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Importance of absence of mesothelial cells and other useful parameters in the diagnosis of tubercular pleural effusion: our experience in a tertiary care hospital

Authors:Dr. M Bargotya MD, Dr. P Kachhap DCP, DNB, Dr. L Kumar MD, Dr. P Das MD, Dr. V. Sachdeva, DNB
Int J Biol Med Res. 2020; 11(2): 7046-7050  |  PDF File


BACKGROUND: Tuberculosis (TB) is a major public health problem in developing countries as well as across the world. In developing country like India, cytological examination of pleural fluid plays a major role in early diagnosis of tuberculosis as it is rapid, easy and cost effective. MATERIALS AND METHODS: The present study was conducted in the Department of Pathology, Rajiv Gandhi Super Speciality Hospital, Delhi. It includes 64 samples of pleural fluid of the patients who had biopsy proven tuberculous pleurisy. Samples were processed and underwent cytological examination. The physical and biochemical parameters were correlated with cytological findings. Ziehl Neelsen stain (ZN stain) for acid-fast bacilli was also done. RESULTS: Absence or paucity of mesothelial cells with predominance of lymphocytes in a pleural effusion directs towards tubercular etiology. It was suggested that presence of numerous mesothelial cells in a pleural aspirate almost excludes the diagnosis of tuberculosis. In current study three cases (4.6%) showed numerous mesothelial cells, while 11 cases (17.2%) showed only occasional mesothelial cells. Adenosine deaminase (ADA) is a useful marker in the diagnosis towards tuberculous pleural effusion. Our study demonstrated (87.5%) patients had ADA level >40 IU/L. The lymphocyte/neutrophil (L/N) ratio together with the ADA value favours diagnosis of tubercular effusion. 53 patients had value of lymphocyte /neutrophil ratio ≥ 0.75. CONCLUSION: In a predominantly lymphocyte rich pleural fluid, the absence or minimal presence of mesothelial cells is highly suggestive of TB. When cytological examination is combined with other parameters like ADA and L/N ratio, it further enhances the possibility of accurate diagnosis of tuberculous pleural effusion. Cytological examination of pleural fluid can be used for early diagnosis of tuberculosis as well as can be well correlated with the other ancillary techniques. As compared with pleural biopsy, it is less painful, inexpensive as well as minimally invasive.