Diagnosing tuberculous pericarditis
Date
2006
Authors
Reuter H.
Burgess L.
van Vuuren W.
Doubell A.
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Abstract
Background: 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.
Description
Keywords
adenosine deaminase, gamma interferon, globulin, adult, article, blood chemistry, chemical analysis, clinical examination, clinical trial, controlled clinical trial, controlled study, cytopathology, diagnostic accuracy, diagnostic value, female, fever, human, human cell, Human immunodeficiency virus, leukocyte differential count, lymphocyte count, major clinical study, male, microbiological examination, Mycobacterium tuberculosis, neutrophil count, night sweat, observational study, pericarditis, polymerase chain reaction, priority journal, protein blood level, receiver operating characteristic, regression analysis, risk assessment, sensitivity and specificity, sputum culture, sputum smear, statistical model, weight reduction, Female, Humans, Male, Mycobacterium tuberculosis, Pericarditis, Tuberculous, Prospective Studies, South Africa
Citation
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