Legionnaires' Disease in China Caused by Legionella pneumophila Corby.

Legionella pneumophila is an intracellular pathogen causing pneumonia in humans. In February 2022, Legionnaires' disease caused by L. pneumophila strain Corby in a patient with lung adenocarcinoma was identified for the first time in China. This paper includes the case report and phenotypic and genomic analysis of the Corby (ICDC) strain. Its biological characteristics were evaluated by antibiotic sensitivity testing and cytology experiments, and genomic analysis was performed to understand its genetic evolution. The patient's clinical manifestations included cough, fever, pulmonary infiltration, and significantly decreased activity endurance. After empirical antimicrobial therapy, infection indicators decreased. The Corby (ICDC) strain was susceptible to nine antibiotics and exhibited strong intracellular proliferation ability. A phylogenetic tree showed that the Corby (ICDC) strain was closely related to the Corby strain, but under the pressure of a complex environment, its genome had undergone more rearrangement and inversion. The type IF CRISPR-Cas system was identified in its genome, and spacer analysis indicated that it had been invaded by several foreign plasmids, bacteria, and viruses during evolution. Legionnaires' disease caused by L. pneumophila strain Corby may be ignored in China, and it is urgent to improve long-term monitoring and investigation of aquatic environments and patients with respiratory infections to prevent a large-scale outbreak of Legionnaires' disease.

A cluster of health care workers with COVID-19 pneumonia caused by SARS-CoV-2.

BACKGROUND: The current outbreak of coronavirus disease 2019 (COVID-19) caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, Hubei, China, spreads across national and international borders. METHODS: We prospectively collected medical records of 14 health care workers (HCWs) who were infected with SARS-CoV-2, in neurosurgery department of Wuhan Union Hospital, China. RESULTS: Among the 14 HCWs, 12 were conformed cases, the other 2 were suspected cases. Most of them were either exposed to the two index patients or infected coworkers, without knowing they were COVID-19 patients. There were 4 male and 10 female infected HCWs in this cohort, whose mean age was 36 years (SD, 6 years). The main symptoms included myalgia or fatigue (100%), fever (86%) and dry cough (71%). On admission, 79% of infected HCWs showed leucopenia and 43% lymphopenia. Reduced complement C3 could be seen in 57% of the infected HCWs and IL-6 was significantly elevated in 86% of them. The proportion of lymphocytes subsets, concentrations of immunoglobulins, complement C4, IL-2, IL-4, IL-10, TNF-α and IFN-γ were within normal range in these 14 infected HCWs. The most frequent findings on pulmonary computed tomographic images were bilateral multifocal ground-glass opacifications (86%). CONCLUSIONS: Human-to-human transmission of COVID-19 pneumonia has occurred among HCWs, and most of these infected HCWs with confirmed COVID-19 are mild cases. Our data suggest that in the epidemic area of COVID-19, stringent and urgent surveillance and infection-control measures should be implemented to protect doctors and nurses from COVID-19 infection.

A preliminary study on the potential of Mycoplasma pneumoniae to induce dyskaryotic change in respiratory epithelium in adult community-acquired pneumonia.

BACKGROUND: This study aimed to explore the cellular morphology of respiratory epithelium in Mycoplasma pneumonia (MpP) patients. MATERIALS AND METHODS: The cast-off cell morphological findings from bronchoscopic brushings in MpP and community-acquired pneumonia (CAP) caused by typical pathogens were reviewed. RESULTS: Compared with the CAP group, cellular dysplasia in respiratory tract epithelial brushings was significantly greater in MpP patients (P = 0.033). CONCLUSION: Unique biological characteristics and mechanisms of pathogenesis of Mycoplasma pneumoniae (Mp) may result in dyskaryotic changes in respiratory epithelium in adult MpP.

Rapid Identification of Bacterial Species Associated with Bronchiectasis via Metagenomic Approach.

Bronchiectasis is a chronic lung disorder and a number of bacterial pathogens are involved. However, 30%-40% of sputum and purulent samples in good quality failed to grow any pathogenic bacteria, making it difficult to confirm the pathogen. In this study, we collected bronchoalveolar lavage fluid from a bronchiectasis patient undergoing acute exacerbation, and sent for 16S rDNA pyrosequencing by a 454 GS Junior machine. Metagenomic analysis showed the composition of bacterial community in sample was complex. More than a half of reads (51.3%) were from Pseudomonas aeruginosa. This result was corresponding with the culture result but came out 2 d earlier, which is meaningful for early diagnosis and treatment. The detection with 16S rDNA pyrosequencing technology is more sensitive and rapid than routine culture, and can detect the co-infection or symbiosis in airway, giving us a novel and convenient approach to perform rapid diagnosis.

