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1.
Scand J Clin Lab Invest ; 67(8): 877-84, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17852820

RESUMO

The diagnosis of pleural tuberculosis (pTB) is difficult, and more sensitive and specific techniques are needed. In the period August 1998 to November 2002, we evaluated 132 patients with a pleural effusion submitted to a thoracentesis and pleural biopsy in a tertiary care hospital in Rio de Janeiro, Brazil. Three tests were performed and compared in the pleural fluid: ADA activity measurement, IgA-ELISA for two combined specific Mycobacterium tuberculosis antigens, and polymerase chain reaction (PCR) for detection of M. tuberculosis DNA. Ninety-five patients (72%) were given a final diagnosis of pTB. Overall histopathologic sensitivity was 77%. The sensitivities of pleural fluid culture and AFB smear were 42% and 1%, respectively. Twenty-one (22%) additional patients had a clinical diagnosis of pTB. Median follow-up time of all TB patients after the completion of antituberculous treatment was 13 months. Sensitivities of ADA, IgA-ELISA and PCR were 91%, 78% and 82%, while specificities were 93%, 96% and 85%, respectively. Only ADA sensitivity was significantly higher than the histopathologic examination (McNemar chi2 test; p = 0.002) and also significantly higher than ELISA (p = 0.049), but not higher than PCR (p = 0.143). We conclude that the routine use of ADA activity measurement in pleural fluid can obviate the need for a pleural biopsy in the initial diagnostic approach to pleural effusions, while IgA-ELISA and PCR techniques, potentially more specific tests, need further refinement to improve their accuracy.


Assuntos
Adenosina Desaminase/análise , Ensaio de Imunoadsorção Enzimática/métodos , Imunoglobulina A/análise , Cavidade Pleural/enzimologia , Reação em Cadeia da Polimerase/métodos , Tuberculose Pleural/diagnóstico , Tuberculose Pleural/enzimologia , Adenosina Desaminase/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , DNA Bacteriano/análise , DNA Bacteriano/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Pleural/patologia , Sensibilidade e Especificidade
2.
Int J Tuberc Lung Dis ; 9(4): 461-6, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15830754

RESUMO

SETTING: Microbiological tests lack sensitivity for pleural tuberculosis (TB) and histopathology is expensive, time consuming and needs specialised personnel. Immunoassay (ELISA) may be a promising approach in this respect. OBJECTIVE: To evaluate the reactivity of IgA antibody to MPT-64 and MT-10.3 recombinant mycobacterial protein antigens in pleural fluid as a marker of pleural TB, based on the fact that IgA is the main antibody in the mucosa/serosa of the gastrointestinal and respiratory tract. METHOD: Anti-MPT-64 and MT-10.3 IgA response was determined by ELISA in 72 patients with pleural TB and 27 with other pleural conditions. RESULTS: High sensitivities for IgA were measured against MPT-64 (52/72, 72%) and MT-10.3 (52/72,72%) antigens. Combining the sensitivities of both antigens, further increase in sensitivity (55/72, 76%) was obtained with no loss of specificity (96%). Similar IgA reactivity was obtained from culture-negative and culture-positive specimens. In eight pleural TB patients with human immunodeficiency virus (HIV) co-infection, the sensitivity was 88% (7/8). CONCLUSION: To our knowledge, this is the first description of the presence of IgA antibody pleural TB effusion reactive to MPT-64 and MT-10.3, with sensitivity similar to histopathological examination, which is presently considered the gold standard for pleural TB.


Assuntos
Anticorpos Antibacterianos/análise , Antígenos de Bactérias/imunologia , Proteínas de Bactérias/imunologia , Imunoglobulina A/análise , Mycobacterium tuberculosis/imunologia , Derrame Pleural/imunologia , Tuberculose Pleural/imunologia , Ensaio de Imunoadsorção Enzimática , Humanos , Proteínas Recombinantes/imunologia
3.
Int J Tuberc Lung Dis ; 6(2): 150-4, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11931414

RESUMO

In this study two molecular typing methods, a simple double repetitive element PCR-based assay and the standardized restriction fragment length polymorphism (RFLP), were used to confirm cross-contamination in the mycobacteriology laboratory. Clinical specimens from 12 patients, submitted for acid-fast bacilli stain smear and processed for culture in Lowenstein-Jensen on the same day, resulted in positive bacterioscopy (+++) and confluent growth only for one of the patients. The specimens from all the other patients but two were smear-negative and culture-positive, with one or two colonies. None of them had clinical symptoms and radiological findings for active tuberculosis (TB). The suspicion of false-positive cultures arose when a health care worker who had had a PPD skin test conversion, claimed to be healthy and had no TB symptoms, was found to have a positive sputum culture. DRE-PCR demonstrated that all nine cultures typed belonged to one cluster, further confirmed by RFLP. Although DRE-PCR has been found to be poorly reproducible, it has enough discriminatory power to be useful for rapid epidemiological investigation in selected settings.


Assuntos
Técnicas de Tipagem Bacteriana , Infecção Hospitalar/diagnóstico , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/isolamento & purificação , Reação em Cadeia da Polimerase/métodos , Tuberculose Pulmonar/microbiologia , Síndrome da Imunodeficiência Adquirida , Brasil , Impressões Digitais de DNA , DNA Bacteriano/análise , Reações Falso-Positivas , Hospitais Gerais , Humanos , Laboratórios Hospitalares , Mycobacterium tuberculosis/genética , Polimorfismo de Fragmento de Restrição , Sensibilidade e Especificidade , Manejo de Espécimes , Tuberculose Pulmonar/diagnóstico
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