Archives of Disease in Childhood 2006;91:985-989
ORIGINAL ARTICLE
Evaluation of polymerase chain reaction and adenosine deaminase assay for the diagnosis of tuberculous effusions in children
1 Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
2 Department of Biochemistry, Institute of Medical Sciences
3 Department of Microbiology, Institute of Medical Sciences
Correspondence to:
O P Mishra
Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, 12 G F, Kabir Colony, PO BHU, Varanasi 221005, India;opmpedia{at}yahoo.co.uk
Aim: To evaluate and compare the utility of polymerase chain reaction (PCR) for the diagnosis of tuberculous effusions in children.
Methods: PCR, adenosine deaminase (ADA) activity and absolute lymphocyte count (ALC) were evaluated in the fluid of 31 tuberculous (20 pleural, 8 ascites and 3 pericardial) and 24 non-tuberculous (10 transudtative ascites, 8 empyema thoracis, 3 malignant pleural and 3 pyopericardium) effusions.
Results: Fluid PCR for Mycobacterium tuberculosis was positive in 74% of tuberculous effusions, whereas it was falsely positive in 13% of the non-tuberculous group. The mean fluid ADA and ALC values were significantly higher in tuberculous effusions than in non-tuberculous effusions (p<0.001). The sensitivity and specificity of PCR, ADA (
38 IU/l) and ALC (275/mm3) were 74% and 88%, 81% and 75%, and 90% and 83%, respectively, in diagnosing tuberculous effusions. The sensitivity of PCR, ADA and ALC was 100%, 100% and 88%, respectively, for confirmed tuberculous effusions. When the two tests were combined (either/or positive), the sensitivity increased (90–100%) at the expense of specificity. When both the tests were positive, then the specificity markedly increased (92–96%), but sensitivity of the tests decreased.
Conclusion: Fluid PCR alone should not be relied on as a single test; rather, combined analysis with either ADA or ALC could be more useful in the diagnosis of tuberculous effusions in children.
Abbreviations: ADA, adenosine deaminase; AFB, acid-fast bacillus; ALC, absolute lymphocyte count; BCG, Bacillus-Calmette Guerin; PCR, polymerase chain reaction
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Arch. Dis. Child. 2006 91: e8.
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