Clinical features and biochemical pleural fluid analysis – valuable tools for the diagnosis of tuberculous pleurisy

Abstract

Introduction. The infection with Mycobacterium tuberculosis represents a common cause of pleural effusions, and its diagnosis poses difficulties for clinicians. In the attempt to facilitate a quick, accurate and inexpensive diagnosis, the research is focused on evaluating useful biomarkers in the pleural fluid. Adenosine deaminase (ADA) level in the pleural fluid is a biomarker with high specificity and sensitivity for the diagnosis. The objective of the study was to assess the association between ADA levels in the pleural fluid, other pleural fluid characteristics, and clinical aspects in tuberculous pleurisy. Material and methods. We performed a retrospective study on 77 patients diagnosed with tuberculous pleurisy (positive Mycobacterium tuberculosis cultures in the pleural fluid or biopsy specimens and/or specific histological aspect: epithelioid granuloma with caseous necrosis in pleural biopsy), between 2011-2018, in The National Institute of Pneumology “Marius Nasta” Bucharest, Romania. Results. The ADA values were positively and statistically significant correlated with lactate dehydrogenase (LDH) and protein levels in the pleural fluid. Also, the mean ADA value was increased in febrile patients as compared with the afebrile ones, statistically significant (p <0.05). Conclusions. Probability scores (developed on the ground of biochemical and cytological characteristics of the pleural fluid, clinical and demographic parameters), together with the local epidemiological context, may contribute to a faster, reliable, accessible and non-invasive diagnosis of tuberculous pleurisy.

Keywords

• ada
• ldh
• tuberculous pleurisy
• scoring systems