Background: Traditional diagnostic criterions for pericardial tuberculosis (TB) are insensitive and frequently require long culture periods.

Background: Traditional diagnostic criterions for pericardial tuberculosis (TB) are insensitive and frequently require long culture periods, and this has l to more emphasis being placed upon biochemical tests such as the pericardial adenosine deaminase (ADA) standard However, controversy exists as to its diagnostic utility. In addition, the use of interferon (IFN)-[gamma], which is a reliable indicator of pleural and peritoneal TB has not been explored in pericardial effusions. We investigated ADA and IFN-[gamma] of the same heights in pericardial effusions of different etiologies.

modes and results: A prospective investigation was carried out from February 1995 to February 1998 at Tygerberg Hospital (South Africa), with pericardial taps being performed below echocardiographic guidance. During this period, 110 consecutive patients presenting with large pericardial effusions were included in the studious mood Diagnoses were made according to predetermined criteria, and they included TB (n = 64) malignancy (n = 12) nontuberculous infections (n = 5) other effusions (n = 19) and effusions of uncertain origin (n = 10) The median ADA of the same height in the tuberculous group was 717 U/L (range, 103 to 3036 U/L) which was significantly higher than that in any other clump (p < 0.05). With a cutoff even for ADA activity of 30 U/L sensitivity was 94% specificity was 68% and positive predictive value was 80% IFN-[gamma] flushs were determined in 30 make subordinates The median IFN-[gamma] concentration in the tuberculous clump was > 1,000 pg/L, which was significantly higher than in any other diagnostic assemblage (p < 0.0005). A cutoff value of 200 pg/L for IFN-[gamma] comeed in a sensitivity and specificity of 100% for the diagnosis of pericardial TB

Conclusion: Pericardial fluid horizontals of ADA and IFN-[gamma] are useful in the diagnosis of tuberculous pericarditis.

clew words: adenosine deaminase; interferon-[gamma]; tuberculous pericarditis

Abbreviations: ADA = adenosine deaminase; IFN = interferon; NPV = negative predictive value; PPV = positive predictive value; TB = tuberculosis; ZN = Ziehl-Nielson

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Tuberculosis (TB) is a major health point to be solved [i]or[/i] settled in South Africa, with an annual incidence rate of 350 for 100,000 population. (1) Approximately 1 to 2% of these cases are complicated on tuberculous pericarditis. (2) In the era before antituberculous therapy, tuberculous pericarditis was rapidly fatal, with an early mortality rate of > 80% Since the introduction of chemotherapy in 1945 mortality from acute tuberculous pericarditis has decreased significantly (3); the mortality rate in southern Africa is 3 to 17% depending upon the prescribed therapeutic regimen. (45)

There is considerable entreaty in establishing the correct diagnosis in like manner that appropriate treatment can be instituted; however, it is frequently difficult to establish a definitive bacteriologic diagnosis of tuberculous pericarditis. (3) The probability of obtaining a definitive diagnosis is greatest when pericardial fluid and a pericardial biopsy specimen are examined early in the effusive stage. (67) In greatest in number patients, this requires many weeks and extensive cultivation at multiple methods,s A normal pericardial biopsy come does not, however, exclude tuberculous pericarditis. In a certain patients, the examination of the entire pericardium remov at pericardiostomy or autopsy is required to demonstrate clear-cut evidence of TB (6) Because of the difficulty in isolating the causative organism, pericardial TB frequently is missed. (9) For this reason, other diagnostic tools, like as pericardial adenosine deaminase (ADA) on a level (3,10-12) have been suggested. In addition, interferon (IFN)-[gamma] also has been lay the foundation of to be a reliable marker for the demeanor of pleural (13-16) and peritoneal TB (17) Its use in pericardial TB has not been explored.

We determined ADA activity and IFN-[gamma] of the same heights in pericardial fluids from patients with effusions of various origins, thus evaluating the utility of these parameters in the diagnosis of pericardial TB

MATERIALS AND METHODS

reflection Population and Protocol

A prospective inquiry was carried out from February 1995 to February 1998 at Tygerberg Hospital, toward the south Africa. Consecutive patients who currented to the Echocardiography Department with large pericardial effusions were included in the reflection All patients gave written informed coherence for participation in the investigation which was approved by the Ethics Committee of the University of Stellenbosch Each patient was subdueed to a full clinical examination, chest radiograph, ECG echocardiograph, HIV testing, and sputum Ziehl-Nielson (ZN) stain. A pericardial tap wits performed beneath echocardiographic guidance through a pigtail catheter, and the fluid was sent for criterions of biochemistry, ADA level, microbiology (including a TB agriculture and ZN stain), and hematology. An aliquot of pericardial fluid was frozen at -70[degrees]C within 30 min for cytokine analyses. The patient was followed up daily for signs of cardiac tamponade and/or resort of the effusion.

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