Tuberculosis and Respiratory Diseases

  • 제75권4호
  • /
  • Pages.150-156
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  • 2013
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  • 1738-3536(pISSN)
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  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
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Clinical Utility of CT-Based Bronchial Aspirate TB-PCR for the Rapid Diagnosis of Pleural Tuberculosis

  • Lee, Jaehee (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, So Yeon (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Choi, Keum Ju (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lim, Jae Kwang (Department of Radiology, Kyungpook National University School of Medicine) ;
  • Yoo, Seung Soo (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Shin Yup (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Cha, Seung Ick (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Park, Jae Yong (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kim, Chang Ho (Department of Internal Medicine, Kyungpook National University School of Medicine)
  • 투고 : 2013.05.22
  • 심사 : 2013.06.25
  • 발행 : 2013.10.30
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초록

Background: Thoracoscopic pleural biopsy is often required for rapid and confirmative diagnosis in patients with suspected pleural tuberculosis (PL-TB). However, this method is more invasive and costly than its alternatives. Therefore, we evaluated the clinical utility of the chest computed tomography (CT)-based bronchial aspirate (BA) TB-polymerase chain reaction (PCR) test in such patients. Methods: Bronchoscopic evaluation was performed in 54 patients with presumptive PL-TB through diagnostic thoracentesis but without a positive result of sputum acid-fast bacilli (AFB) smear, pleural fluid AFB smear, or pleural fluid TB-PCR test. Diagnostic yields of BA were evaluated according to the characteristics of parenchymal lesions on chest CT. Results: Chest radiograph and CT revealed parenchymal lesions in 25 (46%) and 40 (74%) of 54 patients, respectively. In cases with an absence of parenchymal lesions on chest CT, the bronchoscopic approach had no diagnostic benefit. BA TB-PCR test was positive in 21 out of 22 (95%) patients with early-positive results. Among BA results from 20 (37%) patients with patchy consolidative CT findings, eight (40%) were AFB smear-positive, 18 (90%) were TB-PCR-positive, and 19 (95%) were culture-positive. Conclusion: The BA TB-PCR test seems to be a satisfactory diagnostic modality in patients with suspected PL-TB and patchy consolidative CT findings. For rapid and confirmative diagnosis in these patients, the bronchoscopic approach with TB-PCR may be preferable to the thoracoscopy.

