증례를 통한 결핵심장막염 진단에서 혈액 및 심장막액 인터페론감마 분비검사의 유용성의 고찰 = Interferon-γ Release Assay Using Pericardial Fluid and Peripheral Blood for the Diagnosis of Tuberculous Pericarditis: A Case Report

다국어 초록 (Multilingual Abstract)

Here, we report a case in which the rapid diagnosis of tuberculous pericarditis was made using Mycobacterium tuberculosis (MTB)-specific interferon-γ release assay on peripheral blood and pericardial effusion. Acid-fast bacilli staining, mycobacterial culture, and nucleic acid amplification targeting MTB using pericardial fluid were negative. However, elevated adenosine deaminase (ADA) activity in pericardial fluid and interferon-γ release assay positivity in both pericardial fluid and peripheral blood indicated the presence of tuberculous pericarditis. After anti-tuberculous and steroid treatment, the patient’s clinical symptoms improved, and pericardial effusion has not reoccurred.

국문 초록 (Abstract)

저자들은 결핵심장막염의 신속한 진단을 위해 말초혈액과 심낭삼출액에서 결핵균특이인터페론감마분비검사를 실시하였던 증례를 보고하는 바이다. 환자의 심낭삼출액에서 실시한 항산염색, 결핵균배양 및 결핵균핵산증폭검사에서 모두 음성이었지만, 심낭삼출의 ADA 결과와 심낭삼출과 말초혈액에서 실시한 인터페론감마분비검사 결과에 의해 결핵심장막염으로 진단하였다. 환자는 항결핵제 및 스테로이드로 치료를 받은 후 임상증상이 호전되었으며, 추적 관찰에서 심낭삼출이 발견되지 않았다.

참고문헌 (Reference)

1 Sagristá-Sauleda J, "Tuberculous pericarditis : ten year experience with a prospective protocol for diagnosis and treatment" 11 : 724-728, 1988

2 Ortbals DW, "Tuberculous pericarditis" 139 : 231-234, 1979

3 Fowler NO, "Tuberculous pericarditis" 266 : 99-103, 1991

4 Mayosi BM, "Tuberculous pericarditis" 112 : 3608-3616, 2005

5 Hageman JH, "Tuberculosis of the Pericardium. A Long-Term Analysis of Forty-Four Proved Cases" 270 : 327-332, 1964

6 Burgess LJ, "The use of adenosine deaminase and interferon-gamma as diagnostic tools for tuberculous pericarditis" 122 : 900-905, 2002

7 Komsuoğlu B, "The diagnostic and prognostic value of adenosine deaminase in tuberculous pericarditis" 16 : 1126-1130, 1995

8 Burgess LJ, "Role of biochemical tests in the diagnosis of large pericardial effusions" 121 : 495-499, 2002

9 Kobashi Y, "Rapid diagnosis of tuberculous pericarditis by ELISPOT assay" 42 : 712-715, 2010

10 Jafari C, "Rapid diagnosis of smear-negative tuberculosis by bronchoalveolar lavage enzyme-linked immunospot" 174 : 1048-1054, 2006

11 Jain S, "Profile of cardiac tamponade in the medical emergency ward of a North Indian hospital" 15 : 671-675, 1999

12 Fan L, "Interferon-gamma release assays for the diagnosis of extrapulmonary tuberculosis : a systematic review and meta-analysis" 65 : 456-466, 2012

13 Pai M, "Interferon-gamma assays in the immunodiagnosis of tuberculosis : a systematic review" 4 : 761-776, 2004

14 Zayas R, "Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis" 75 : 378-382, 1995

15 World Health Organization, "Global tuberculosis report 2012" WHO 2012

16 Wilkinson KA, "Ex vivo characterization of early secretory antigenic target 6-specific T cells at sites of active disease in pleural tuberculosis" 40 : 184-187, 2005

17 Reuter H, "Epidemiology of pericardial effusions at a large academic hospital in South Africa" 133 : 393-399, 2005

18 Jiménez Castro D, "Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions" 21 : 220-224, 2003

19 Bathoorn E, "Diagnostic potential of an enzyme-linked immunospot assay in tuberculous pericarditis" 18 : 874-877, 2011

20 Liao CH, "Diagnostic performance of an enzyme-linked immunospot assay for interferon-gamma in extrapulmonary tuberculosis varies between different sites of disease" 59 : 402-408, 2009

21 Lee JH, "Comparison of polymerase chain reaction with adenosine deaminase activity in pericardial fluid for the diagnosis of tuberculous pericarditis" 113 : 519-521, 2002

22 Biglino A, "Clinical usefulness of ELISPOT assay on pericardial fluid in a case of suspected tuberculous pericarditis" 36 : 601-604, 2008

23 Mayosi BM, "Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era : the Investigation of the Management of Pericarditis in Africa(IMPI Africa)registry" 6 : 2-, 2006

24 Quraishi Au, "Clinical and echocardiographic characteristics of patients with significant pericardial effusion requiring pericardiocentesis" 55 : 66-70, 2005

25 Strang G, "Bedside culture to confirm tuberculous pericarditis" 338 : 1600-1601, 1991

26 Tuon FF, "Adenosine deaminase and tuberculous pericarditis--a systematic review with meta-analysis" 99 : 67-74, 2006

27 Syed FF, "A modern approach to tuberculous pericarditis" 50 : 218-236, 2007