suggest that the pleural fluid T-SPOT.TB test could be the most useful test among the IFN-gamma release assays for diagnosing tuberculous pleurisy in an area with an intermediate prevalence of TB infection.

Keyword

Interferon-gamma Release Tests; Tuberculosis, Pleural

MeSH Terms

Humans
Interferon-gamma
Interferon-gamma Release Tests
Mycobacterium tuberculosis
Pleural Effusion
Prevalence
Prospective Studies
Republic of Korea
ROC Curve
T-Lymphocytes
Tuberculosis
Tuberculosis, Pleural
Interferon-gamma

Figure

• 

  Figure 1 Comparison of the numbers of interferon-gamma producing spot-forming cells (SFCs) using the T-SPOT.TB method in pleural fluid and in blood, between the pleural tuberculosis (plTB) and non-pleural TB (non-TB) groups. All results have been calculated after subtraction of SFC counts in the negative control wells. For group comparison by a Mann-Whitney test. NS: not significant. *p<0.005. †p<0.001.

• 

  Figure 2 The concentrations of interferon-gamma (IFN-γ) using the QuantiFERON-TB Gold method in pleural fluid and in blood, between the pleural tuberculosis (plTB) and non-pleural TB (non-TB) groups. IFN-γ values have been subtracted from the corresponding background control values. For group comparison by Mann-Whitney test. NS: not significant. *p<0.05. †p<0.01.

• 

  Figure 3 Receiver operating characteristic curves between T-SPOT.TB and QuantiFERON-TB Gold (QFT-G) test for the diagnosis of tuberculous pleurisy. ROC: receiver operating characteristic; PF: pleural fluid; B: peripheral blood.

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