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respectivamente<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a>&#46; En otras 2<span class="elsevierStyleHsp" style=""></span>series espa&#241;olas&#44; los cultivos de LP y esputo en medios s&#243;lidos tuvieron&#44; de forma independiente&#44; una sensibilidad aproximada del 40&#37;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; Adem&#225;s de la baja sensibilidad&#44; el retraso de varias semanas en la obtenci&#243;n de los resultados de los cultivos convencionales es un factor limitante para la toma de decisiones cl&#237;nicas<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a>&#46; La combinaci&#243;n de an&#225;lisis histol&#243;gico y cultivo de una biopsia pleural alcanz&#243; el 86&#37; de sensibilidad en 92 pacientes con DPT<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#46; Sin embargo&#44; la biopsia pleural es un procedimiento invasivo y operador dependiente&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Las t&#233;cnicas de amplificaci&#243;n de &#225;cidos nucleicos o reacci&#243;n en cadena de la polimerasa &#40;PCR&#41; son r&#225;pidas y espec&#237;ficas&#46; Sin embargo&#44; su sensibilidad en el DPT parece limitada&#46; Un estudio efectuado en nuestro centro mostr&#243; una sensibilidad del 15&#37; para el test Xpert&#174; MTB&#47;RIF en LP<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a>&#46; En un metaan&#225;lisis de 24 estudios&#44; esta misma t&#233;cnica automatizada de PCR &#40;Xpert&#174; MTB&#47;RIF&#41; en LP tuvo una sensibilidad del 22&#44;7&#37; cuando se aplic&#243; a pacientes con DPT probable&#59; es decir&#44; con un diagn&#243;stico cl&#237;nico de tuberculosis&#44; pero sin confirmaci&#243;n microbiol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En 2013 se publicaron los resultados de un nuevo m&#233;todo de PCR conocido como FluoroType MTB&#174;&#44; que obtuvo una sensibilidad del 95&#44;1&#37; en 661 muestras respiratorias con cultivos micobacterianos positivos<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a>&#46; Estudios posteriores han mostrado diferentes sensibilidades en varios espec&#237;menes biol&#243;gicos&#58; del 56&#37; en la saliva de 32 pacientes con diagn&#243;stico microbiol&#243;gico de tuberculosis pulmonar<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a>&#59; del 71&#37; en la sangre de 31 pacientes con sospecha cl&#237;nica de tuberculosis diseminada y coinfecci&#243;n con el virus de la inmunodeficiencia humana<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a>&#59; del 60&#37; en 17 muestras de tejido parafinado pertenecientes a granulomas de diferentes etiolog&#237;as<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> y del 63&#37; sobre 59 muestras de ganglios linf&#225;ticos con cultivo micobacteriano positivo<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#46; Sin embargo&#44; la sensibilidad de esta t&#233;cnica sobre el LP de pacientes con DPT no se ha descrito hasta la fecha&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los objetivos de este estudio fueron&#58; 1&#41; evaluar la rentabilidad diagn&#243;stica de la t&#233;cnica FluoroType MTB&#174; en muestras de LP y esputo de pacientes con sospecha de DPT y 2&#41; analizar el aumento de la rentabilidad diagn&#243;stica de una segunda prueba FluoroType MTB&#174; en LP &#40;mediante nueva toracentesis&#41; cuando una primera determinaci&#243;n fue negativa&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se recogi&#243; de forma prospectiva y consecutiva a los pacientes intervenidos de toracocentesis diagn&#243;stica en el Hospital Universitario Arnau de Vilanova de L&#233;rida desde enero de 2017 hasta septiembre de 2019&#46; A todos aquellos con sospecha de DPT se les solicit&#243; la prueba Fluorotype MTB&#174; en espec&#237;menes de LP y&#44; si era factible&#44; en esputo&#46; A criterio del cl&#237;nico responsable&#44; esta t&#233;cnica de PCR tambi&#233;n se indic&#243; en sujetos con otras causas de derrame y se evit&#243;&#44; en general&#44; cuando la etiolog&#237;a del LP era altamente previsible &#40;por ejemplo&#44; en una proporci&#243;n importante de insuficiencias cardiacas&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se realiz&#243; una segunda toracocentesis cuando no se ten&#237;a un diagn&#243;stico de certeza despu&#233;s de conocerse los resultados del primer procedimiento&#46; El protocolo del estudio fue aprobado por el Comit&#233; &#201;tico local &#40;CEIC-1674&#41; y todos los pacientes firmaron un