[Dieulafoy disease of the bronchus: 3 cases report with literature review].

OBJECTIVES: To improve the understanding of bronchial Dieulafoy disease by summarizing the clinical and literature reported cases. METHODS: The clinical data of 3 patients with bronchial Dieulafoy disease diagnosed by pathology from January 1, 2007 to May 31, 2012 in our hospital was collected and summarized. The data of 19 cases from literature case report regarding bronchial Dieulafoy disease both in Chinese and English were also reviewed through databases including Wanfang Data, National Knowledge Infrastructure, National Center for Biotechnology Information and Ovid Technologics from January 1, 2005 to May 31, 2012. The clinical characteristics, diagnosis and treatment of all the 22 cases were summarized and analyzed. RESULTS: The average age of the 22 cases with bronchial Dieulafoy disease was (47 ± 15) years, and the preponderance was in male adults (16/22). Right lung (16/22) was more commonly involved than the left lung (4/22), and rarely in both lungs (2/22). Eight cases had smoking history, and 10 cases had underlying diseases such as tuberculosis.Sudden onset of massive hemoptysis was a common manifestation. Massive or lethal hemorrhage was often caused by biopsy injury. The abnormality of bronchial Dieulafoy disease was usually demonstrated as nodular lesions within the lumen of the bronchus.However, It was unable to determine their originating of the anomalous arteries in half of the cases(11/22). Most anomalous arteries confirmed by pathology were branched from bronchial artery (9/22), and rarely from pulmonary artery (2/22). The definitive diagnosis was made by pathological examination.Selective bronchial artery embolization and pulmonary lobectomy were the major therapeutic strategies, but bleeding may relapse after bronchial artery embolization, and lobectomy of the lung was a cure approach. CONCLUSIONS: Bronchial Dieulafoy disease should be differentiated in patients with massive and unexplained hemoptysis.It takes a very high risk for biopsy, which rarely needs to be implemented. Bronchial arteriography and selective bronchial artery embolization should be promptly carried out to avoid life-threatening hemoptysis.Lobectomy could be an alternative choice for a cure.

[Diagnostic investigation of the detection of granulocyte-macrophage colony stimulating factor antibody in serum for pulmonary alveolar proteinosis].

OBJECTIVE: To evaluate the diagnostic value of granulocyte-macrophage colony stimulating factor (GM-CSF) antibody in serum for pulmonary alveolar proteinosis (PAP). METHODS: Twelve PAP patients visiting Peking University People's Hospital or Fujian Provincial Hospital from January 1, 2002 to December 31, 2012, 25 patients with other pulmonary diseases (disease control), and 25 healthy volunteers (healthy control) were recruited in the study. The titer level of GM-CSF antibody in serum was determined with enzyme-linked immunosorbent assay (ELISA), and the clinical characteristics were collected in the PAP patients. RESULTS: The geometric mean titers of GM-CSF antibody in the PAP patients, the disease controls and the healthy controls were 1: 25 349, 1: 311 and 1: 256, respectively. The differences between the disease controls and the healthy controls were of no statistic significance (t = -1.14, P = 0.261) . With 3 times standard error (3s) above the mean value as the higher limit of X value(X = lgT, T standing for the reciprocal of the titer), the upper limit for T was 1698. With the T value ≥ 1698 as the diagnostic threshold for PAP, both the sensitivity and the specificity were 100%. The diagnostic value of GM-CSF antibody was similar to that of surgical lung biopsy and higher than that of transbronchial lung biopsy. CONCLUSION: The detection of serum GM-CSF is non-invasive, convenient and efficient for the diagnosis of PAP with high sensitivity and specificity.

Treatment responses of procaterol and CD38 inhibitors in an ozone-induced airway hyperresponsiveness mice model.

