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Objective: To summarize the clinical diagnostic essentials of pediatric tuberculous pleurisy so as to reduce the misdiagnosis rate. Method: A retrospective study was conducted on 113 cases of tuberculous pleurisy who were seen from August 2006 to September 2014 in the second Department of Respiratory Medicine, Beijing Children's Hospital Affiliated to Capital Medical University. Meanwhile, another 113 cases of children over 5 years of age with mycoplasma pneumoniae pneumonia complicated with pleural effusion were randomly selected as control group. The following five items were analyzed in relation to the diagnosis: fever, cough, lung lesions, pleural effusion(unilateral or bilateral), adenosine deaminase (ADA) level in pleural effusion, tuberculin skin test(PPD). The sensitivity and specificity of single item and combined items in diagnosis were studied. Result: (1) Among two groups, the proportion of patients with persisting fever was 92.0% (104 cases) and 98.2% (111 cases), while the proportion of patients with cough was 47.8% (54 cases) and 99.1% (112 cases) (χ(2)=76.3, P <0.01), respectively. There were 25(22.1%) cases and 113(100.0%) cases with lung lesions (except for atelectasis) in two groups (χ(2)=144.1, P <0.01), respectively. The proportion of patients with unilateral pleural effusion was 94.7%(107 cases) and 71.7%(81 cases)(χ(2)=21.4, P <0.01) while the patients with positive PPD results was 93.8%(106 cases) and 3.5%(4 cases)(χ(2)=184.3, P <0.01). The level of ADA in pleural effusion in both groups are comparable[46.4(22.0-70.9)U/L]and[39.5(26.3-78.5)U/L]. (2)The sensitivity of the lack of cough, lack of lung lesions, unilateral pleural effusion and PPD test positive in diagnosis of tuberculous pleurisy were 52.2%, 77.9%, 94.7%, 93.8%, while the specificity was 99.1%, 100.0%, 28.3%, 96.5%, respectively. Among the four items, the specificity of unilateral pleural effusion was only 28.3%, so it needed to be added with other indicators to improve the specificity. The sensitivity of unilateral pleural effusion combined with positive PPD, lack of cough, lack of lung lesions were 88.5%, 50.4% and 73.5%, while the specificity was 96.5%, 99.1%, and 100.0%, respectively, which significantly improved the specificity so as to reduce misdiagnosis. Conclusion: In children aged over 5 years who present with persistent fever and pleural effusion, tuberculous pleurisy should be considered even in the absence of cough or lung lesions(except for atelectasis), or with positive PPD result, any of the three features is specific for the diagnosis. Unilateral pleural effusion is more meaningful for the diagnosis when it is combined with any of the above three features.

Objective: To evaluate the performance of T cell enzyme-linked immuno-spot assay (T-SPOT) on peripheral blood in combination with adenosine deaminase (ADA) on pleural fluid for diagnosis of tuberculous (TB) pleurisy within different age groups. Methods: The data of patients with pleural effusion from the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from April 2012 to November 2016 were retrospectively analyzed, and the diagnoses of these patients were histopathologically confirmed through medical thoracoscopy. The cases who had confirmed diagnosis, in the same time, received peripheral blood T-SPOT.TB were enrolled. The performance of peripheral blood T-SPOT.TB in combination with pleural fluid ADA on diagnosing TB pleurisy in the younger patients (16-59 years old) and elderly patients (≥60 years old) were analyzed respectively. The sensitivity, specificity and the receiver operating characteristic (ROC) curve were adopted for statistical analysis. Results: A total of 448 cases were finally enrolled, 341(76.1%) confirmed with TB pleurisy, 224 males, 117 females, (47±19) years old; and 107 (23.9%) classified as non-TB pleurisy, 65 males, 42 females, (61±14) years old. There were 285 cases who were classified as younger group, and the other 163 cases were classified as elderly group. The sensitivity and specificity of peripheral blood T-SPOT.TB were 85.4% (204/239) and 71.7% (33/46) in the younger patients, 76.5% (78/102) and 59.0% (36/61) respectively in the elderly patients. The sensitivity of peripheral blood T-SPOT.TB in the younger patients was significantly higher than that in the elderly patients ( P =0.047). The sensitivity and specificity were 99.2% and 95.7% in combination with peripheral blood T-SPOT.TB and pleural fluid ADA respectively in the younger patients. The area under ROC curve (AUC) of T-SPOT.TB in the younger patients was 0.833, AUC of T-SPOT.TB combined with ADA was 0.911. The combination test of 2 tests had the sensitivity of 96.1% and the specificity of 90.2% respectively in the elderly patients. The AUC of T-SPOT.TB in the elderly patients was 0.747, AUC of T-SPOT.TB combined with ADA was 0.911. Conclusion: Peripheral blood T-SPOT.TB combined with pleural fluid ADA can improve the diagnostic performance for TB pleurisy with different ages, especially for elderly patients who can't tolerate pleural biopsy.

