PLoS ONE (Jan 2009)

Clinical diagnostic utility of IP-10 and LAM antigen levels for the diagnosis of tuberculous pleural effusions in a high burden setting.

  • Keertan Dheda,
  • Richard N Van-Zyl Smit,
  • Leonardo A Sechi,
  • Motasim Badri,
  • Richard Meldau,
  • Gregory Symons,
  • Hoosein Khalfey,
  • Igshaan Carr,
  • Alice Maredza,
  • Rodney Dawson,
  • Helen Wainright,
  • Andrew Whitelaw,
  • Eric D Bateman,
  • Alimuddin Zumla

DOI
https://doi.org/10.1371/journal.pone.0004689
Journal volume & issue
Vol. 4, no. 3
p. e4689

Abstract

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BackgroundCurrent tools for the diagnosis of tuberculosis pleural effusions are sub-optimal. Data about the value of new diagnostic technologies are limited, particularly, in high burden settings. Preliminary case control studies have identified IFN-gamma-inducible-10 kDa protein (IP-10) as a promising diagnostic marker; however, its diagnostic utility in a day-to-day clinical setting is unclear. Detection of LAM antigen has not previously been evaluated in pleural fluid.MethodsWe investigated the comparative diagnostic utility of established (adenosine deaminase [ADA]), more recent (standardized nucleic-acid-amplification-test [NAAT]) and newer technologies (a standardized LAM mycobacterial antigen-detection assay and IP-10 levels) for the evaluation of pleural effusions in 78 consecutively recruited South African tuberculosis suspects. All consenting participants underwent pleural biopsy unless contra-indicated or refused. The reference standard comprised culture positivity for M. tuberculosis or histology suggestive of tuberculosis.Principal findingsOf 74 evaluable subjects 48, 7 and 19 had definite, probable and non-TB, respectively. IP-10 levels were significantly higher in TB vs non-TB participants (pConclusionAlthough IP-10, like ADA, has sub-optimal specificity, it may be a clinically useful rule-out test for tuberculous pleural effusions. Larger multi-centric studies are now required to confirm our findings.