Airway hyperresponsiveness (AHR) and airway inflammation are key pathophysiological features of many respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD). To evaluate the treatment responses of procaterol and CD38 inhibitors in an ozone-induced AHR mice model, we hypothesized that procaterol and two synthetic CD38 inhibitors (Compounds T and H) might have therapeutic effects on the ozone-induced AHR mice model, and the nuclear factor-kappaB (NF-κB) pathway and the CD38 enzymatic activity might be involved in the mechanisms. With the exception of the Control group, ozone exposure was used to establish an AHR model. Male Kunming mice in the Procaterol and CD38 inhibitors groups were treated with an emulsifier of procaterol hydrochloride, Compound T or H. Results indicated that (1) no drug showed severe toxicity in this study; (2) ozone exposure induced airway inflammation and AHR; (3) intragastric treatment with procaterol and Compound T achieved potent therapeutic effects, but Compound H did not show any therapeutic effect; (4) the NF-κB pathway was involved in both the pathogenic mechanisms of ozone and therapeutic mechanisms of procaterol and Compound T; (5) however, the in vivo effect of Compound T was not caused by its inhibitory activity on CD38. Taken together, procaterol and Compound T are potentially good drugs to treat asthma and COPD complicated with ozone exposure.

[A study on the differential diagnosis of ciliated epithelial cells from Lophomonas blattarum in bronchoalveolar lavage fluid].

OBJECTIVE: To validate the authenticity of the cases diagnosed as pulmonary Lophomonas blattarum infection in literatures and Lophomonas blattarum as a kind of pathogen resulting in pulmonary infection. METHODS: From June 2012 to May 2013, mobile cells with cilia at the anterior end of the cells were observed in BALF from 6 patients with pulmonary disease in our hospital. Morphological feature and ultrastructure of the cells were further investigated by optical microscope and electron microscope to determine the type of the cells referring to literature-published photos of Lophomonas blattarum. Literatures about Lophomonas blattarum infection were searched with keyword Lophomonas blattarum from Wanfang Data, China National Knowledge Infrastructure (CNKI) and PubMed. Diagnostic methods and figures provided by the literature were carefully reviewed, and the accuracy of diagnosis of pulmonary Lophomonas blattarum was identified. RESULTS: Mobile cells found in BALF from the 6 patients in our hospital had the morphological features of bronchial ciliate epithelial cells. A nucleus far from the cilia was observed in the middle or at the bottom of the cytoplasm, and these cells did not display the characteristic cytological structures of Lophomonas blattarum: calyx, perinuclear tubules and axial filament. Diagnosis of pulmonary Lophomonas blattarum reported in literatures so far were all based on the morphological features of mobile cells with a cluster of flagellate at anterior end of the cell by optical microscopy. None of the authors did further exploration on the ultrastructure of such a kind of cells and compared with features of Lophomonas blattarum described in the literature. All the active cells reported in literatures had the identical morphological features to those found in our investigation. CONCLUSION: In the past 20 years, all the diagnosed cases as pulmonary Lophomonas blattarum infection reported in our country were misdiagnosed. Currently, there is no evidence to show Lophomonas blattarum as a pathogen resulting in pulmonary infection.

[The characteristics and clinical manifestation of subjects with non-specific pattern of pulmonary function tests].

OBJECTIVE: To analyze the characteristics of pulmonary function and the clinical significance of non-specific pattern (NSP). METHODS: A total of 1933 pulmonary function tests of adult patients were analyzed, and those with NSP were selected. The pulmonary function test results, clinical diagnosis and radiological manifestations were analyzed. Normal distribution data were compared by t test, while non-normal distribution data were compared by Mann-Whitney U test, and χ(2) test was used to compare ratios. RESULTS: There were 61 patients in the NSP group and 1017 in the control group. The BMI of the 2 groups was (24.5 ± 4.6) and (24.5 ± 3.8) kg/m(2), respectively, being not significantly different (t = 0.008, P > 0.05). The age was 64 (49-74) years and 56 (42-70) years, and the smoking index was 0.4 (0-20) and 0 (0-10), respectively, showing no significant differences (Z values were -2.209 and -2.571, respectively, all P < 0.05). In the NSP group, FEV1 was 69% (66%-73%) predicted, FVC 75% (70%-77%) predicted, FEV1/FVC 75% (73%-78%), RV 118% (105%-145%) predicted, and TLC 86% (82%- 93%) predicted, which were significantly different as compared to those of the control group [95% (87%-104%), 98% (90%-106%), 79% (76%-84%), 101% (88%-114%) and 94% (88%-102%), respectively],(Z values are -13.059--5.185, all P < 0.05). RV/TLC was (52 ± 11)% in the NSP group and (39 ± 9)% in the control group, the difference being significant (t = -10.351, P < 0.05). The decreased TLC indicated restricted ventilation, while the increased RV and RV/TLC indicated air trapping. The clinical diagnosis of NSP included obstructive and restrictive diseases, some of which showed severe radiological abnormalities, but there were 31 patients without pulmonary lesions. CONCLUSIONS: Age and smoking, but not obesity, may play a role in NSP.NSP has characteristics of obstructive and restrictive ventilation defects, but does not associate with particular diseases, thus having limited clinical significance.

