FluoroType® MTB in pleural fluid for diagnosing tuberculosis.

To assess the cost-effectiveness of a nucleic acid amplification test (FluoroType MTB®) in pleural fluid (PF) and sputum to diagnose tuberculous pleural effusion (TPE). We also analysed the increase in diagnostic yield of a second FluoroType MTB® test, obtained through a new thoracentesis, when the first had resulted negative. We conducted a prospective single-centre study that included 207 patients with pleural effusion (31 tuberculous and 176 from other causes). Of the 31 cases of TPE, 21 (68%) were confirmed histologically or microbiologically; the other cases were considered probable. The operational characteristics of FluoroType MTB® in PF for identifying tuberculosis were a sensitivity of 13%, a specificity of 99%, a positive likelihood ratio of 11 and a negative likelihood ratio of 0.9. The diagnostic efficacy data for sputum samples was 21%, 91%, 2.4 and 0.9, respectively. The PF and sputum cultures in solid and liquid media had greater sensitivity (36% and 31%, respectively). A second FluoroType MTB® test in PF was negative for 24 patients with TPE, and a first FluoroType MTB® test also negative. Only 2 (6.5%) patients with TPE had a confirmed diagnosis based exclusively on the positive results of the FluoroType MTB® in PF. Due to its low sensitivity, the FluoroType MTB® test in PF has a limited role in diagnosing tuberculous pleurisy.

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