{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:13:44Z","timestamp":1786115624929,"version":"build-2736575974"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tuberculous pleurisy (TBP), a major extrapulmonary form of tuberculosis, is characterized by a paucibacillary state that makes diagnosis challenging. Metagenomic next-generation sequencing (mNGS) has emerged as a promising approach for MTB detection; however, its discriminatory value between TBP and pulmonary tuberculosis (PTB) among mNGS-confirmed cases, and its integration with clinical features for differential diagnosis, remain insufficiently defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective cohort included hospitalized patients with MTB-positive mNGS results from January 2020 to January 2025. As only mNGS-positive cases were included, overall mNGS diagnostic sensitivity cannot be estimated. Twelve TBP patients were matched 1:2 with twenty-four PTB patients by age and sex; patients with immunosuppressive conditions were excluded prior to matching. Clinical, laboratory, mNGS, and conventional TB test data were collected. Logistic regression and ROC analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Conventional tests showed limited sensitivity in TBP despite universal mNGS positivity. MTB read counts were similar between groups (median 1976.5 vs. 990.0, P\u00a0=\u00a00.920). Pleural-derived specimens predominated in TBP (41.7% vs. 4.2%, P\u00a0=\u00a00.007). CRP demonstrated the highest individual discriminatory value (AUC\u00a0=\u00a00.658, P\u00a0=\u00a00.131), though no single predictor reached significance. A combined model (cough, fever, CRP, WBC) showed modest non-significant improvement (AUC\u00a0=\u00a00.722, overall P\u00a0=\u00a00.359; sensitivity 66.7%, specificity 83.3%). Given EPV \u2248 3, all findings are exploratory only. No significant prognostic predictors were identified in TBP; a non-significant trend toward lower lymphocyte counts was observed in patients with unfavorable outcomes (0.60 vs. 1.10 \u00d710\n                      <jats:sup>9<\/jats:sup>\n                      \/L, P\u00a0=\u00a00.115).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among mNGS-confirmed cases, MTB read counts were comparable between TBP and PTB. No single parameter reliably distinguished the two; a combined clinical model showed modest improvement but requires prospective validation in larger cohorts. Integrating mNGS with systematic clinical evaluation remains essential for accurate TB diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1772516","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T04:25:18Z","timestamp":1785990318000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Differentiating tuberculous pleurisy from pulmonary tuberculosis using mNGS: a multicenter cohort analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Yangmiao","family":"Zhang","sequence":"first","affiliation":[{"name":"State Key Laboratory of Metabolic Dysregulation & Prevention and Treatment of Esophageal Cancer, Tianjian Laboratory of Advanced Biomedical Sciences, School of Convergence Medicine, Zhengzhou University","place":["Zhengzhou, China"]},{"name":"Gene Hospital of Henan Province, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyi","family":"Li","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Metabolic Dysregulation & Prevention and Treatment of Esophageal Cancer, Tianjian Laboratory of Advanced Biomedical Sciences, School of Convergence Medicine, Zhengzhou University","place":["Zhengzhou, China"]},{"name":"Gene Hospital of Henan Province, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoke","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Tuberculosis, The Affiliated Chest Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuwen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zujiang","family":"Yu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Metabolic Dysregulation & Prevention and Treatment of Esophageal Cancer, Tianjian Laboratory of Advanced Biomedical Sciences, School of Convergence Medicine, Zhengzhou University","place":["Zhengzhou, China"]},{"name":"Gene Hospital of Henan Province, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]},{"name":"Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1097\/mcp.0000000000001052","article-title":"Tuberculous pleuritis: clinical presentations and diagnostic challenges","volume":"30","author":"Chan","year":"2024","journal-title":"Curr. 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