Diffuse pulmonary lymphangiomatosis: a case report with literature review.

Diffuse pulmonary lymphangiomatosis (DPL) is a rare disease that is characterized by diffuse proliferation of abnormal pulmonary lymphatic channels. DPL occurs mostly in children and young adults and often undergoes a progressive clinical course, eventually causing deterioration of the lung. Both the clinical diagnosis and treatment of DPL remain a challenge. Here, we report a case of DPL in a 53-year-old Chinese woman with comprehensive investigations including pulmonary function tests, computer tomography (CT), bronchoscopy and histological examination of the lung biopsy, and review the literature.

Chronic intermittent hypoxia from pedo-stage decreases glucose transporter 4 expression in adipose tissue and causes insulin resistance.

BACKGROUND: The persistence of sleep disordered breathing (SDB) symptoms after tonsil and/or adenoid (T&A) surgery are common in children with obstructive sleep apnea (OSA). We tested the hypothesis that disturbances of glucose transporters (GLUTs) in intraabdominal adipose tissue caused by chronic intermittent hypoxia (CIH) from the pedo-period could facilitate the appearance of periphery insulin resistance in Sprague-Dawley (SD) rats. We tested the hypothesis that the changes of GLUTs in adipose tissue may be one of the reasons for persistent SDB among clinical OSA children after T&A surgery. METHODS: Thirty 21-day-old SD rats were randomly divided into a CIH group, a chronic continuous hypoxia (CCH) group, and a normal oxygen group (control group) and exposed for 40 days. The changes of weight, fasting blood glucose and fasting blood insulin levels were measured. Hyperinsulinemic-euglycemic clamp techniques were used to measure insulin resistance in each animal. Real-time quantitative PCR and Western blotting were used to measure GLUT mRNA and proteins in intraabdominal adipose tissue. Additional intraabdomial white adipose tissue (WAT) was also processed into paraffin sections and directly observed for GLUTs1-4 expression. RESULTS: When compared with control group, CIH increased blood fasting insulin levels, (245.07 +/- 53.89) pg/ml vs. (168.63 +/- 38.70) pg/ml, P = 0.038, and decreased the mean glucose infusion rate (GIR), (7.25 +/- 1.29) mg x kg(-1) x min(-1) vs. (13.34 +/- 1.54) mg x kg(-1) x min(-1), P < 0.001. GLUT-4 mRNA and protein expression was significantly reduced after CIH compared with CCH or normal oxygen rats, 0.002 +/- 0.002 vs. 0.039 +/- 0.009, P < 0.001; 0.642 +/- 0.073 vs. 1.000 +/- 0.103, P = 0.035. CONCLUSIONS: CIH in young rats could induce insulin resistance via adverse effects on glycometabolism. These findings emphasize the importance of early detection and treatment of insulin insensitivity in obese childhood OSA.

[Histopathologic study of avian influenza H5N1 infection in humans].