consentimiento informado&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Criterios diagn&#243;sticos</span><p id="par0030" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de DPT se consider&#243; confirmado cuando se aisl&#243; bacilo tuberculoso en esputo&#44; LP o biopsia pleural&#44; o bien se demostraron granulomas en esta &#250;ltima&#46; El diagn&#243;stico de tuberculosis pleural probable se estableci&#243; cuando se cumpl&#237;an las siguientes condiciones&#58; a&#41; cuadro cl&#237;nico compatible con DPT&#59; b&#41; presencia de un exudado pleural con concentraciones de adenosina desaminasa &#8805; 35 U&#47;L&#59; c&#41; resoluci&#243;n del derrame con tratamiento antituberculoso y d&#41; exclusi&#243;n razonable de otras causas potenciales de derrame durante un seguimiento cl&#237;nico de al menos un a&#241;o&#46; La demostraci&#243;n de bacilo tuberculoso en una muestra de LP o esputo mediante examen microsc&#243;pico&#44; cultivo o t&#233;cnica de PCR defini&#243; un aislamiento microbiol&#243;gico positivo&#46; Se clasific&#243; como idiop&#225;tico aquel derrame que se resolvi&#243; sin tratamiento espec&#237;fico y cuya etiolog&#237;a no se pudo determinar a pesar de un estudio exhaustivo que incluy&#243; an&#225;lisis del LP&#44; una tomograf&#237;a computarizada y una biopsia pleural&#46; Otros diagn&#243;sticos se establecieron seg&#250;n criterios cl&#237;nicos ampliamente aceptados<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">T&#233;cnicas</span><p id="par0035" class="elsevierStylePara elsevierViewall">Las muestras de LP se recogieron en tubos de 10<span class="elsevierStyleHsp" style=""></span>mL que conten&#237;an &#225;cido etilendiaminotetraac&#233;tico&#46; La t&#233;cnica de FluoroType MTB&#174; &#40;Hain Lifescience&#44; Nehren&#44; Alemania&#41; se emple&#243; el mismo d&#237;a de la extracci&#243;n&#46; Las muestras de LP y esputo fueron descontaminadas y concentradas por el m&#233;todo del hidr&#243;xido s&#243;dico y N-acetil-ciste&#237;na<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a>&#46; Se centrifugaron durante 20&#160;min a 2&#46;800<span class="elsevierStyleHsp" style=""></span>rpm&#46; El sedimento obtenido se suspendi&#243; en 2<span class="elsevierStyleHsp" style=""></span>mL de tamp&#243;n fosfato y 0&#44;5<span class="elsevierStyleHsp" style=""></span>mL de la mezcla se utilizaron para la PCR&#46; La extracci&#243;n del ADN se efectu&#243; de forma manual con el kit FluoroLyse&#174; &#40;Hain Lifescience&#44; Nehren&#44; Alemania&#41; seg&#250;n instrucciones del fabricante&#46; Para la PCR en tiempo final con curva de <span class="elsevierStyleItalic">melting</span> se utiliz&#243; el instrumento FluoroCycler&#174;&#44; usando los reactivos de FluoroType&#174; MTB&#46; Los an&#225;lisis microbiol&#243;gicos rutinarios incluyeron la tinci&#243;n de auramina en muestras de esputo y los cultivos de micobacterias en medios s&#243;lidos &#40;L&#246;wenstein-Jensen&#41; y l&#237;quidos &#40;Middlebrook l&#237;quido TH9&#41; tanto en esputo como en LP&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0040" class="elsevierStylePara elsevierViewall">Las medidas de eficacia diagn&#243;stica &#40;sensibilidad&#44; especificidad&#44; <span class="elsevierStyleItalic">likelihood ratios</span> &#91;LR&#93;&#41; y sus intervalos de confianza del 95&#37; &#40;IC&#160;95&#37;&#41; se calcularon a partir de una tabla de contingencia 2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#46; Si una de las cifras de la tabla correspond&#237;a a un cero&#44; se a&#241;adi&#243; 0&#44;5 a cada casilla para poder obtener un valor de LR&#46; Los c&#225;lculos se hicieron con el paquete estad&#237;stico SPSS versi&#243;n 24&#46;0 &#40;Chicago&#44; IL&#44; EE&#46;UU&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Pacientes</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se incluy&#243; a 31 pacientes con tuberculosis pleural &#40;22 varones y 9 mujeres con una edad mediana de 35 a&#241;os&#41; y 176 con otros diagn&#243;sticos &#40;122 varones y 54 mujeres con una edad mediana de 72 a&#241;os&#41;&#46; En el primer grupo&#44; 21 &#40;68&#37;&#41; pacientes dispon&#237;an de un diagn&#243;stico histol&#243;gico o microbiol&#243;gico definitivo de tuberculosis&#44; mientras que en 10 &#40;32&#37;&#41; el diagn&#243;stico fue cl&#237;nico&#46; Solo un paciente estaba coinfectado con el virus de la inmunodeficiencia humana&#46; Las causas de derrame pleural no tuberculoso se especifican en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; mientras