Diagnosing tuberculous pericarditis

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dc.contributor.authorReuter H.
dc.contributor.authorBurgess L.
dc.contributor.authorvan Vuuren W.
dc.contributor.authorDoubell A.
dc.date.accessioned2011-05-15T16:17:47Z
dc.date.available2011-05-15T16:17:47Z
dc.date.issued2006
dc.description.abstractBackground: Definitive diagnosis of tuberculous pericarditis requires isolation of the tubercle bacillus from pericardial fluid, but isolating the organism is often difficult. Aim: To improve diagnostic efficiency for tuberculous pericarditis, using available tests. Design: Prospective observational study. Methods: Consecutive patients (n=233) presenting with pericardial effusions underwent a predetermined diagnostic work-up. This included (i) clinical examination; (ii) pericardial fluid tests: biochemistry, microbiology, cytology, differential white blood cell (WBC) count, gamma interferon (IFN-γ), adenosine deaminase (ADA) levels, polymerase chain reaction testing for Mycobacterium tuberculosis; (iii) HIV; (iv) sputum smear and culture; (v) blood biochemistry; and (vi) differential WBC count. A model was developed using 'classification and regression tree' analysis. The cut-off for the total diagnostic index (DI) was optimized using receiver operating characteristic (ROC) curves. Results: Fever, night sweats, weight loss, serum globulin (>40g/l) and peripheral blood leukocyte count (<10 × 10 9/l) were independently predictive. The derived prediction model had 86% sensitivity and 84% specificity when applied to the study population. Pericardial fluid IFN-γ ≥50pg/ml, concentration had 92% sensitivity, 100% specificity and a positive predictive value (PPV) of 100% for the diagnosis of tuberculous pericarditis; pericardial fluid ADA ≥40 U/l had 87% sensitivity and 89% specificity. A diagnostic model including pericardial ADA, lymphocyte/neutrophil ratio, peripheral leukocyte count and HIV status had 96% sensitivity and 97% specificity; substituting pericardial IFN-γ for ADA yielded 98% sensitivity and 100% specificity. Discussion: Basic clinical and laboratory features can aid the diagnosis of tuberculous pericarditis. If available, pericardial IFN-γ is the most useful diagnostic test. Otherwise we propose a prediction model that incorporates pericardial ADA and differential WBC counts. © 2006 Oxford University Press.
dc.description.versionArticle
dc.identifier.citationQJM
dc.identifier.citation99
dc.identifier.citation12
dc.identifier.issn14602725
dc.identifier.other10.1093/qjmed/hcl123
dc.identifier.urihttp://hdl.handle.net/10019.1/14369
dc.subjectadenosine deaminase
dc.subjectgamma interferon
dc.subjectglobulin
dc.subjectadult
dc.subjectarticle
dc.subjectblood chemistry
dc.subjectchemical analysis
dc.subjectclinical examination
dc.subjectclinical trial
dc.subjectcontrolled clinical trial
dc.subjectcontrolled study
dc.subjectcytopathology
dc.subjectdiagnostic accuracy
dc.subjectdiagnostic value
dc.subjectfemale
dc.subjectfever
dc.subjecthuman
dc.subjecthuman cell
dc.subjectHuman immunodeficiency virus
dc.subjectleukocyte differential count
dc.subjectlymphocyte count
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmicrobiological examination
dc.subjectMycobacterium tuberculosis
dc.subjectneutrophil count
dc.subjectnight sweat
dc.subjectobservational study
dc.subjectpericarditis
dc.subjectpolymerase chain reaction
dc.subjectpriority journal
dc.subjectprotein blood level
dc.subjectreceiver operating characteristic
dc.subjectregression analysis
dc.subjectrisk assessment
dc.subjectsensitivity and specificity
dc.subjectsputum culture
dc.subjectsputum smear
dc.subjectstatistical model
dc.subjectweight reduction
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectMycobacterium tuberculosis
dc.subjectPericarditis, Tuberculous
dc.subjectProspective Studies
dc.subjectSouth Africa
dc.titleDiagnosing tuberculous pericarditis
dc.typeArticle
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