OBJECTIVE: To identify histopathologic changes of major organs and to correlate clinical symptoms in patients infected by avian influenza H5N1. METHODS: Autopsy study was performed in two patients died of avian influenza HSN1 infection, following conventional protocols and strict safety procedures. Tissue samples from all major organs of two cases and lung samples of one case were collected and fixed in 4% formaldehyde. Histopathologic changes were evaluated by light microscope. RESULTS: Diffuse alveolar damage (DAD) of the lung was seen in both cases. Lesions at various stages of development were seen involving different areas of the lung. At the early stages, the lungs exhibited exudative changes, including capillary congestion, necrosis of alveolar epithelial cells, and intra-alveolar edema. Hyaline membranes were prominent and diffusely distributed along alveoli. In the middle-late stages of the disease, the lungs exhibited proliferative and fibrotic changes, including proliferation of pneumocytes and bronchial epithelium, fibrosis of the interstitium and alveolar spaces. Lung biopsy tissue of one case showed DAD and interstitial fibrosis in a background of bronchiectasis. Lymph nodes and spleens showed quantity reduction of lymphocytes and active hemophagocytosis. Other changes in major organs included interstitial carditis in one case and acute renal tubular necrosis in one case. In one case, the brain showed edema with cytoplasmic eosinophilia, loss of structure, axon welling and focal necrosis around ventricle. Multiple foci of trophoblastic necrosis with dystrophic calcification were observed in placenta of one pregnant patient. Acute necrotizing deciduitis was found focally. Sections of fetal lung showed edema and scattered interstitial neutrophils were consistent with acute interstitial pneumonitis. CONCLUSIONS: The respiratory tract is the major target of avian influenza A H5N1 virus infection. The changes of DAD in the lungs resulted in hypoxia, leading to multiple organ failure and death.

[The molecular mechanisms of the effects of murine interferon-gamma transgenic expression on allergen-induced allergic model via adenoviral vector].

OBJECTIVE: To investigate adenoviral vector mediated murine interferon-gamma (mIFN-gamma) transgene expression and its effect on allergen-induced airway inflammation and multiple interleukin (IL) cytokines (IL-4, IL-5, IL-6, IL-10, IL-12, IL-13 and IL-18) expression in a murine allergic model. METHODS: Forty-eight mice were divided into 7 groups by random digits table: a negative control group (A), allergic model groups I, II, III (B, D, F), gene therapy groups I, II, III (C, E, G). Except for group A, mice of the other groups were peritoneally sensitized with ovalbumin (OVA, 15 microg/mouse) twice on day 0 and day 5, and challenged by inhalation of 0.5% OVA (20 ml per time) twice per day from day 12 to 14. On day 15, AdCMVmIFN-gamma (5 x 10(9) PFU/mouse) solution 50 microl was administrated by nasal drip in groups C, E and G. For groups A, B, D and F, 0.9% NaCl 50 microl was administrated by nasal drip. Groups A, B and C were sacrificed on day 18. Groups D and E were sacrificed on day 21. Groups F and G were sacrificed on day 25. The concentration of mIFN-gamma in bronchioalveolar lavage (BALF) was measured by enzyme-linked immunosorbant assay. Accumulation of inflammatory cells and eosinophils (EOS) were quantified by cell count and histopathological analysis. Multi-cytokine expression was tested by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR). RESULTS: (1) mIFN-gamma was efficiently expressed after gene therapy. The concentration of mIFN-gamma in BALF was (729.0 +/- 104.7) pg/ml 3 days after gene therapy (group C); it was (984.5 +/- 119.1) pg/ml after 6 days (group E); and (310.6 +/- 59.7) pg/ml after 10 days (group G). (2) The total cell number in BALF of group B and C was (318 +/- 41) x 10(3)/ml and (137 +/- 12) x 10(3)/ml, respectively (P < 0.01); the constituent ratio of EOS in BALF was 0.715 +/- 0.054 and 0.452 +/- 0.016, respectively (P < 0.01). The total cell number in BALF of group D and E was (183 +/- 23) x 10(3)/ml and (92 +/- 6) x 10(3)/ml, respectively (P < 0.01); the constituent ratio of EOS was 0.393 +/- 0.065 and 0.083 +/- 0.038, respectively (P < 0.01). The total cell number in BALF of groups F and G was (196 +/- 7) x 10(3)/ml and (98 +/- 15) x 10(3)/ml, respectively (P < 0.01); the constituent ratio of EOS was 0.253 +/- 0.035 and 0.068 +/- 0.025, respectively (P < 0.01). (3) The histopathological results showed that in the gene therapy groups, the infiltration of inflammatory cells was markedly reduced and the damage of airway epithelium was alleviated. (4) For group D and E, the ratio of IL-10 mRNA abundance to that of home gene was 0.14 +/- 0.10 and 0.49 +/- 0.27, respectively (P < 0.01); that of IL-12 was 0.15 +/- 0.05 and 0.63 +/- 0.17, respectively (P < 0.01); that of IL-13 was 0.76 +/- 0.17 and 0.37 +/- 0.10, respectively (P < 0.01). For group F and G, the ratio of IL-10 mRNA abundance to that of home gene was 0.13 +/- 0.04 and 0.27 +/- 0.17, respectively (P = 0.019); that of IL-12 was 0.14 +/- 0.05 and 0.35 +/- 0.21, respectively (P = 0.006); that of IL-13 was 0.57 +/- 0.24 and 0.30 +/- 0.09, respectively (P = 0.003). However, there were no statistically significant changes in IL-4, IL-5, IL-6, and IL-18 in lung tissue between allergic model groups (B, D, F) and gene therapy groups (C, E, G, P > 0.05). CONCLUSIONS: (1) mIFN-gamma gene transferred via adenoviral vector could abrogate the infiltration of EOS in OVA-induced allergic model. (2) The molecular mechanisms for effect by AdCMVmIFN-gamma transgenic therapy on murine allergic model involve the indirect action by the upregulation of IL-10 and IL-12 expression and the downregulation of IL-13 expression locally in the lungs, in addition to the direct effects of locally overexpressed mIFN-gamma.

