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Use of Pleural Fluid Digital PCR Analysis to Improve the Diagnosis of Pleural Tuberculosis
The diagnosis of pleural tuberculosis (TB) remains difficult due to the paucity of Mycobacterium tuberculosis in pleural fluid (PF). This study aimed to improve pleural TB diagnosis using highly sensitive digital PCR (dPCR) technique. A total of 310 patients with evidence of PF were consecutively en...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Society for Microbiology
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9769588/ https://www.ncbi.nlm.nih.gov/pubmed/36264250 http://dx.doi.org/10.1128/spectrum.01632-22 |
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author | Li, Zihui Sun, Qi Du, Boping Jia, Hongyan Dong, Jing Lyu, Lingna Zhu, Chuanzhi Xing, Aiying Yang, Xinting Wei, Rongrong Chen, Xiaoyou Zhang, Zongde Pan, Liping |
author_facet | Li, Zihui Sun, Qi Du, Boping Jia, Hongyan Dong, Jing Lyu, Lingna Zhu, Chuanzhi Xing, Aiying Yang, Xinting Wei, Rongrong Chen, Xiaoyou Zhang, Zongde Pan, Liping |
author_sort | Li, Zihui |
collection | PubMed |
description | The diagnosis of pleural tuberculosis (TB) remains difficult due to the paucity of Mycobacterium tuberculosis in pleural fluid (PF). This study aimed to improve pleural TB diagnosis using highly sensitive digital PCR (dPCR) technique. A total of 310 patients with evidence of PF were consecutively enrolled, 183 of whom suffered from pleural TB and 127 from non-TB. PF samples were prospectively collected and total DNA was extracted. The copy numbers of M. tuberculosis insertion sequence (IS) 6110 and IS1081 in DNA were quantified using dPCR. The overall area under the curve of IS6110-dPCR was greater than that of IS1081-dPCR (0.85 versus 0.79). PF IS6110 OR IS1081-dPCR (according to their cut-off values, “positive” was defined as either of them was positive, while “negative” was defined as both of them were negative) had higher sensitivity and equal specificity compared with single target-dPCR. The sensitivity of PF IS6110 OR IS1081-dPCR for total, definite, and probable pleural TB was 59.0% (95% CI = 51.5% to 66.2%), 72.8% (95% CI = 62.6% to 81.6%), and 45.1% (95% CI = 34.6% to 55.8%), respectively. Its specificity was 100% (95% CI = 97.1% to 100.0%). PF IS6110 OR IS1081-dPCR showed a higher sensitivity than smear microscopy (57.4% versus 7.1%), mycobacterial culture (55.3% versus 31.8%), and Xpert MTB/RIF (57.6% versus 23.0%). Long antituberculosis treatment time (>1 month) was found to be associated with negative dPCR results in pleural TB patients. This study indicates that PF IS6110 OR IS1081-dPCR is an accurate molecular assay, which is more sensitive than routine etiological tests and has the potential to enhance the definite diagnosis of pleural TB. IMPORTANCE Pleural TB is one of the most frequent causes of pleural effusion, especially in areas with high burden of TB. Due to the paucibacillary nature of the disease, the diagnostic sensitivities of all available bacteriological and molecular tests remain poor. There is an urgent need to develop new efficient methods. Digital PCR (dPCR) is the third generation of PCR that enables the exact quantification of trace nucleic acids in samples. This study evaluates the diagnostic performance of pleural fluid (PF) dPCR analysis for pleural TB, and shows that PF IS6110 OR IS1081-dPCR has a higher sensitivity than routine etiological tests such as smear microscopy, mycobacterial culture, and Xpert MTB/RIF. This work provides a new choice for improving the definite diagnosis of pleural TB. |
format | Online Article Text |
id | pubmed-9769588 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Society for Microbiology |
record_format | MEDLINE/PubMed |