que la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> resume las caracter&#237;sticas bioqu&#237;micas del LP en la poblaci&#243;n de estudio&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">FluoroType MTB&#174; en el l&#237;quido pleural</span><p id="par0050" class="elsevierStylePara elsevierViewall">La prueba &#237;ndice o FluoroType MTB&#174; en LP fue positiva en 4 de los 31 &#40;13&#37;&#41; pacientes con tuberculosis y en 2 de los 176 &#40;1&#37;&#41; con derrames de otras causas&#44; lo que supone una sensibilidad del 13&#37; &#40;IC&#160;95&#37; 5-29&#37;&#41;&#44; una especificidad del 99&#37; &#40;IC&#160;95&#37; 96-100&#37;&#41;&#44; una LR positiva de 11 &#40;IC&#160;95&#37; 2-59&#41; y una LR negativa de 0&#44;9 &#40;IC&#160;95&#37; 0&#44;8-1&#41;&#46; La sensibilidad de FluoroType MTB&#174; fue inferior a la de otras pruebas microbiol&#243;gicas&#44; como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; Se utilizaron como pruebas de referencia las ya mencionadas para definir los t&#233;rminos de tuberculosis pleural confirmada y probable&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">En 9 pacientes &#40;33&#37;&#41; con un cultivo de LP positivo para <span class="elsevierStyleItalic">M&#46; tuberculosis</span>&#44; la prueba FluoroType MTB&#174; result&#243; negativa &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Por otro lado&#44; 2 de los 4 &#40;50&#37;&#41; pacientes con una prueba FluoroType MTB&#174; positiva en LP no ten&#237;an ning&#250;n otro aislamiento microbiol&#243;gico positivo&#46; Es decir&#44; en 2 de los 31 &#40;6&#44;5&#37;&#41; pacientes con DPT el diagn&#243;stico confirmatorio se hizo exclusivamente mediante la t&#233;cnica de PCR&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">FluoroType MTB&#174; en esputo</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se analiz&#243; el esputo de 25 pacientes mediante FluoroType MTB&#174;&#46; Fue positivo en 3 de 14 &#40;21&#37;&#41; con DPT y en uno de 11 &#40;9&#37;&#41; con otros diagn&#243;sticos &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Los 3 pacientes con DPT y positividad en esta t&#233;cnica de PCR en esputo mostraron tambi&#233;n cultivos positivos de esputo y&#44; uno de ellos&#44; un cultivo de LP positivo&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">FluroType MTB&#174; en pacientes con una primera determinaci&#243;n negativa</span><p id="par0065" class="elsevierStylePara elsevierViewall">En 57 pacientes &#40;24 con tuberculosis y 33 con otros diagn&#243;sticos&#41; se realiz&#243; una segunda determinaci&#243;n de FluoroType MTB&#174; en LP con una mediana de diferencia entre las 2<span class="elsevierStyleHsp" style=""></span>toracocentesis de 3 d&#237;as &#40;cuartiles 25 y 75&#58; 1-7&#41;&#46; En todos los casos el segundo an&#225;lisis fue negativo&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Falsos positivos de FluoroType MTB&#174;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Hubo 2 pacientes con una prueba de FluoroType MTB&#174; en LP interpretada como un falso positivo&#46; Se trataba de un paciente con un trasudado secundario a insuficiencia cardiaca y otro con un derrame paraneum&#243;nico al que se le realiz&#243; una biopsia pleural que mostr&#243; inflamaci&#243;n aguda sin granulomas&#46; En ambos casos una segunda muestra de FluoroType MTB&#174; fue negativa 2<span class="elsevierStyleHsp" style=""></span>d&#237;as despu&#233;s de la primera&#46; Tambi&#233;n hubo un falso positivo de FluoroType MTB&#174; sobre una muestra de esputo&#44; que correspondi&#243; a una paciente con un derrame maligno secundario a linfoma&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">En este estudio&#44; la t&#233;cnica FluoroType MTB&#174; sobre LP ha demostrado una utilidad limitada en el diagn&#243;stico del DPT debido a su baja sensibilidad &#40;13&#37;&#41;&#46; No obstante&#44; en un 6&#44;5&#37; de los pacientes con DPT la confirmaci&#243;n diagn&#243;stica se obtuvo exclusivamente mediante esta t&#233;cnica de PCR&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Las t&#233;cnicas de PCR para diagnosticar tuberculosis pueden hacerse mediante m&#233;todos comercializados o desarrollados en un laboratorio para su propio uso <span class="elsevierStyleItalic">&#40;in house&#41;</span><a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a>&#46; Entre los primeros&#44; la prueba Xpert&#174; MTB&#47;RIF ha sido avalada por la Organizaci&#243;n Mundial de la Salud<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a>&#46; En