[Clinical investigation of application of lung biopsy in the diagnosis of diffuse pulmonary interstitial disease].

OBJECTIVE: To evaluate the application of lung biopsy in the diagnosis of diffuse pulmonary interstitial disease (DPID). METHODS: The data of lung biopsy from 17 cases with uncertain DPID obtained during the period of July 1997 and December 2002 were retrospectively analysed. RESULTS: All the cases were diagnosed by pathology. Three of them were diagnosed as sarcoidosis. Two were pulmonary alveolar proteinosis. One with usual interstitial pneumonia (UIP), one with bronchiolitis obliterans and organizing pneumonia, one with nonspecific pneumonia, one with Castleman's disease, one with pulmonary lymph angio-leiomyomatosis, two with bronchioalveolar carcinoma, one as rheumatoid pulmonary fibrosis complicated with pulmonary squamous cancer and locally metastasis in lungs, two as pulmonary lymphangitic carcinomatosis, one as lung squamous cancer with pulmonary lymphangitic metastasis, and one with primary pulmonary paraganglioma. CONCLUSION: Harvest of lung tissue directly by biopsy could be the most useful diagnostic method for DPID, and it is a highly valuable diagnostic tool for those patients whose diagnosis is uncertain with routine chest film and high resolution computed tomography.

[Clinical investigation of the diagnostic value of interferon-gamma, interleukin-12 and adenosine deaminase isoenzyme in tuberculous pleurisy].

OBJECTIVE: To investigate the diagnostic value of interferon-gamma (IFN-gamma), interleukin-12 (IL-12) and adenosine deaminase isoenzymes (ADA(2)) in tuberculous pleural effusions. METHODS: One hundred and ninety specimens of pleural effusion were collected from 190 patients with pleural effusion in Peking University People's Hospital, Beijing Chest Hospital, and Beijing Tuberculosis and Thoracic Tumor Institute, from March 2002 to February 2003. Of them 141 pleural specimens were diagnosed as tuberculous, and 49 as malignant. IFN-gamma and IL-12 concentrations and ADA isoenzyme activity in all the specimens were determined by ELISA and enzyme kinetic analytical method respectively. RESULTS: (1) ADA(2) activity (47.9 +/- 6.9) U/L in tuberculous effusions was significantly higher than that in malignant effusion (13.2 +/- 3.2) U/L (P < 0.01). The IFN-gamma level (112.1 +/- 45.8) ng/L in tuberculous effusion was significantly higher than that in malignant diseases (24.8 +/- 5.9) ng/L (P < 0.01). The IL-12 level (104.3 +/- 32.3) ng/L in tuberculous effusions was significantly higher than that in malignant diseases (61.8 +/- 10.8) ng/L (P < 0.05). (2) By analysis of ROC curves, the cut-off values for IFN-gamma, IL-12 and ADA(2) were defined. The sensitivity and specificity of IFN-gamma for tuberculous effusion were 84.4% and 95.9% respectively. Those of IL-12 for tuberculous effusion were 85.1% and 65.3% respectively, while those of ADA(2) were 84.4% and 91.8%. CONCLUSIONS: IFN-gamma and IL-12 could be used as valuable parameters for the differentiation of tuberculous effusion from malignant, and IFN-gamma was more sensitive and specific for tuberculous effusion than IL-12 and ADA(2).