Tuberculous Pleural Effusions: Efficacy Utilization and Comparison of Various Diagnostic Techniques

Abstract

Aim: To observe the efficiency and utilization of smear microscopy, AFB culture, GeneXpert, fluid cytology and adenosine deaminase levels in diagnosing TPE and comparing them with each other Study design: Cross Sectional Study Place and duration: Department of TB and Chest Medicine King Edward Medical University/Mayo Hospital Lahore from June 2016 to December 2017 Methods: Specimens of aseptically collected pleural fluids with a quantity of 20 ml or above were received in the lab and divided in at least 3 portions. One half of the each specimen was used for microbiology i.e. smear and culture, one fourth for cytology and biochemical examination and one fourth was used for GeneXpert MTB Rif Assay. Results: Of the total 143 patients 70 (48.9%) were males and 73 (51.1%) were females with mean age of 34.63±15.93 years. Fourteen (9.8%) of the patients were categorized under relapse and 6 (4.2%) were defaulters while rest of the patients were new patients. History of contact was present in 87 (60.9%) cases. Response to ATT was taken as gold standard in present study therefore all patients were followed for 2 months, so 124 (86.7%) patients showed good response. Sensitivities of fluorescent microscopy, culture, GeneXpert, Lymphocyte counts and adenosine deaminase levels remained 9.7%, 21.8%, 17.8%, 79.1% and 93.8% respectively. Conclusions: Although bacterial confirmation of TB bacilli is necessary for definite diagnosis but sensitivity is compromised and multivariate approach is necessary and still in use for timely management of TPE.