Positive predictive value of ELISpot in BAL and pleural fluid from patients with suspected pulmonary tuberculosis

Regina W. Hofland*, Steven F. T. Thijsen, Anne S. R. van Lindert, Wiel C. M. de Lange, Tamara van Gorkom, Ingeborg van der Tweel, Jan-Willem Lammers, Aik W. J. Bossink

*Corresponding author for this work

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    Abstract

    Background: The aim of this study was to evaluate the positive predictive value (PPV) of ELISpot in bronchoalveolar lavage (BAL) and pleural fluid for the diagnosis of active tuberculosis (TB) in real-life clinical practice, together with the added value of a cut-off >1.0 for the ratio between the extra-sanguineous and systemic interferon-gamma responses in positive samples.

    Methods: A retrospective, single-centre study was performed. Patients with positive ELISpot in BAL and pleural fluid were included.

    Results: The PPV for TB in patients with positive ELISpot in BAL (n = 40) was 64.9%, which increased to 82.6% for the ESAT-6 panel and 71.4% for the CFP-10 panel after the introduction of a cut-off >1.0 for the ratio between the BAL and blood interferon-gamma responses. In patients with positive ELISpot in pleural fluid (n = 16), the PPV for TB was 85.7%, which increased to 91.7% for the ESAT-6 panel and 92.3% for the CFP-10 panel after the introduction of a cut-off >1.0 for the ratio between the pleural fluid and blood interferon-gamma responses.

    Conclusions: This report describes the PPV of ELISpot in BAL and pleural fluid for the diagnosis of active TB in real-life clinical practice. The results indicate the possibility of an increase of the PPV using a cut-off >1.0 for the ratio between the extra-sanguineous and systemic interferon-gamma responses. Further studies are needed to underline this ratio-approach and to evaluate the full diagnostic accuracy of ELISpot in extra-sanguineous fluids like BAL and pleural fluid.

    Original languageEnglish
    Pages (from-to)347-355
    Number of pages9
    JournalACS Infectious Diseases
    Volume49
    Issue number5
    DOIs
    Publication statusPublished - 2017

    Keywords

    • Tuberculosis
    • interferon-gamma release assays
    • ELISpot
    • bronchoalveolar lavage
    • pleural fluid
    • GAMMA RELEASE ASSAYS
    • MONONUCLEAR-CELLS
    • PERIPHERAL-BLOOD
    • DIAGNOSIS
    • METAANALYSIS

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