Diagnosis of active tuberculous serositis by antigen-specific interferon-γ response of cavity fluid cells

Abstract

Background. To develop a more accurate methodology for diagnosing active tuberculous pleurisy, as well as peritonitis and pericardits of tuberculous origin, we established an antigen-specific interferon γ (IFN-γ)-based assay that uses cavity fluid specimens. Methods. Over a 19-month period, 155 consecutive, nonselected patients with any cavity effusion were evaluated. Study subjects were 28 patients with bacteriologically confirmed active tuberculous serositis and 47 patients with definitive nontuberculous etiology. Culture was performed for 18 h with fluid mononuclear cells in the supernatant of the effusion together with saline or Mycobacterium tuberculosis-specific antigenic peptides, early secretory antigenic target 6 and culture filtrate protein 10. IFN-γ concentrations in the culture supernatants were measured. Results. In patients with active tuberculous serositis, antigen-specific IFN-γ responses of cavity fluid samples were significantly higher than those of nontuberculous effusion samples. Area under the receiver operating characteristic (AUROC) curve was significantly greater for cavity fluid IFN-γ response (AUROC curve, 0.996) than for cavity fluid adenosine deaminase and whole-blood IFN-γ responses (AUROC curve, 0.882 and 0.719, respectively; P = .037 and respectively). Although the AUROC curve was greater for cavity fluid IFN-γ response than for background cavity fluid IFN-γ level (AUROC curve, 0.975), the AUROC curves were not statistically significantly different (P = .74). However, multivariate logistic regression analysis revealed that cavity fluid IFN-γ responses were significantly associated with the diagnosis, even after adjustment for background IFN-γ level (adjusted odds ratio, 1.21; 95% confidence interval, 1.03-1.42; ). P < .001 Conclusions. The cavity fluid IFN-γ assay could be a method for accurately and promptly diagnosing active tuberculous serositis. © 2007 by the Infectious Diseases Society of America. All rights reserved.