una revisi&#243;n Cochrane&#44; la sensibilidad global del Xpert&#174; MTB&#47;RIF en LP fue del 51&#37; &#40;IC&#160;95&#37; 40-63&#37;&#41;&#44; pero disminuy&#243; hasta el 18&#37; &#40;IC&#160;95&#37; 10-31&#37;&#41; cuando el <span class="elsevierStyleItalic">gold standard</span> aplicado fue el diagn&#243;stico cl&#237;nico de DPT sin confirmaci&#243;n microbiol&#243;gica&#59; la especificidad de la prueba fue del 99&#37;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&#46; En un estudio reciente&#44; la nueva t&#233;cnica Xpert&#174; MTB&#47;RIF Ultra sobre LP mostr&#243; una sensibilidad global superior al cultivo &#40;44 vs&#46; 26&#37;&#41; en 208 pacientes con DPT&#44; si bien el porcentaje de positividades se redujo al 20&#37; en los casos de tuberculosis pleural probable<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Este es el primer estudio que valora la rentabilidad diagn&#243;stica de FluoroType MTB&#174; en LP&#46; Otro estudio compar&#243; FluoroType MTB&#174; y Xpert MTB&#47;RIF en 70 muestras de esputo positivas para <span class="elsevierStyleItalic">M&#46; tuberculosis</span> y 226 con cultivos negativos<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a>&#46; La sensibilidad de FluoroType MTB&#174; fue superior a la de Xpert MTB&#47;RIF &#40;88&#44;6 vs&#46; 78&#44;6&#37;&#41;&#44; pero su especificidad result&#243; inferior &#40;59&#44;7 vs&#46; 93&#44;8&#37;&#41;&#59; es decir&#44; present&#243; un porcentaje mayor de potenciales falsos positivos<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Si bien FluoroType MTB&#174; permite disponer de los resultados con rapidez y es m&#225;s barato que Xpert&#174; MTB&#47;RIF Ultra &#40;aproximadamente 39 vs&#46; 76&#160;&#8364; euros por muestra en nuestro centro&#44; respectivamente&#41;&#44; no detecta resistencias farmacol&#243;gicas como este &#250;ltimo&#46; Algunas razones para la baja sensibilidad de las t&#233;cnicas de PCR en LP son la naturaleza paucibacilar de la tuberculosis pleural<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> y la presencia de inhibidores de PCR en este medio<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">17&#44;20</span></a>&#46; La utilidad de FluoroType MTB&#174; tambi&#233;n se ve limitada por la existencia de falsos positivos que&#44; aunque fueron poco frecuentes en nuestro estudio&#44; ya se han constatado en trabajos previos<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">11&#44;19</span></a>&#58; se han asociado a reacciones cruzadas o a una deficiente lectura de la curva que muestra el FluoroCycler&#174;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La repetici&#243;n de la t&#233;cnica de PCR cuando una primera ha sido negativa ya se ha evaluado previamente&#46; Un estudi&#243; mostr&#243; que&#44; de 645 casos de tuberculosis pulmonar con prueba Xpert&#174; MTB&#47;RIF positiva&#44; 615 &#40;95&#37;&#41; lo fueron con la primera determinaci&#243;n y 30 &#40;5&#37;&#41; con una segunda<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a>&#46; En el caso de 168 tuberculosis extrapulmonares estos porcentajes respectivos fueron del 89 y del 11&#37;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a>&#46; En nuestro estudio una segunda muestra no aument&#243; la rentabilidad diagn&#243;stica en ning&#250;n paciente&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Este estudio tiene limitaciones&#46; La principal es que se incluy&#243; un n&#250;mero peque&#241;o de pacientes con DPT&#44; de los que un tercio carec&#237;an de confirmaci&#243;n microbiol&#243;gica&#46; No obstante&#44; la inclusi&#243;n de pacientes con probable DPT&#44; seg&#250;n los criterios establecidos&#44; est&#225; ampliamente aceptada en la literatura m&#233;dica&#46; Solo se test&#243; una muestra de esputo con t&#233;cnica de PCR en la mitad de los casos&#46; Tampoco pudo obtenerse una segunda muestra de LP en el 11&#37; de los pacientes con DPT que tuvieron una primera determinaci&#243;n de FluoroType MTB&#174; negativa&#46; Asimismo&#44; no se realiz&#243; examen microsc&#243;pico y tinci&#243;n de auramina en espec&#237;menes de LP &#40;la &#250;nica prueba que podr&#237;a compararse&#44; por la rapidez de resultados&#44; con la PCR&#41;&#44; debido a la baja sensibilidad que mostr&#243; esta t&#233;cnica en un estudio previo de nuestro centro &#40;3&#37; de positividades en una serie de 274 muestras de LP&#41;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a>&#46; Por &#250;ltimo&#44; una limitaci&#243;n inherente de FluoroType