Possibilities of modern laboratory methods for the diagnosis of tuberculosis pleurisy
Background. The etiological structure of pleurisy is diverse, the most common causes of pleural effusion are tuberculosis, malignancy, pneumonia. The accurate etiological diagnosis of pleural effusion is very hard. We aimed to compare the clincial efficacy of modern bacteriological and immunological methods for diagnosing tuberculous pleurisy and clarify the tactics of their application in clinical practice. Materials and methods: 74 patients with pleural effusion of tuberculosis (n=30) and non-tuberculous etiology (n=44) were studied. We compared the information value of smear of pleural fluid, cultures of exudates, identification of M. tuberculosis DNA in pleural fluid, lymphocytic effusion, skin test «Diaskintest», level of INF gamma in “Tubinferon test” for confirmation of tuberculosis etiology of pleurisy. Result. The diagnostic performance of standard methods for diagnosis of tuberculosis pleurisy are limited. The accuracy of the methods for diagnosing tuberculous pleurisy - level of IFN gamma in the pleural fluid with cut off 50pg/ml, the skin test «Diaskintest», identification of bacterial DNA in exudate, the bacterioscopy and culture of the exudate, the determination of the lymphocytic effusion were 74.42%, 72.73%, 69.81%, 61.67%, 57.14%, 51.35% respectively. Conclusion. Identification of bacterial DNA in pleural exudate in combination with pleural fluid research in the «Tubinferon-test» are more informative for the differential diagnosis of tuberculous pleurisy.