Role of Cartridge-based Nucleic Acid Amplification Test in Diagnosis of Tuberculous Pleural Effusion Compared to Tuberculous Empyema in HIV-seronegative Patients
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2017, Vol 5, Issue 6
Abstract
Introduction: The tuberculous pleural effusion is the second most common form of extrapulmonary tuberculosis (TB) in high TB burden country such as India. Since the endorsement of cartridge-based nucleic acid amplification test (CBNAAT) in the diagnosis of extrapulmonary TB by the World Health Organization, there are several publications assessing the diagnostic accuracy of CBNAAT in pleural effusion. However, there is very little data on its role in tuberculous empyema which is a very common clinical presentation in this part of the world. The objective of the present study is to reevaluate the role of CBNAAT in the diagnosis of tuberculous pleural effusion compared to tuberculous empyema. Materials and Methods: This was a prospective observational study where patients with a clinical and radiological diagnosis of pleural effusion attending the outpatient department and emergency of a tertiary care hospital were enrolled in the study after obtaining consent and satisfying the set inclusion and exclusion criteria over a period of 1 year. All the pleural fluid samples were sent for CBNAAT for Mycobacterium tuberculosis and BACTEC culture along with other routine tests. Statistical analysis was done using SPSS version 20.0 (SPSS Inc., Chicago, IL) software for MS-Windows. Results: Among a total of 105 patients of tuberculous pleural effusion (male 68 and female 37) with the mean age 36.23 ± 13.45 years, 10 (male 5, female 5) had tuberculous empyema. Pleural fluid acid-fast bacilli smear, mycobacterial culture, and CBNAAT were positive in 8.57%, 20%, and 15.23%, respectively. The sensitivity and specificity of CBNAAT, considering mycobacterial culture positivity as standard reference, were 4.76% (95% confidence interval [CI] 0.99-13.29) and 87.5% (95% CI 71.01-96.49), respectively, for tuberculous pleural effusion, while they are 100% (95% CI 66.37-100) and 100% (95% CI 2.5-100) in tuberculous empyema, respectively. A single case of rifampicin resistance was detected among tuberculous effusion without empyema which was later confirmed by solid and liquid culture. Conclusion: CBNAAT is a useful rapid diagnostic tool for suspected tuberculous pleural effusion/empyema considering the advantage of rapid test result and information about drug resistance pattern, especially in high burden country such as India.
Authors and Affiliations
Debabani Biswas, Subhasis Mukherjee, Shabana Begum, Amitava Paul, Priyanka Ghosh, Supriya Sarkar
Keywords
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