Rapid diagnosis of tuberculous peritonitis by T cell-based assays on peripheral blood and peritoneal fluid mononuclear cells.

Abstract

OBJECTIVES:

The utility of a newly-developed Mycobacterium tuberculosis-specific enzyme-linked immunosorbent spot (ELISPOT) assay for diagnosis of tuberculous peritonitis (TBP) has not been fully assessed.

METHODS:

All patients with suspected TBP in a tertiary care hospital in an intermediate TB burden country were prospectively enrolled over a 30-month period. ELISPOT assays were performed on peripheral mononuclear cells (PBMC) and mononuclear cells from peritoneal fluid (PF-MC).

RESULTS:

Sixty-four patients with suspected TBP were enrolled. Of these, 30 (47%) were classified as having TBP (27 confirmed and 3 probable cases), and 25 (39%) were classified as not having active tuberculosis. The remaining 9 (14%) with possible TBP were excluded from the final analysis. Five (8%) of the total 64 patients gave indeterminate PBMC ELISPOT results and 7 (18%) of 39 patients who underwent PF-MC ELISPOT assay revealed indeterminate PF-MC ELISPOT results. The sensitivity and specificity, respectively, of the tested methods for diagnosing TBP were as follows: PBMC ELISPOT (≥ 6 spots), 86% and 67%; PF-MC ELISPOT (≥ 14 spots), 92% and 86%; PF-MC ELISPOT/PBMC ELISPOT ratio (≥ 2), 75% and 93%; and PF ADA levels (≥ 38 IU/L), 95% and 100%. The areas under the receiver operating characteristics curves were as follows: PF-MC ELISPOT, 0.96; PF ADA, 0.96; PBMC ELISPOT, 0.88; and PF-MC ELISPOT/PBMC ELISPOT ratio, 0.87, respectively.

CONCLUSIONS:

Although the ELISPOT assay does not outperform PF ADA, the ELISPOT assay using PBMC and PF-MC is a useful adjunct for diagnosing TBP, especially for a rule-in test when PF/MC/PBMC ELISPOT ratio (≥ 2) is used. However, the relatively high proportion of indeterminate results limits test utility, so further studies are needed to develop an optimized assay prototype.

• Authors: Oh-Hyun Cho, Ki-Ho Park, Su-Jin Park, Sun-Mi Kim, Seong Yeon Park, Song Mi Moon, Yong Pil Chong, Mi-Na Kim, Sang-Oh Lee, Sang-Ho Choi, Jun Hee Woo, Yang Soo Kim, Sung-Han Kim
• Journal: The Journal of infection (J Infect) Vol. 62 Issue 6 Pg. 462-71 (Jun 2011) ISSN: 1532-2742 [Electronic] England
• PMID: 21549430 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Topics

• Adult
• Aged
• Ascitic Fluid (immunology)
• Blood (immunology)
• Clinical Laboratory Techniques (methods)
• Enzyme-Linked Immunospot Assay (methods)
• Female
• Humans
• Leukocytes, Mononuclear (immunology)
• Male
• Middle Aged
• Peritonitis, Tuberculous (diagnosis)
• ROC Curve
• Sensitivity and Specificity