DOI: 10.36347/sjams.2017.v05i10.059

Pages: 4105-4113

Tuberculous pleural effusion (TPE) is diagnosed by biopsy or PCR on clinical suspects and delay in this is still frequent in India. ADA is not readily available mostly in hospitals with limited laboratory facilities. Pleural fluid cholesterol has been used to classify exudates and transudates as it misclassifies fewer cases than any other Light’s parameters. To evaluate the utility of cholesterol in lymphocytic exudates in diagnosing TPE in a region of high prevalence of PTB which has never been done before. The study was carried out on 80 patients with PE. Fluid classified as lymphocytic exudates based on light’s criteria and lymphoytic proportion >0.75 were differentiated into tubercular and non-tubercular PE based on biopsy or PCR. Fluid ADA and fluid cholesterol were done in both the groups. 49 were positive for TPE. Fluid ADA and fluid cholesterol levels were significantly different in tubercular and non-tubercular PE cases. Fluid cholesterol correlated positively with fluid ADA. Sensitivity, specificity, PPV, NPV with fluid cholesterol value of 50 mg/dL as cut off were 95.9 %, 100 %, 1005, 84.6 % which was better than using fluid cholesterol value of 60 mg/dL as cut off and fluid ADA. Fluid cholesterol estimation could be a feasible option for cheaper diagnosis of TPE and it correlates with fluid ADA. The good accuracy of this method makes it a promising diagnostic tool that could be used for diagnosis of TPE in area where disease has high prevalence. A negative result excludes TPE with a high degree of certainty.