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Expert Review of Anti-infective Therapy Jan 2017Pulmonary involvement is a rare, focal complication of human brucellosis. The aim of this review is to describe clinical and radiologic features, treatment administered... (Review)
Review
Pulmonary involvement is a rare, focal complication of human brucellosis. The aim of this review is to describe clinical and radiologic features, treatment administered and clinical course of these patients. Areas covered: We conducted a systematic search of scientific reports of brucellosis with pulmonary involvement published from January 1985 to July 2016. Four main patterns of disease were observed: pneumonia, pleural effusion, nodules and interstitial pattern. Cough and fever were the most common symptoms. Brucella spp. culture was obtained from blood (50%) or pleural fluid. Treatment is based on the same antibiotics and combinations of antibiotics as for patients with acute no complicated brucellosis. The most frequent antimicrobial combination was doxycycline and rifampin for six weeks. The clinical course was favorable in most reports, and mortality was remarkably low (<1%). Expert commentary: Non-specific clinical and radiological manifestations were the main reason for the delay in proper treatment. Difficulty in distinguishing Brucellosis from other pulmonary infections, such as tuberculosis, sometimes posed an added diagnostic challenge.
Topics: Anti-Bacterial Agents; Brucellosis; Drug Therapy, Combination; Humans; Lung Diseases; Practice Guidelines as Topic; Respiration, Artificial
PubMed: 27790937
DOI: 10.1080/14787210.2017.1254042 -
Tropical Medicine and Infectious Disease Jan 2022Motivated by a case finding of Mediterranean spotted fever (MSF) associated with atypical pneumonia and pleural effusion in which was identified by molecular methods in... (Review)
Review
BACKGROUND
Motivated by a case finding of Mediterranean spotted fever (MSF) associated with atypical pneumonia and pleural effusion in which was identified by molecular methods in the pleural fluid, we wanted to summarize the clinical presentations of rickettsiosis in Italy by systematic research and to make a systematic review of all the global cases of rickettsiosis associated with pleural effusion.
METHODS
For the literature search, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. We chose to select only the studies published in last 25 years and confirmed both with serological and molecular assays.
RESULTS
Human cases of rickettsiosis in Italy were reported in 48 papers describing 2831 patients with very different clinical presentations; the majority was MSF accounted to and was reported in Sicily. Pleural effusion associated with infection with microorganisms belonging to Rickettsiales was described in 487 patients. It was rarely associated with microorganisms different from also rarely, cases of scrub typhus were reported outside Southeast Asia and in the largest majority, the diagnosis was achieved with serology.
CONCLUSIONS
MSF, especially when caused by may be a severe disease. A high index of suspicion is required to promptly start life-saving therapy. Pleural effusion and interstitial pneumonia may be part of the clinical picture of severe rickettsial disease and should not lead the physician away from this diagnosis.
PubMed: 35051127
DOI: 10.3390/tropicalmed7010011 -
British Journal of Cancer Mar 2017Radiological markers of treatment response and prognostication in malignant pleural mesothelioma have limitations due to the morphology of the disease. Serum or pleural... (Review)
Review
BACKGROUND
Radiological markers of treatment response and prognostication in malignant pleural mesothelioma have limitations due to the morphology of the disease. Serum or pleural fluid biomarkers that could act as an adjunct to radiological assessment would be of significant value. The aim of this review was to collate and summarise the literature relating to this topic.
METHODS
A systematic review was performed on the databases Pubmed and EMBASE to identify relevant studies. Two independent researchers read the abstracts and used the Quality in Prognostic Studies tool to assess the quality of the evidence.
RESULTS
Forty-five studies were identified from the current literature. Twenty studies investigated the role of serum soluble mesothelin with majority suggesting that it has variable utility as a baseline test but when measured serially correlates with treatment response and prognosis. Several studies demonstrated that serum osteopontin correlated with survival at baseline. Other biomarkers have shown prognostic utility in individual studies but are yet to be reproduced in large cohort studies.
CONCLUSIONS
From the available literature no serum or pleural fluid biomarker was identified that could be recommended currently for routine clinical practice. However, a falling serum soluble mesothelin might correlate with treatment response and improved survival.
