Yu Chen,1,* Yuyang Ling,2,* Xudong Xu,3 Yanqin Shen,4 Kan Xu,3 Guocan Yu3 

1Department of Geriatrics, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University (Hangzhou Third People’s Hospital), Hangzhou, Zhejiang, People’s Republic of China; 2The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 3Zhejiang Tuberculosis Diagnosis and Treatment Center, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, People’s Republic of China; 4Department of Nursing, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Kan Xu, Email xukanmed@163.com Guocan Yu, Email dabaitwo@163.com

Objective: Early and precise diagnosis of tuberculous serous effusions is a huge challenge. Nanopore sequencing is a potentially efficient assay. The objective of the current study was to evaluate the diagnostic accuracy of nanopore sequencing for tuberculous serous effusions using clinical specimens directly, and to provide a new pathway for the early and precise diagnosis of tuberculous serous effusions.
Methods: This was a retrospective analysis of the effectiveness of nanopore sequencing as a diagnostic method for tuberculous serous effusions using clinical specimens (pleural fluid, pericardial effusion, and ascitic fluid). Using clinical diagnosis as reference standard, the diagnostic accuracy indicators such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for the tests in question were evaluated.
Results: In total, 132 patients were eligible for inclusion. Nanopore sequencing showed sensitivity of 93.3%, specificity of 85.2%, PPV of 96.1%, NPV of 76.7%, and AUC of 0.89 for tuberculous serous effusions. The diagnostic accuracy of nanopore sequencing was significantly superior than that of Xpert MTB/RIF and culture. Similar results were observed in different types of tuberculous serous effusions (pleural tuberculosis, pericardial tuberculosis, and peritoneal tuberculosis).
Conclusion: Nanopore sequencing was efficient for the rapid diagnosis of tuberculous serous effusions and had a very positive effect. For paucibacillary tuberculous serous effusions, nanopore sequencing might become an effective method for detecting pathogenic bacteria.

Keywords: nanopore sequencing, tuberculosis, pleural effusion, pericardial effusion, abdominal effusion, diagnostic accuracy