spelling | pubmed-97695882022-12-22 Use of Pleural Fluid Digital PCR Analysis to Improve the Diagnosis of Pleural Tuberculosis Li, Zihui Sun, Qi Du, Boping Jia, Hongyan Dong, Jing Lyu, Lingna Zhu, Chuanzhi Xing, Aiying Yang, Xinting Wei, Rongrong Chen, Xiaoyou Zhang, Zongde Pan, Liping Microbiol Spectr Research Article The diagnosis of pleural tuberculosis (TB) remains difficult due to the paucity of Mycobacterium tuberculosis in pleural fluid (PF). This study aimed to improve pleural TB diagnosis using highly sensitive digital PCR (dPCR) technique. A total of 310 patients with evidence of PF were consecutively enrolled, 183 of whom suffered from pleural TB and 127 from non-TB. PF samples were prospectively collected and total DNA was extracted. The copy numbers of M. tuberculosis insertion sequence (IS) 6110 and IS1081 in DNA were quantified using dPCR. The overall area under the curve of IS6110-dPCR was greater than that of IS1081-dPCR (0.85 versus 0.79). PF IS6110 OR IS1081-dPCR (according to their cut-off values, “positive” was defined as either of them was positive, while “negative” was defined as both of them were negative) had higher sensitivity and equal specificity compared with single target-dPCR. The sensitivity of PF IS6110 OR IS1081-dPCR for total, definite, and probable pleural TB was 59.0% (95% CI = 51.5% to 66.2%), 72.8% (95% CI = 62.6% to 81.6%), and 45.1% (95% CI = 34.6% to 55.8%), respectively. Its specificity was 100% (95% CI = 97.1% to 100.0%). PF IS6110 OR IS1081-dPCR showed a higher sensitivity than smear microscopy (57.4% versus 7.1%), mycobacterial culture (55.3% versus 31.8%), and Xpert MTB/RIF (57.6% versus 23.0%). Long antituberculosis treatment time (>1 month) was found to be associated with negative dPCR results in pleural TB patients. This study indicates that PF IS6110 OR IS1081-dPCR is an accurate molecular assay, which is more sensitive than routine etiological tests and has the potential to enhance the definite diagnosis of pleural TB. IMPORTANCE Pleural TB is one of the most frequent causes of pleural effusion, especially in areas with high burden of TB. Due to the paucibacillary nature of the disease, the diagnostic sensitivities of all available bacteriological and molecular tests remain poor. There is an urgent need to develop new efficient methods. Digital PCR (dPCR) is the third generation of PCR that enables the exact quantification of trace nucleic acids in samples. This study evaluates the diagnostic performance of pleural fluid (PF) dPCR analysis for pleural TB, and shows that PF IS6110 OR IS1081-dPCR has a higher sensitivity than routine etiological tests such as smear microscopy, mycobacterial culture, and Xpert MTB/RIF. This work provides a new choice for improving the definite diagnosis of pleural TB. American Society for Microbiology 2022-10-20 /pmc/articles/PMC9769588/ /pubmed/36264250 http://dx.doi.org/10.1128/spectrum.01632-22 Text en Copyright © 2022 Li et al. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Research Article Li, Zihui Sun, Qi Du, Boping Jia, Hongyan Dong, Jing Lyu, Lingna Zhu, Chuanzhi Xing, Aiying Yang, Xinting Wei, Rongrong Chen, Xiaoyou Zhang, Zongde Pan, Liping Use of Pleural Fluid Digital PCR Analysis to Improve the Diagnosis of Pleural Tuberculosis |
title | Use of Pleural Fluid Digital PCR Analysis to Improve the Diagnosis of Pleural Tuberculosis |
title_full | Use of Pleural Fluid Digital PCR Analysis to Improve the Diagnosis of Pleural Tuberculosis |
title_fullStr | Use of Pleural Fluid Digital PCR Analysis to Improve the Diagnosis of Pleural Tuberculosis |
title_full_unstemmed | Use of Pleural Fluid Digital PCR Analysis to Improve the Diagnosis of Pleural Tuberculosis |
title_short | Use of Pleural Fluid Digital PCR Analysis to Improve the Diagnosis of Pleural Tuberculosis |
title_sort | use of pleural fluid digital pcr analysis to improve the diagnosis of pleural tuberculosis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9769588/ https://www.ncbi.nlm.nih.gov/pubmed/36264250 http://dx.doi.org/10.1128/spectrum.01632-22 |
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