Comparative efficacy of methods for early diagnosis of tuberculosis pleuritis with rifampicin-resistance.

Abstract

The purpose of the article was to explore the effectiveness of a complex morphological study of pleural biopsies and molecular genetic study (GeneXpert MBT/Rif) of pleural effusion in verifying the diagnosis of pleurisy of tuberculous aetiology. The participants of the study were 120 patients with a exudative pleurisy who were admitted to the department of extrapulmonary tuberculosis of the Regional Phthisiopulmonology Center (RPPC) in Aktobe (Republic of Kazakhstan) in the period from 2018 to 2020. Significant differences were obtained in the compared groups (p<0.05), which testifies to the rather high diagnostic efficiency of the GeneXpert MBT/RIF molecular genetic method in comparison with bacterioscopy in detecting Mycobacterium tuberculosis (MBT) in pleural fluid obtained by video thoracoscopy. Using the GeneXpert method, positive results of the presence of MBT in the pleural fluid were obtained in 26.3% of patients of the main group, while in patients of the control group, MBT was detected only in 3.2% of cases by simple bacterioscopy (p<0.05). The high diagnostic efficiency of the GeneXpert express method (26.3%) is confirmed and proven by the "gold standard" of bacteriological examination of pleural fluid - the growth of MBT colonies in 24.6% of cases by the BACTEC MGIT-960 method and in 28.1% of cases of MBT growth on solid nutrient medium Lowenstein-Jensen in patients of the main group. The combination of the invasive method of video thoracoscopy diagnostics with the GeneXpert microbiological express method for detecting MBT in the pleural fluid is today, the optimal method for early diagnosis of a drug-resistant form of exudative pleurisy of tuberculous etiology.