Program Schedule

1686
A Rapid and Non-Invasive 2-Step Algorithm for Diagnosing Tuberculous Peritonitis Using T Cell-Based Assays on Peripheral Blood and Peritoneal Fluid Mononuclear Cells and Peritoneal Fluid Adenosine Deaminase

Session: Poster Abstract Session: Mycobacterial Infection: Screening and Diagnosis
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background : The diagnosis of tuberculous peritonitis (TBP) is still challenging, largely dependent on invasive procedures such as laparoscopic biopsy. A recently developed RD-1 (region of difference 1) gene-based assay for diagnosing TBP shows promising results. We thus created a clinical algorithm to enable clinicians to differentiate patients with TBP from those with other diagnoses by using peripheral blood mononuclear cells (PBMC) and peritoneal fluid mononuclear cells (PF-MC) with conventional tests.

 

Methods : All adult patients with suspected TBP in whom enzyme-linked immunosorbent spot (ELISPOT) assays were performed both on PBMC and PF-MC were prospectively enrolled over a 6-year period. In addition to the conventional tests for diagnosing TBP, the IFN-gamma-producing T cell response to early secretory antigenic target-6 (ESAT-6) and culture filtration protein-10 (CFP-10) by ELISPOT assays using PBMC and PF-MC were performed.

 

Results : The total 74 patients with suspected TBP were enrolled. Of these, 45 (61%) patients with 19 confirmed, 16 probable, and 10 possible TBP were classified as TBP, and 29 (39%) patients were classified as not-TB. Of the 74 patient, 5 (7%) patients in the PBMC ELISPOT assays and 15 (20%) patients in the PF-MC ELISPOT assays gave indeterminate results, respectively. The sensitivity and specificity, respectively, of the tested methods for diagnosing TBP were as follows: PBMC ELISPOT (=>6 spots), 84% and 59%; PF-MC ELISPOT (=>6 spots), 87% and 86%; PF-MC/PBMC ratio (=>3), 69% and 97%; and PF-ADA level (=>21 IU/L), 82% and 79%. The areas under the receiver operating characteristics curves were as follows: PF-MC ELISPOT, 0.90; PF-MC/PBMC ratio, 0.82; PBMC ELISPOT, 0.80; and PF-ADA, 0.80, respectively. If a 2-step algorithm (1st step, PBMC ELISPOT =>6 spots or PF-ADA =>21 IU/L as a rule-out test; 2nd step, PF-MC/PBMC ratio =>3 as a rule-in test) was applied, 67% (30/45) of patients with TBP were exactly classified without undergoing invasive procedures.

 

Conclusion : A 2-step algorithm using PBMC/PF-MC ELISPOT and PF-ADA appears to be a promising rapid and non-invasive approach for diagnosing TBP.


Figure 1. A proposed 2-step algorithm using PBMC/PF-MC ELISPOT and PF-ADA for diagnosing TBP.

Ju Young Lee, MD1, Sun In Hong, MD1, Yong Kyun Kim, MD1, Shinae Yu, MD1, Jiwon Jung, MD1, Sun-Mi Kim1, Su-Jin Park1, Mi-Na Kim, MD, PhD2, Sang-Oh Lee, MD1, Sang-Ho Choi, MD1, Yang Soo Kim, MD1, Jun Hee Woo, MD1 and Sung-Han Kim, MD1, (1)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (2)Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Disclosures:

J. Y. Lee, None

S. I. Hong, None

Y. K. Kim, None

S. Yu, None

J. Jung, None

S. M. Kim, None

S. J. Park, None

M. N. Kim, None

S. O. Lee, None

S. H. Choi, None

Y. S. Kim, None

J. H. Woo, None

S. H. Kim, None

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