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참고문헌

  1. Hooper C, Lee YC, Maskell N; BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65 Suppl 2:ii4-17. https://doi.org/10.1136/thx.2009.123141
  2. Moon JW, Chang YS, Kim SK, Kim YS, Lee HM, Kim SK, et al. The clinical utility of polymerase chain reaction for the diagnosis of pleural tuberculosis. Clin Infect Dis 2005;41:660-6. https://doi.org/10.1086/432474
  3. Light RW. Update on tuberculous pleural effusion. Respirology 2010;15:451-8. https://doi.org/10.1111/j.1440-1843.2010.01723.x
  4. Porcel JM. Tuberculous pleural effusion. Lung 2009;187:263- 70. https://doi.org/10.1007/s00408-009-9165-3
  5. Laniado-Laborin R. Adenosine deaminase in the diagnosis of tuberculous pleural effusion: is it really an ideal test? A word of caution. Chest 2005;127:417-8. https://doi.org/10.1378/chest.127.2.417
  6. Koegelenberg CF, Diacon AH. Pleural controversy: close needle pleural biopsy or thoracoscopy-which first? Respirology 2011;16:738-46. https://doi.org/10.1111/j.1440-1843.2011.01973.x
  7. Gopi A, Madhavan SM, Sharma SK, Sahn SA. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest 2007;131:880-9. https://doi.org/10.1378/chest.06-2063
  8. Conde MB, Loivos AC, Rezende VM, Soares SL, Mello FC, Reingold AL, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med 2003;167:723- 5. https://doi.org/10.1164/rccm.2111019
  9. Kim HJ, Lee HJ, Kwon SY, Yoon HI, Chung HS, Lee CT, et al. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest 2006;129:1253-8. https://doi.org/10.1378/chest.129.5.1253
  10. Tueller C, Chhajed PN, Buitrago-Tellez C, Frei R, Frey M, Tamm M. Value of smear and PCR in bronchoalveolar lavage fluid in culture positive pulmonary tuberculosis. Eur Respir J 2005;26:767-72. https://doi.org/10.1183/09031936.05.00046105
  11. Lee JE, Lee BJ, Roh EY, Kim DK, Chung HS, Lee CH. The diagnostic accuracy of tuberculosis real-time polymerase chain reaction analysis of computed tomography-guided bronchial wash samples. Diagn Microbiol Infect Dis 2011;71:51-6. https://doi.org/10.1016/j.diagmicrobio.2010.12.019
  12. Lee J, Lee SY, Yoo SS, Cha SI, Won DI, Park JY, et al. Clinical value of whole-blood interferon-gamma assay in patients with suspected pulmonary tuberculosis and AFB smear- and polymerase chain reaction-negative bronchial aspirates. Diagn Microbiol Infect Dis 2012;73:252-6. https://doi.org/10.1016/j.diagmicrobio.2012.03.019
  13. Feinsilver SH, Barrows AA, Braman SS. Fiberoptic bronchoscopy and pleural effusion of unknown origin. Chest 1986;90:516-9. https://doi.org/10.1378/chest.90.4.516
  14. Chang SC, Perng RP. The role of fiberoptic bronchoscopy in evaluating the causes of pleural effusions. Arch Intern Med 1989;149:855-7. https://doi.org/10.1001/archinte.1989.00390040071014
  15. Heaton RW, Roberts CM. The role of fibreoptic bronchoscopy in the investigation of pleural effusion. Postgrad Med J 1988;64:581-2. https://doi.org/10.1136/pgmj.64.754.581
  16. Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972;77:507-13. https://doi.org/10.7326/0003-4819-77-4-507
  17. Diacon AH, Van de Wal BW, Wyser C, Smedema JP, Bezuidenhout J, Bolliger CT, et al. Diagnostic tools in tuberculous pleurisy: a direct comparative study. Eur Respir J 2003;22:589-91. https://doi.org/10.1183/09031936.03.00017103a
  18. Valdes L, Alvarez D, San Jose E, Penela P, Valle JM, Garcia- Pazos JM, et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med 1998;158:2017-21. https://doi.org/10.1001/archinte.158.18.2017
  19. Ruan SY, Chuang YC, Wang JY, Lin JW, Chien JY, Huang CT, et al. Revisiting tuberculous pleurisy: pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area. Thorax 2012;67:822-7. https://doi.org/10.1136/thoraxjnl-2011-201363
  20. Matsuoka S, Uchiyama K, Shima H, Suzuki K, Shimura A, Sasaki Y, et al. Relationship between CT findings of pulmonary tuberculosis and the number of acid-fast bacilli on sputum smears. Clin Imaging 2004;28:119-23. https://doi.org/10.1016/S0899-7071(03)00148-7
  21. Canetti G. Present aspects of bacterial resistance in tuberculosis. Am Rev Respir Dis 1965;92:687-703.
  22. Kumar P, Sen MK, Chauhan DS, Katoch VM, Singh S, Prasad HK. Assessment of the N-PCR assay in diagnosis of pleural tuberculosis: detection of M. tuberculosis in pleural fluid and sputum collected in tandem. PLoS One 2010;5:e10220. https://doi.org/10.1371/journal.pone.0010220
  23. Rosso F, Michelon CT, Sperhacke RD, Verza M, Olival L, Conde MB, et al. Evaluation of real-time PCR of patient pleural effusion for diagnosis of tuberculosis. BMC Res Notes 2011;4:279. https://doi.org/10.1186/1756-0500-4-279
  24. de Lassence A, Lecossier D, Pierre C, Cadranel J, Stern M, Hance AJ. Detection of mycobacterial DNA in pleural fluid from patients with tuberculous pleurisy by means of the polymerase chain reaction: comparison of two protocols. Thorax 1992;47:265-9. https://doi.org/10.1136/thx.47.4.265

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