Objective: To compare the diagnostic performance of interferon gamma releasing assays (T-SPOT. TB) and adenosine deaminase (ADA) in pleural tuberculosis, and therefore to evaluate the value of T-SPOT. TB in a high tuberculosis burden country., Methods: From June 2011 to November 2012, 111 patients with pleural fluid in Beijing Chest Hospital, Capital Medical University were enrolled prospectively and categorized as culture/biopsy-confirmed pleural tuberculosis group (n = 59) and non-pleural tuberculosis group (n = 52). Patients with uncertain diagnosis and clinically diagnosed pleural tuberculosis were excluded from the study. Pleural fluid T-SPOT. TB and ADA measurements were performed, in addition to other routine laboratory tests. Continuous variables (spot forming cells, SFCs) were compared using nonparametric Mann-Whitney U test. Comparisons between proportions were performed using Chi-squared test., Results: The receiver operating characteristic (ROC) curve and cut-off value of pleural fluid T-SPOT. TB were established according to spot forming cells (SFC) between culture/biopsy-confirmed pleural tuberculosis group and non-pleural tuberculosis group (216 SFC/10(6) pleural fluid mononuclear cells). The sensitivity of pleural fluid T-SPOT. TB and ADA was 91.5% (54/59) and 71.2% (42/59), respectively. The specificity was 90.4% (47/52) and 92.0% (46/50), respectively. The sensitivity of pleural fluid T-SPOT. TB was significantly higher than that of ADA (χ(2) = 8.045, P < 0.01). There was no significant difference of specificity between pleural fluid T-SPOT. TB and ADA (χ(2) = 0.000, P > 0.05). The area under the ROC curve was 0.912 for pleural fluid T-SPOT. TB and 0.903 for ADA. The sensitivity of combination diagnosis of ADA and pleural fluid T-SPOT. TB decreased to 67.8% (40/59), but the specificity increased to 100.0% (50/50)., Conclusions: Pleural fluid T-SPOT. TB are relatively accurate supplementary assays for the diagnosis of pleural tuberculosis in this high tuberculosis burden country, and the combination of pleural fluid ADA and T-SPOT. TB is of diagnostic value.

Objective: To investigate the clinical value of pleural fluid adenosine deaminase (ADA) activity in differentiating tuberculous pleural effusions (TPE) from malignant effusions., Methods: The serum and pleural adenosine deaminase activity of 91 cases confirmed by pleural biopsy through medical thoracoscopy were retrospectively analyzed. TPE was confirmed in 49 cases and malignant effusion in 42 cases. The optimal cutoff for TPE was determined by using the ROC curve., Results: The mean pleural ADA was significantly (t = 7.383, P < 0.01) higher in PTE (46 +/- 26) U/L as compared to malignancy (16 +/- 8) U/L, so was the pleural fluid/serum ADA ratio (4.1 +/- 4.0 vs 1.76 +/- 1.2, t = 3.852, P < 0.01), but there was no statistically significant difference between malignant and tuberculous effusion in serum ADA activity [(13 +/- 5) U/L vs (12 +/- 6) U/L, t = 1.582, P > 0.05]. The cutoff value of pleural ADA for PTE was 28.7 U/L, with a sensitivity of 75.5% and a specificity of 95.2%., Conclusions: Pleural fluid, but not serum, ADA activity, can be used for the differentiation between tuberculous and malignant pleural effusions.

