| Identification of mycobacterium tuberculosis in pleural effusion by polymerase chain reaction(PCR). |
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Ho Joong Kim2, Young Whan Kim1, Sung Koo Han1, Young Soo Shim1, Keun Youl Kim3, Yong Chol Han1 |
1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
2Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
3Department of Internal Medicine, Dankook University College of Medicine, Seoul, Korea |
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| Abstract |
Background
By amplifying small amount of DNA, polymerase chain reaction (PCR) can be used for the detection of very small amount of microbial agent, and may be especially useful in certain cases which are difficult to be diagnosed microbiologically or serologically. Tuberculous pleurisy is a disease that can be diagnosed in only 70% of cases by conventional diagnostic tools, and PCR would be a very rapid, easy, and sensitive diagnostic method Method: The specificity and sensitivity of PCR to detect Mycobacterium tuberculosis DNA were evaluated using various strains of Mycobacteria. To evaluate the diagnostic usefulness of PCR in tuberculous pleurisy, we used PCR to detect Mycobacterium tuberculosis DNA in pleural fluid. The amplification target was 123 base pair DNA, a paπ of IS6110 fragment, 10-16 copies of which are known to exist per genome. The diagnostic yield of PCR was compared with conventional methods, including pleural fluid adenosine deaminase (ADA) activity. Also, the significance of PCR in undiagnosed pleural effusion was evaluated prospectively with antituberculosis treatment Results:
1) Using cultured Mycobacterium tuberculosis and other strains, PCR could detect upto 1 fg DNA and specific for only Mycobacterium tuberculosis and Mycobacterium bovis.
2) Using pleural effusions of proven tuberculosis cases, the sensitivity of PCR was 80.0% (16/ 20), and the specificity 95.0% (19 / 20)
3) Among 13 undiagnosed, but suspected tuberculous effusion, the positive rate was 60% in 10 improved cases after antituberculosis medications, and 0% in 3 cases of proven malignancy later 4) Adenosine deaminase level of proven and clinlcally diagnosed tuberculous pleurisy patients was significantly higher than that of excluded patients, and correlated well with PCR results.
Conclusion
We can conclude that PCR detection of Mycobacterium tuberculosis in pleural effusion has acceptable sensitivity and specificity, and could be an additional diagnostic tool for the diagnosis of tuberculous pleurisy. |
| Key Words:
Tuberculosis, Pleural effusion, PCR, ADA |
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