MTB&#174;&#44; a diferencia de otras t&#233;cnicas de PCR existentes en el mercado&#44; es que no detecta resistencias a f&#225;rmacos antituberculosos&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusiones</span><p id="par0105" class="elsevierStylePara elsevierViewall">La t&#233;cnica FluoroType MTB&#174; aplicada al LP tiene una limitada capacidad para diagnosticar tuberculosis y su especificidad no es absoluta&#46; El hecho de que la confirmaci&#243;n de DPT se obtuviese en el 6&#44;5&#37; de los casos exclusivamente mediante esta t&#233;cnica no parece justificar su implementaci&#243;n en la pr&#225;ctica cl&#237;nica rutinaria&#44; fuera del &#225;mbito de la investigaci&#243;n&#46; Tampoco resulta rentable la repetici&#243;n de la prueba cuando una primera determinaci&#243;n ha resultado negativa&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Financiaci&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">Este estudio ha sido financiado por la Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41; con la &#171;Ayuda FEMI para internistas j&#243;venes&#187; 2016&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0115" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Material y m&#233;todos"
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            0 => array:2 [
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              "titulo" => "Pacientes"
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            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "FluoroType MTB&#174; en el l&#237;quido pleural"
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              "titulo" => "FluoroType MTB&#174; en esputo"
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              "identificador" => "sec0050"
              "titulo" => "FluroType MTB&#174; en pacientes con una primera determinaci&#243;n negativa"
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            4 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Falsos positivos de FluoroType MTB&#174;"
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          "titulo" => "Financiaci&#243;n"
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          "titulo" => "Conflicto de intereses"
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          "titulo" => "Bibliograf&#237;a"
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    "fechaRecibido" => "2020-01-02"
    "fechaAceptado" => "2020-04-02"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1340491"
          "palabras" => array:3 [
            0 => "FluoroType MTB"
            1 => "Tuberculosis pleural"
            2 => "Derrame pleural"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1340492"
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            0 => "FluoroType MTB"
            1 => "Pleural tuberculosis"
            2 => "Pleural effusion"
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This work aims to investigate the diagnostic accuracy of a nucleic acid amplification test &#40;FluoroType MTB&#174;&#41; in pleural fluid &#40;PF&#41; and sputum to diagnose tuberculous pleural effusion &#40;TPE&#41;&#46; We also analyzed the increase in diagnostic accuracy of a second FluoroType MTB&#174; test on a second thoracentesis sample when the first was negative&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We conducted a prospective single-center study that included 207 patients with pleural effusion &#40;31 tuberculous and 176 due to other causes&#41;&#46; Of the 31 cases of TPE&#44; 21 &#40;68&#37;&#41; were confirmed histologically or microbiologically&#59; the other cases were considered probable&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The operational characteristics of FluoroType MTB&#174; in PF for identifying tuberculosis were a sensitivity of 13&#37;&#44; a specificity of 99&#37;&#44; a positive likelihood ratio of 11&#44; and a negative likelihood ratio of 0&#46;9&#46; The diagnostic efficacy data for sputum samples were 21&#37;&#44; 91&#37;&#44; 2&#46;4&#44; and 0&#46;9&#44; respectively&#46; PF and sputum cultures in solid and liquid media had greater sensitivity &#40;36&#37; and 31&#37;&#44; respectively&#41;&#46; A second FluoroType MTB&#174; test in PF was negative for 24 patients who had TPE and for whom the first FluoroType MTB&#174; test was also negative&#46; Only two &#40;6&#46;5&#37;&#41; patients with TPE had a confirmed diagnosis based exclusively on the positive results of the FluoroType MTB&#174; in PF&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Due to its low sensitivity&#44; the FluoroType MTB&#174; test in PF has a limited role in diagnosing tuberculous pleurisy&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivos"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
