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The pleural fluid concentration of gamma-interferon (gamma-IFN) was studied in 44 patients with exudative pleurisy. The tuberculous nature of exudative pleurisy was established in 25 patients on the basis of X-ray study, a follow-up, microbiological study of pleural exudate specimens, and morphological studies of biopsy specimens obtained at video-assisted thoracoscopy or surgery. The the pleural exudate concentrations of gamma-IFN were over 300 pg/ml (mean 1019 +/- 161 pg/ml) in 19 out of 21 patients with exudative pleuritis in a phase of active inflammation. The patients with the fibrous outcome of pleurisy of tuberculous etiology and those with exudative pleurisy of non-tuberculous etiology, including that in malignancies and papapneumonic pleurisy, were observed to have lower concentrations of gamma-IFN (mean 118 +/- 16 pg/ml). With the discriminating level of above 300 pg/ml, the sensitivity and specificity of the test were 90.5 and 100%, respectively.

Mycobacterial antigens were identified by inhibition solid-phase enzyme immunoassay specific antibodies to M.H37Rv labelled with horse radish peroxidase in 20, 27, 24, 47 and 21 patients with tuberculous pleurisy, tuberculous empyema, meningitis, pleurisy and nontuberculous empyema, respectively. Mycobacterial antigens were found more frequently and in greater quantities in pleural and cerebrospinal fluids in tuberculosis than in the above nontuberculous affections. These differences were less pronounced in serum assays.

The authors relate the data on the importance of a biochemical analysis of the pleural fluid for the differential diagnosis of pleurisy and identification of the early signs of pleural fluid suppuration. For the purposes of the differential diagnosis between transudates and exudates measurements are made of the protein content and LDH activity in the pleural fluid. The exudate protein/serum protein and exudate LDH/serum LDH ratios are computed in necessary cases. The high prothrombin index (over 100%) and the level of lysozyme (over 25 (micrograms/ml) in the pleural fluid provide evidence in favour of the tuberculous etiology of pleurisy. The low level of glucose (under 2 mmol/l), high activity of LDH (over 6.2 mmol/l) and the negative ethanol test may point to the initial signs of exudate suppuration.

Determination of antitryptic activity of blood serum and exudate in patients with tuberculous pleurisy revealed that concentrations of trypsin inhibitors were significantly increased while their activity was markedly decreased (2-3-fold) in the exudate. This indicated exhaustion of the adaptation mechanisms in the inflammatory areas, which required their local correction. Intrapleural administration of contrical increased the body's protective and adaptation potentials and treatment efficiency such as shorter times of intoxication and pleural exudation and less frequency of pronounced concomitant pleural lesions.