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BACKGROUND: Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation which still has lasting effect on lung function, however conventional diagnostic tests for TPE register multiple limitations. OBJECTIVES: This study aims to investigate diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics comparing to adenosine deaminase (ADA), in order to clarify its appropriate setting in clinical diagnosis.METHODS: We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively from June 2015 to October 2018. By using receiver operating characteristic (ROC) curves, technical cut-offs for all enrolled participants were determined, and the utility of IGRA for pleural fluid (PF) was analysed. We obtained the independent risk factors using logistic regression analysis for TPE and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA.RESULTS: A total of 601 individuals was consecutively recruited. The maximum of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, with a sensitivity of 83.0% and a specificity of 83.1%. The corresponding cut-off value was 466 SFCs/106 mononuclear cells, which was equal to ADA (0.885 vs 0.887, P=0.957) and superior to PB. Among the TPE patients with low ADA (PPP=0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity (76.5% vs. 23.5%, P=0.016) for ADA and had noninferior specificity (84.4% vs. 96.9%, P=0.370).CONCLUSIONS: In conclusion, the overall potency of the PF T-SPOT assay is equal to that of ADA for diagnosing TPE. In addition, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is extremely superior to ADA in unconventional TPE patients (age≥45 yrs, female or BMI≥22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.

BACKGROUND: Interferon Gamma Release Assay (IGRA) is still controversial in differentiating tuberculous pleural effusion (TPE), through recommended by World Health Organization (WHO) for identification of latent tuberculosis infection. OBJECTIVES: Aim to in comparison to Adenosine deaminase (ADA), evaluate the IGRA (T-SPOT.TB) diagnostic efficacy for TPE patients of different characteristics, to clarify its appropriate scene in clinical diagnosis. METHODS: A prospective, single-centre study including all suspected pleural effusion patients consecutively from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, all enrolled participants were determined technical cut-off and the utility of IGRA for pleural fluid (PF). Obtain the independent risk factors by logistic regression analysis for TPE, and evaluate the performance of T-SPOT stratified by risk factors, in comparison to ADA. RESULTS: A total of 601 individuals were consecutively recruited. The maximum of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in PF T-SPOT had the best diagnostic efficiency in our study, with a sensitivity of 83.0% and a specificity of 83.1%, corresponding cut-off value is 466 SFCs/10 6 mononuclear cells, which was equal to ADA (0.885 vs 0.887, P=0.957) and superior than in PB; Among the TPE patients with low ADA(45yrs, female or BMI≧22). PF T-SPOT assay is an extremely good choice to supplement ADA to diagnose TPE.

Background Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation and may have lasting effect on lung function. However conventional diagnostic tests for TPE register multiple limitations. This study estimates diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics. Methods We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively enrolled from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, technical cut-offs and the utility of T-SPOT on pleural fluid (PF) were determined and analysed. Logistic regression analysis was performed to obtain the independent risk factors for TPE, and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA. Results A total of 601 individuals were consecutively recruited. The maximum spot-forming cells (SFCs) of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, which was equal to ADA (0.885 vs 0.887, P = 0.957) and superior to peripheral blood (PB), with a sensitivity of 83.0% and a specificity of 83.1% (The cut-off value was 466 SFCs/106 mononuclear cells). Among the TPE patients with low ADA (P P P = 0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity for ADA (76.5% vs. 23.5%, P = 0.016) and had noninferior specificity (84.4% vs. 96.9%, P = 0.370). Conclusions In conclusion, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is superior to ADA in unconventional TPE patients (age ≥ 45 yrs., female or BMI ≥ 22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.

Background. Treatment response for the Mycobacterium abscessus (M. abscessus) lung disease remains far from satisfying. An effective regimen is needed to solve the problem. Methods. We retrospectively reviewed the medical records of all patients with M. abscessus lung disease who received antibiotics regimen at Beijing Chest Hospital Affiliated to Capital Medical University between July 1, 2010, and February 1, 2018. Patients were administered a conventional antibiotics regimen (including macrolide and moxifloxacin, along with an initial 12-week course of low-dose cefoxitin and amikacin) or intensified regimen (including a higher dosage of cefoxitin and linezolid besides conventional drugs), respectively. The time to sputum-culture conversion and proportion of sputum-culture conversion in liquid broth were investigated to evaluate the efficacy and evaluation of safety by performing the classification of adverse events according to the Division of AIDS, National Institute of Allergy and Infectious Disease. Patients were followed for 18 months from baseline. Results. In the conventional regimen group, the sputum conversion rate at 18 months was 29.4% (10/34), and the median time until sputum conversion was 2 months (IQR, 1-2 mo). Furthermore, in the intensified regimen group, the sputum conversion rate was 81.3% (13/16), and the median time until sputum conversion was 1 month (IQR, 1-1 mo). Leukopenia and drug-induced hepatotoxicity occurred more frequently in the intensified regimen group in contrast with the conventional regimen group patients. However, only 1 adverse event in the intensified regimen group was classified as severe adverse event. Conclusions. The intensified regimen could improve sputum conversion of M. abscessus lung disease compared with conventional regimen, but close safety surveillance is necessary to monitor adverse events.

Supplemental Digital Content is available in the text, Vitamin D is associated with the susceptibility of tuberculosis and might have an adjunctive effect on anti-tuberculosis treatment. This study aims to investigate the association of vitamin D deficiency and vitamin D receptor (VDR) gene polymorphisms with susceptibility and severity to multidrug-resistant tuberculosis (MDR-TB) in comparison with drug-sensitive tuberculosis (DS-TB) and health controls in China. A total of 180 patients with pulmonary TB (128 DS-TB, 52 MDR-TB) and 59 healthy controls were enrolled into 3 groups. Vitamin D levels and VDR genotypes at FokI, BsmI, ApaI, and TaqI sites of all the participants and clinical characteristics of patients with TB were measured and collected. Statistical analysis revealed that vitamin D levels were lower in both TB groups. Patients with TB with bilateral lesions and patients with MDR-TB with extrapulmonary TB had lower vitamin D levels. The frequencies of ff genotype and f allele were higher in both TB groups. Patients with Ff genotype and ff genotype had lower proportion of extrapulmonary TB. Patients with ff genotype had higher proportion of retreatment. Male patients with ff genotype had higher proportion of cavity formation. Patients with DS-TB with AA genotype had higher proportion of cavity formation. Our findings demonstrate that vitamin D deficiency and ff genotype may be the risk factors of TB in Chinese population. In addition, patients with TB with lower level of vitamin D may have a greater risk of bilateral lesions and extrapulmonary TB. VDR genotypes may be associated with TB clinical characteristics.