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            "titulo" => "Resultados"
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            "identificador" => "abst0020"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This work aims to investigate the diagnostic accuracy of a nucleic acid amplification test &#40;FluoroType MTB&#174;&#41; in pleural fluid &#40;PF&#41; and sputum to diagnose tuberculous pleural effusion &#40;TPE&#41;&#46; We also analyzed the increase in diagnostic accuracy of a second FluoroType MTB&#174; test on a second thoracentesis sample when the first was negative&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We conducted a prospective single-center study that included 207 patients with pleural effusion &#40;31 tuberculous and 176 due to other causes&#41;&#46; Of the 31 cases of TPE&#44; 21 &#40;68&#37;&#41; were confirmed histologically or microbiologically&#59; the other cases were considered probable&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The operational characteristics of FluoroType MTB&#174; in PF for identifying tuberculosis were a sensitivity of 13&#37;&#44; a specificity of 99&#37;&#44; a positive likelihood ratio of 11&#44; and a negative likelihood ratio of 0&#46;9&#46; The diagnostic efficacy data for sputum samples were 21&#37;&#44; 91&#37;&#44; 2&#46;4&#44; and 0&#46;9&#44; respectively&#46; PF and sputum cultures in solid and liquid media had greater sensitivity &#40;36&#37; and 31&#37;&#44; respectively&#41;&#46; A second FluoroType MTB&#174; test in PF was negative for 24 patients who had TPE and for whom the first FluoroType MTB&#174; test was also negative&#46; Only two &#40;6&#46;5&#37;&#41; patients with TPE had a confirmed diagnosis based exclusively on the positive results of the FluoroType MTB&#174; in PF&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Due to its low sensitivity&#44; the FluoroType MTB&#174; test in PF has a limited role in diagnosing tuberculous pleurisy&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Algoritmo diagn&#243;stico del estudio&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Neoplasia</span>Pulm&#243;nLinfomaDigestivoOtras<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">48 &#40;27&#41;2110512&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Confirmado</span><span class="elsevierStyleItalic">Probable</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21 &#40;68&#41;10 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">44 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Insuficiencia cardiaca</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">9 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Posquir&#250;rgico</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Miscel&#225;nea</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Total</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ADA &#8805; 35 U&#47;L n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LR&#43;&#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LR&#8722;&#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VPN en&#37; &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">FluoroType MTB&#174; en LP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">176&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;5-29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;96-100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11 &#40;2-59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9 &#40;0&#44;8-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67 &#40;30-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;81-91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cultivo de LP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;22-53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;97-100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">127 &#40;8-2&#46;105&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6 &#40;0&#44;5-0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100 &#40;74-100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">90 &#40;85-93&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">FluoroType MTB&#174; en esputo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9 &#40;0&#44;6-1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75 &#40;30-95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">48 &#40;28-68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tinci&#243;n de auramina en esputo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#44;7 &#40;0&#44;5-171&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;85 &#40;0&#44;71-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100 &#40;51-100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">57 &#40;43-70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Cultivo de esputo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100 &#40;85-100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#44;3 &#40;1&#44;1-301&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;7 &#40;0&#44;54-0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FluoroType MTB&#174;LP &#43; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FluoroType MTB&#174;LP &#8722; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Cultivo LP &#43;Cultivo LP &#8722;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#47;27 &#40;33&#41;18&#47;27 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;516&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">FluoroType MTB&#174; en esputo &#43;FluoroType MTB&#174; en esputo &#8722;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#47;1 &#40;100&#41;0&#47;1 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#47;13 &#40;15&#41;11&#47;13 &#40;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;512&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tinci&#243;n de auramina en esputo &#43;Tinci&#243;n de auramina en esputo &#8722;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#47;4 &#40;50&#41;2&#47;4 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#47;22 &#40;9&#41;20&#47;22 &#40;91&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cultivo de esputo &#43;Cultivo de esputo &#8722;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;4 &#40;50&#41;2&#47;4 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#47;22 &#40;27&#41;16&#47;22 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;365&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cualquier aislamiento &#43;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>Cualquier aislamiento &#8722;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;4 &#40;50&#41;2&#47;4 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;27 &#40;56&#41;12&#47;27 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;835&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2532835.png"
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            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Los numeradores se refieren al n&#250;mero de pacientes con la caracter&#237;stica definida en la fila correspondiente y los denominadores al total de pacientes con la caracter&#237;stica definida en la columna correspondiente&#46;</p>"
            ]
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              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Los aislamientos incluyen auramina de esputo&#44; cultivo de l&#237;quido pleural o esputo&#46;</p>"
            ]
          ]
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Complementariedad de FluoroType MTB&#174; con otros datos microbiol&#243;gicos en pacientes con tuberculosis pleural<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a></p>"
        ]
      ]
    ]
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        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advances in the diagnosis of tuberculous pleuritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;M&#46; Porcel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.21037/atm.2016.07.23"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Transl Med&#46;"
                        "fecha" => "2016"
                        "volumen" => "4"
                        "paginaInicial" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27570776"
                            "web" => "Medline"
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              "identificador" => "bib0115"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Derrame pleural tuberculoso&#58; caracter&#237;sticas cl&#237;nicas de 320 pacientes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Bielsa"
                            1 => "C&#46; Acosta"
                            2 => "M&#46; Pardina"
                            3 => "C&#46; Civit"
                            4 => "J&#46;M&#46; Porcel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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