Investigation of the patient with pleural effusion.

摘要

Given the fact that culture of pleural fluid (using Lowenstein medium) has only 36.6% sensitivity for diagnosis of tuberculous pleural effusion versus 79.8% sensitivity obtained with the more invasive modality of histological identification of caseating granuloma, among the non-invasive 'special tests' for evaluation of pleural effusion, mention should also have been made of adenosine deaminase (ADA) and inter-feron-gamma (IFN-gamma), so as to complement strategies such as staining and culture for acid-fast bacilli. In a systematic review of 63 studies ADA was characterised by positive likelihood ratio 9.03 (95% confidence interval (CI) 7.19 to 11.35), negative likelihood ration 0.10 (95% CI 0.07 to 0.14) for diagnosis of tuberculous pleural effusion. Correspondingly, in a systematic review of 22 studies, diagnostic accuracy of IFN-gamma was characterised by positive likelihood ration amounting to 23.45 (95% CI 17.31 to 31.78), and negative likelihood ratio 0.11 (95% CI 0.07 to 0.16). In the setting of tuberculous effusion prevalence of 5%, post-test probability of a negative ADA test has been estimate to be 0.4%, increasing to 2.4% where tuberculous pleural effusion has a 25% prevalence. For INF-gamma, corresponding post-test probabilities are 0.22% and 1.2% respectively.