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a Division of
Respiratory Diseases and Tuberculosis, b Division of
Allergy and Clinical Immunology, c Department of Medicine, Faculty of Medicine,
Chulalongkorn University, Bangkok 10330, Thailand
Correspondence to: Dr S Wongtim.
Received 6 January 1999; Returned to authors 22 March 1999; Revised version received 8 June 1999; Accepted for publication 24 June 1999
BACKGROUND
A study was
undertaken to evaluate the diagnostic value of pleural fluid
concentrations of interferon gamma (IFN-
) as a marker of tuberculosis.
METHODSPatients
admitted to King Chulalongkorn Memorial Hospital between April 1997 and
January 1998 with a lymphocytic exudative pleural effusion were
enrolled into the study. The pleural fluids were examined for cytology,
staining for acid fast bacilli, and mycobacterial culture. Pathological
examination and mycobacterial culture were performed on each pleural
biopsy specimen. The diagnosis of tuberculosis was made when one of the
following criteria was met: (1) Mycobacterium
tuberculosis was isolated from either the pleural fluid or
pleural tissue; (2) granulomas were demonstrated in the pleural tissue
which stained positive for acid fast bacilli (AFB); or (3) in the
presence of granulomas negative on staining for AFB in pleural tissue
there was a response to antituberculous treatment on follow up. All
pleural fluid samples were stored at -70°C and the IFN- level was
measured by immunoassay. Analysis was made using sensitivity,
specificity, and likelihood ratio for a positive test result. The best
cut off point was determined by the highest likelihood ratio and
receiver operating characteristic curve.
RESULTSA total of 66 patients were enrolled and tuberculosis was confirmed in 39 of them.
The diagnoses in the non-tuberculous group included malignancy (15),
paramalignancy (11), and chronic pleuritis secondary to infective
endocarditis (1). The mean (SE) IFN- level in the pleural fluid was
significantly higher in the tuberculous group than in the
non-tuberculous group (1493.3 (131.3) pg/ml versus 80.1 (50.4) pg/ml,
p<0.001). The overlap between the two groups was minimal. At the cut
off value of 240 pg/ml the sensitivity was 94.9% (95% CI 86.6 to
100), the specificity was 96.3% (95% CI 89.2 to 100), and the
likelihood ratio for a positive test result was 25.6.
CONCLUSIONSThe
pleural fluid concentration of IFN- is a good and useful diagnostic
marker of tuberculosis presenting as a lymphocytic exudative pleural effusion.
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