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Free Content Can tuberculous pleural effusions be diagnosed by pleural fluid analysis alone?

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OBJECTIVE: To assess whether pleural fluid analysis (PFA) can confidently diagnose tuberculous pleural effusion (TPE).

METHODS: PFA of 548 TPEs was performed between January 1991 and December 2011. The control group consisted of patients with malignant PE (MPE), complicated parapneumonic/empyema (infectious) PE (IPE), miscellaneous PE (MisPE) and transudative PE (TrPE).

RESULTS: The PFA of 548 histologically or culture-positive consecutive cases of TPE was compared with that of 158 consecutive cases of MPE, 113 cases of IPE, 37 cases of MisPE and 115 cases of TrPE. Statistically significant differences were noted in pleural fluid glucose, pH, cholesterol, triglycerides, adenosine deaminase (ADA), and total percentages of lymphocytes, neutrophils and macrophages when TPEs were compared to all other groups. Of the TPEs, 99.1% were exudates. Pleural fluid protein ≥ 5.0 g/dl, lymphocytes > 80% and ADA > 45 U/l were diagnostic of TPE, with a specificity of 100%, a sensitivity of 34.9% and an area under the curve of 0.975.

CONCLUSION: PFA alone was diagnostic in one third of the TPE cases, with a high probability in nearly 60%.
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Keywords: ADA; adenosine deaminase; lymphocytosis; total protein

Document Type: Research Article

Affiliations: 1: Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA 2: Servico de Analisis Clinicos, Complexo Hospitalario Clinico, Universitario de Santiago, Santiago de Compostela, A Coruña, Spain 3: Servicio de Neumologia, Complexo Hospitalario Clinico, Universitario de Santiago, Santiago de Compostela, A Coruña, Spain

Publication date: 2013-06-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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