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Does repeated pleural culture increase the diagnostic yield of Mycobacterium tuberculosis from tuberculous pleural effusion in HIV-negative individuals?

Does repeated pleural culture increase the diagnostic yield of Mycobacterium tuberculosis from tuberculous pleural effusion in HIV-negative individuals?
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Ko Y, Song J, Lee SY, Moon JW, Mo EK, Park JY, Kim JH, Park S, Hwang YI, Jang SH, Jhun BW, Sim YS, Shin TR, Kim DG, Hong JY, Lee CY, Lee MG, Kim CH, Hyun IG, Park YB,


Ko Y, Song J, Lee SY, Moon JW, Mo EK, Park JY, Kim JH, Park S, Hwang YI, Jang SH, Jhun BW, Sim YS, Shin TR, Kim DG, Hong JY, Lee CY, Lee MG, Kim CH, Hyun IG, Park YB, (click to view)

Ko Y, Song J, Lee SY, Moon JW, Mo EK, Park JY, Kim JH, Park S, Hwang YI, Jang SH, Jhun BW, Sim YS, Shin TR, Kim DG, Hong JY, Lee CY, Lee MG, Kim CH, Hyun IG, Park YB,

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PloS one 2017 07 2712(7) e0181798 doi 10.1371/journal.pone.0181798

Abstract
BACKGROUND
Despite recent advances in methods for culturing Mycobacterium tuberculosis (MTB), the diagnostic yield of tuberculous pleural effusion (TBPE) remains unsatisfactory. However, unlike repeated sputum cultures of pulmonary tuberculosis, little is known about the role of repeated pleural cultures. We examined whether repeated pleural cultures are associated with increased MTB yield from TBPE.

METHODS
A multicenter, retrospective cohort study was performed from January 2012 to December 2015 in South Korea. Patients were categorized into two groups: single- or repeated-culture groups. The diagnostic yield of MTB and clinical, radiological, and pleural fluid characteristics were evaluated.

RESULTS
Among the 329 patients with TBPE, 77 (23.4%) had repeated cultures and 252 (76.5%) had a single culture. Pleural culture was performed twice in all 77 patients in the repeated-culture group at a 1-day interval (inter-quartile range, 1.0-2.0). In the repeated-culture group, the yield of MTB from the first culture was 31.2%, which was similar to that in the single-culture group (31.2% vs. 29.8%, P = 0.887). However, the yield of MTB from the second culture (10/77, 13.0%) was more than that from the first. These results may be attributable to the insufficient immune clearance for MTB invasion into the pleural space between the first and second cultures. Over time, the yield of the second cultures decreased from 17.4% to 6.7% and then 6.3%. Finally, the overall yield of MTB in the repeated- and single-culture groups was 44.2% and 29.8% respectively (P < 0.001). CONCLUSIONS
The results showed that repeated pleural cultures increased MTB yield from TBPE in human immunodeficiency virus-negative individuals. Furthermore, repeated cultures may increase yield when carried out for two consecutive days.

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