Objective: To investigate the diagnostic value of interferon-gamma (IFN-gamma), interleukin-12 (IL-12) and adenosine deaminase isoenzymes (ADA(2)) in tuberculous pleural effusions., Methods: One hundred and ninety specimens of pleural effusion were collected from 190 patients with pleural effusion in Peking University People's Hospital, Beijing Chest Hospital, and Beijing Tuberculosis and Thoracic Tumor Institute, from March 2002 to February 2003. Of them 141 pleural specimens were diagnosed as tuberculous, and 49 as malignant. IFN-gamma and IL-12 concentrations and ADA isoenzyme activity in all the specimens were determined by ELISA and enzyme kinetic analytical method respectively., Results: (1) ADA(2) activity (47.9 +/- 6.9) U/L in tuberculous effusions was significantly higher than that in malignant effusion (13.2 +/- 3.2) U/L (P < 0.01). The IFN-gamma level (112.1 +/- 45.8) ng/L in tuberculous effusion was significantly higher than that in malignant diseases (24.8 +/- 5.9) ng/L (P < 0.01). The IL-12 level (104.3 +/- 32.3) ng/L in tuberculous effusions was significantly higher than that in malignant diseases (61.8 +/- 10.8) ng/L (P < 0.05). (2) By analysis of ROC curves, the cut-off values for IFN-gamma, IL-12 and ADA(2) were defined. The sensitivity and specificity of IFN-gamma for tuberculous effusion were 84.4% and 95.9% respectively. Those of IL-12 for tuberculous effusion were 85.1% and 65.3% respectively, while those of ADA(2) were 84.4% and 91.8%., Conclusions: IFN-gamma and IL-12 could be used as valuable parameters for the differentiation of tuberculous effusion from malignant, and IFN-gamma was more sensitive and specific for tuberculous effusion than IL-12 and ADA(2).

Objective: To evaluate the tests for anti-TB and adenosine deaminase (ADA) in ascites in an attempt to distinguish between tuberculous ascites and carcinous ascites., Methods: DIGFA was used to test anti-TB and Martineck's method was used to determine the level of ADA in 35 cases of tuberculous ascites and 31 cases of carcinous ascites., Results: The levels of anti-TB and ADA in ascites were significantly higher in tuberculous ascites than those in carcinous ascites (P < 0.01). When the level of ADA was higher than 45 U/L, the sensitivity, specificity and accuracy in the diagnosis of tuberculous ascites were 100%, 97.1% and 98.5%, respectively. When the result of anti-TB test was positive, the sensitivity, specificity and accuracy in the diagnosis of tuberculous ascites were 93.5%, 94.3% and 95.38%, respectively., Conclusion: The tests for anti-TB and ADA in ascites are of important clinical value to differential diagnosis in an attempt to distinguish between tuberculous ascites and carcinous ascites.

Enzyme-Linked Immunospot Assay (ELISPOT) were designed in the diagnostic value of tuberculous pleurisy, had a sensitivity of 90% and specificity of 100%. Anti-PPD IgG antibodies detected by ELISA had a sensitivity of 45% and specificity of 86%. For ADA activity in pleural effesion, the sensitivity and specificity were 75%, 79% respectively. Comparing with ADA and ELISA methods, ELISPOT is a more useful method for diagnosis of tuberculosis pleurisy.