The samples were incubated at 37 °C in a humidified 5% CO2 incubator for 24 h. On the second day, the tubes were centrifuged at 3000 rcf for 10 min DMXAA mw and the

plasma was collected and stored at 4 °C until IFN-γ assay was performed using ELISA. The optical density of each test was read using a 450-nm filter with a 620-nm reference filter with an ELISA plate reader. The results were interpreted as positive, negative or indeterminate using QFT-GIT analysis software (QFT-GIT; Cellestis Ltd). If the IFN-γ secretion in response to TB antigen, after subtracting nil control IFN-γ, was ≥ 0.35 IU mL−1, it was considered positive for QFT-GIT; and if the value was < 0.35 IU mL−1, it was considered negative. If the negativity was associated with poor phytohaemagglutinin (PHA) response (i.e. IFN-γ secretion in response to mitogen was < 0.5 IU mL−1), it was considered as indeterminate or invalid result for QFT-GIT. The subjects with IFN-γ secretion > 8.0 IU mL−1 in the nil control samples were also considered indeterminate for QFT-GIT.

Immediately following blood collection from the right hand of each participant, 0.1 mL (2 T.U/0.1 mL) Tuberculin PPD RT23 (Statens Serum Institute, Copenhagen, Denmark) was administered intradermally in the middle third of the left forearm by an experienced nurse. The diameter induration transverse to the long see more axis of the forearm was measured between 48 and 72 h using a flexible plastic ruler. A diameter of skin induration ≥ 10 mm was considered positive for tuberculin skin test (TST). In all, 40 mL pleural fluid was concentrated by centrifugation at 10 000 g at 4 °C for 20 min. Then the pellet was re-suspended in 1 mL sterile distilled water and stored at −20 °C for DNA extraction. Three sputum specimens (spot-morning-spot) from each participant were collected and M.tb was detected with an AFB smear using

the Ziehl–Neelsen method and mycobacterial culture in both Lowenstein Jensen (Biomerieux Inc., L’Etoile, France) and MGIT tubes (BD BACTC MGIT 960 system). The DNA from pleural fluid pellet suspension was extracted using the DNeasy Lck Blood & Tissue Kit (Qiagen, Hilden, Germany). Nested PCR was performed using the Seeplex® MTB Nested ACE Detection kit according to the manufacturer’s instructions. This detection kit utilizes multi-target (IS6110 and MPB64) instead of single-target PCR for specific detection of M.tb. A mixture of bacterial clones and internal clones were used as positive controls. To eliminate any possibility of cross-contamination from the positive controls, the amplification sizes of the positive control PCR products (810 and 745 bp) were designed differently from those of the specimen PCR products (255 and 190 bp). The statistical analysis was performed with graphpad prism software (version 5.01; GraphPad Software, Inc.) and medcalc Software (Version 11.4.2; MedCalc Software bvba).