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ACCURACY OF POLIMERASE CHAIN REACTION FOR THE DIAGNOSIS OF PLEURAL TUBERCULOSIS
Nucleic acid amplification techniques
Tuberculosis
Pleural
Polymerase chain reaction
Author
Affilliation
Gama Filho University. Graduate Program in Health Education. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Graduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil / McGill University. Montreal Chest Institute. Montreal, Canada.
Federal University of Rio de Janeiro. Graduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Tuberculosis Academic Program e Medical School. Rio de Janeiro, RJ, Brazil.
Gama Filho University. Graduate Program in Health Education. Rio de Janeiro, RJ, Brazil.
Souza Marques Foundation. Medical School. Rio de Janeiro, RJ, Brazil.
Clemente Ferreira Institute. São Paulo, SP, Brazil.
Oswaldo Cruz Foundation. Evandro Chagas Clinical Research Institute. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Graduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Tuberculosis Academic Program e Medical School. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Tuberculosis Academic Program e Medical School. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Graduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Tuberculosis Academic Program e Medical School. Rio de Janeiro, RJ, Brazil.
Gama Filho University. Graduate Program in Health Education. Rio de Janeiro, RJ, Brazil.
Souza Marques Foundation. Medical School. Rio de Janeiro, RJ, Brazil.
Clemente Ferreira Institute. São Paulo, SP, Brazil.
Oswaldo Cruz Foundation. Evandro Chagas Clinical Research Institute. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Graduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Tuberculosis Academic Program e Medical School. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Tuberculosis Academic Program e Medical School. Rio de Janeiro, RJ, Brazil.
Abstract
Introduction: Polymerase chain reaction (PCR)-based techniques to detect Mycobacterium tuberculosis DNA in respiratory specimens have been increasingly used to diagnose pulmonary tuberculosis. Their use in non-respiratory specimens to diagnose extrapulmonary tuberculosis is, however, controversial. In this study, we estimated the accuracy of three in-country commercialized PCR-based diagnostic techniques in pleural fluid samples for the diagnosis of pleural tuberculosis. Methods:
Patients underwent thoracenthesis for diagnosis purposes; pleural fluid aliquots were frozen and subsequently submitted to two real time PCR tests (COBAS®TAQMAN®MTB and Xpert®MTB/Rif) and one conventional PCR test (Detect-TB®). Two different reference standards were considered: probable tuberculosis (based on clinical grounds) and confirmed tuberculosis (bacteriologically or histologically). Results: Ninety-three patients were included, of whom 65 with pleural tuberculosis, 35 of them confirmed. Sensitivities were 29% for COBAS®TAQMAN®MTB, 3% for Xpert®MTB/Rif and 3% for Detect-TB®; specificities were 86%, 100% and 97% respectively, considering confirmed tuberculosis. Considering all cases, sensitivities were 16%, 3% and 2%, and specificities, 86%, 100%, and 97%. Discussion:
Compared to the 95% sensitivity of adenosine deaminase, the most sensitive test for pleural tuberculosis, the sensitivities of the three PCR-based tests were very low. We conclude that at present, there is no major place for such tests in routine clinical use.
Keywords
DiagnosisNucleic acid amplification techniques
Tuberculosis
Pleural
Polymerase chain reaction
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