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Novel tests for diagnosing tuberculous pleural effusion: what works and what does not?

¹ Pró-reitoria de Saúde, Gama Filho University, Rio de Janeiro, Brazil, ² Montreal Chest Institute, McGill University, Montreal, QC, Canada, ³ Division of Pulmonology, Dept of Medicine, University of Cape Town, Rondebosch, South Africa, ⁴ Centre for Infectious Diseases and International Health, Royal Free and UCL Medical School, London, UK, ⁵ Dept of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, and ⁶ Dept of Medicine, Christian Medical College, Vellore, India.

CORRESPONDENCE: M. Pai, Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, Canada H3A 1A2. Fax: 1 5143984503. E-mail: madhukar.pai{at}mcgill.ca

Keywords: Biomarkers, diagnosis, pleuritis, sensitivity, specificity, tuberculosis

Received: November 6, 2007
Accepted January 24, 2008

Tuberculous pleuritis is a common manifestation of extrapulmonary tuberculosis and is the most common cause of pleural effusion in many countries. Conventional diagnostic tests, such as microscopic examination of the pleural fluid, biochemical tests, culture of pleural fluid, sputum or pleural tissue, and histopathological examination of pleural tissue, have known limitations. Due to these limitations, newer and more rapid diagnostic tests have been evaluated. In this review, the authors provide an overview of the performance of new diagnostic tests, including markers of specific and nonspecific immune response, nucleic acid amplification and detection, and predictive models based on combinations of markers. Directions for future development and evaluation of novel assays and biomarkers for pleural tuberculosis are also suggested.