Amer Safaa, Hefnawy Azza El, Wahab Nashwa Abdel, Okasha Hadir, Baz Amira
Medical Microbiology and Immunology Department, Faculty of Medicine Alexandria University, Alexandria, Egypt.
Chest Disease Department, Faculty of Medicine Alexandria University, Alexandria, Egypt.
Int J Mycobacteriol. 2016 Dec;5(4):437-445. doi: 10.1016/j.ijmyco.2016.07.001. Epub 2016 Jul 20.
BACKGROUND/OBJECTIVE: Tuberculous pleurisy is a diagnostic challenge due to its nonspecific clinical presentation, paucibacillary nature of the effusion together with the inefficiency of conventional laboratory methods motivating the evaluation of variable diagnostic strategies.
Using thoracoscopy, the pleural cavity of 50 patients with undiagnosed exudative pleural effusion were fully examined and biopsy specimens of affected parietal pleura were taken under direct vision. Pleural fluid and biopsy specimen were subjected to microscopic examination (direct and after cytocentrifugation), culture, PCR, and histopathological examination.
The pleural biopsy specimens proved to have a higher detection rate of tubercle bacilli than pleural fluid. Also, cytocentrifugation improved the sensitivity of microscopic detection for both pleural fluid and biopsy specimens.
The combination of microbiological results and histopathology examination of the pleural biopsy specimens is essential for the diagnosis of tuberculous pleurisy, as microbiological examination of pleural biopsy specimens has proved to have a higher detection rate than pleural fluid examination.
背景/目的：结核性胸膜炎因其临床表现不具特异性、胸腔积液中细菌数量少以及传统实验室方法效率低下，给诊断带来挑战，这促使人们对多种诊断策略进行评估。
采用胸腔镜对50例未确诊的渗出性胸腔积液患者的胸腔进行全面检查，并在直视下获取患侧壁层胸膜的活检标本。对胸腔积液和活检标本进行显微镜检查（直接检查和细胞离心后检查）、培养、聚合酶链反应（PCR）以及组织病理学检查。
胸膜活检标本中结核杆菌的检出率高于胸腔积液。此外，细胞离心提高了胸腔积液和活检标本显微镜检测的敏感性。
胸膜活检标本的微生物学结果与组织病理学检查相结合对于结核性胸膜炎的诊断至关重要，因为胸膜活检标本的微生物学检查已证明比胸腔积液检查具有更高的检出率。
