Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Clinical Utility of Two Interferon-gamma Release Assays on Pleural Fluid for the Diagnosis of Tuberculous Pleurisy

  • Kang, Ji Young (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Rhee, Chin Kook (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kang, Na Hyun (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Ju Sang (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Yoon, Hyoung-Kyu (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Song, Jeong Sup (Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • Received : 2011.12.08
  • Accepted : 2012.08.02
  • Published : 2012.09.30
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Abstract

Background: The release of interferon-gamma (IFN-${\gamma}$) by T lymphocytes increases after rechallenge with Mycobacterium tuberculosis antigen, especially, at a localized site of tuberculosis (TB) infection. We aimed to compare the clincial efficacy of two commercial IFN-${\gamma}$ release assays from pleural fluid for the diagnosis in tuberculous pleurisy. Methods: We performed T-SPOT.TB and QuantiFERON-TB Gold tests simultaneously on pleural fluid and peripheral blood samples from patients with pleural effusion, in South Korea, an area with intermediate TB burden. Results: Thirty-six patients were enrolled prospectively, and tuberculous pleurisy was found in 21 patients. Both the numbers of IFN-${\gamma}$ secreting T cells and the concentration of IFN-${\gamma}$ were greater in the pleural tuberculous group, comparing with the non-tuberculous group. Moreover, in the tuberculous group, there was a significant difference in IFN-${\gamma}$ producing spot-forming cells using the T-SPOT.TB method between pleural fluid and peripheral blood. The receiver operating characteristic (ROC) curve, was the greatest for pleural fluid T-SPOT.TB test, followed by peripheral blood T-SPOT.TB test, peripheral blood QuantiFERON-TB Gold test, and pleural fluid QuantiFERON-TB Gold test (area under the ROC curve of 0.956, 0.890, 0.743, and 0.721, respectively). The T-SPOT.TB assay produced less indeterminate results than did QuantiFERON-TB Gold assay in both pleural fluid and peripheral blood. Conclusion: These findings suggest that the pleural fluid T-SPOT.TB test could be the most useful test among the IFN-${\gamma}$ release assays for diagnosing tuberculous pleurisy in an area with an intermediate prevalence of TB infection.

Keywords

Acknowledgement

Supported by : Ministry of Health & Welfare

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