Avaliação do Teste Rápido Molecular (TRM –TB) para diagnóstico de Tuberculose Pleural

Abstract

Tuberculosis (TB) is still one of the biggest infectious causes of mortality and morbidity in adults in the world. The Brazil is among the 22 countries with the highest number of cases, and the national average of around 30 cases per 100,000 habitants. The city of Manaus presents incidence above 90 cases/100,000. The pleural TB is considered the most common extrapulmonary form in adults. The diagnosis requires invasive features, such as the removal of fragments of pleura, through percutaneous needle biopsy of Cope or videopleuroscopy in addition, pleural fluid culture in conventional medium which slows the diagnostic confirmation. Molecular Diagnostic rapid test of tuberculosis (TRM-TB – Cepheid’s Xpert® MTB/RIF)) is an automated method of polymerase chain reaction (PCR), enabling early diagnosis of TB and releases the result in 2 hours, plus, determine the sensitivity to rifampicin being validated its use for sputum analysis. The aim of this study was to evaluate the effectiveness of the TRM-TB for the diagnosis of pleural TB through analysis of pleural fluid. We included 17 patients with pleural effusion. 10 males and 7 females. The average age was 44 years. All performed thoracentesis and biopsy of pleura being sent samples to the TRM-TB, solid medium culture and histopathology. Of these, 11 confirmed diagnosis of TB through clinical, histopathological, molecular or microbiological tools. The TRM-TB liquid presented sensitivity of 9% (1/11). The liquid culture showed no bacterial growth in any sample. The TRM-TB pleural fragment worked not detectable in all samples. The biopsy of pleura presented diagnostic accuracy of 76%, being the best performing method for diagnosis. It is concluded that the TRM-TB for the diagnosis of pleural TB through analysis of pleural fluid has low sensitivity and based on these facts, it is not recommended to be used as the initial method of investigation of suspected cases of tuberculous pleural effusion.