Topics: Biomarkers, Tumor; Humans; Mesothelioma; Pleural Neoplasms; Prognosis
PubMed: 28170372
DOI: 10.1038/bjc.2017.22 -
Lung India : Official Organ of Indian... 2022Pleural fluid lysozyme (LP) and its ratio to serum lysozyme (LP/LS) have been proposed as potential biomarkers for diagnosing tuberculous pleural effusion (TPE). We...
OBJECTIVE
Pleural fluid lysozyme (LP) and its ratio to serum lysozyme (LP/LS) have been proposed as potential biomarkers for diagnosing tuberculous pleural effusion (TPE). We assessed the diagnostic accuracy of LP and LP/LS for TPE and evaluated their ability to differentiate TPE from other effusions.
METHODS
We queried the PubMed and Embase databases for studies indexed until October 2021. We included studies that (a) provided information regarding the sensitivity and specificity of LP or LP/LS for the diagnosis of TPE, or (b) compared LP or LP/LS between TPE and malignant or parapneumonic effusions. We used hierarchical summary receiver operating characteristic plots to model summary sensitivity and specificity. Random effects modeling was employed to pool standardized mean differences (SMD) across descriptive studies comparing TPE and other effusions.
RESULTS
We included 11 publications in our review, most of which were small and of poor quality. The summary estimates for sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.94 (95% confidence interval [CI] 0.53-1.00), 0.89 (95% CI 0.63-0.97), and 129.88 (95% CI 6.26-2695), and 0.98 (95% CI 0.58-1.00), 0.91 (95% CI 0.84-0.96), and 708.47 (95% CI 11.42-43946), respectively, for LP and LP/LS. Mean LP and LP/LS in TPE were significantly higher than in malignant effusions (summary SMD 1.51 [95% CI 1.04-1.98] and 1.77 [95% CI 1.31-2.22], respectively), and parapneumonic effusions (summary SMD 0.86 [95% CI 0.51-1.22] and 1.15 [95% CI 0.64-1.66], respectively).
CONCLUSION
There is low-quality evidence of good diagnostic accuracy for both LP and LP/LS in identifying TPE, the latter being marginally superior.
PubMed: 36629203
DOI: 10.4103/lungindia.lungindia_738_21 -
Cytokine May 2021Tumor necrosis factor (TNF) is an important local host response mediator in tuberculous pleural effusion (TPE) and is proposed as a potential biomarker for diagnosing... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Tumor necrosis factor (TNF) is an important local host response mediator in tuberculous pleural effusion (TPE) and is proposed as a potential biomarker for diagnosing TPE. We assessed the performance of pleural fluid TNF in the diagnosis of TPE, and evaluated its ability to distinguish TPE from parapneumonic or malignant effusions.
METHODS
We queried the PubMed and Embase databases for studies indexed till August 2020. We included studies that (a) provided data on sensitivity and specificity of pleural fluid TNF for the diagnosis of TPE, or (b) compared pleural fluid TNF levels between TPE and malignant or parapneumonic effusions. We used a hierarchical summary receiver operating characteristic plot to model summary sensitivity and specificity. A random effects model was used to pool standardized mean differences (SMD) across studies comparing TPE and other effusions. We explored heterogeneity using subgroup analysis. We also performed meta-regression to identify factors significantly influencing results.
RESULTS
We retrieved 1090 citations, and included 38 publications, in our review. The summary estimates for sensitivity, specificity, and diagnostic odds ratio were 0.79 (95% CI 0.72-0.84), 0.82 (95% CI 0.76-0.87), and 16.84 (95% CI 9.47-29.95) respectively. Pleural fluid TNF levels were significantly higher in TPE than in malignant effusions (summary SMD 1.50, 95% CI 1.13-1.87), but not parapneumonic effusions (summary SMD 0.61, 95% CI -0.14 to 1.35). None of the prespecified subgroup variables significantly influenced summary estimates.
CONCLUSION
Pleural fluid TNF has poor diagnostic accuracy for diagnosing TPE and imperfectly discriminates TPE from parapneumonic pleural effusions.
Topics: Humans; Pleural Effusion; Tuberculosis, Pleural; Tumor Necrosis Factor-alpha
PubMed: 33609953
DOI: 10.1016/j.cyto.2021.155467 -
Frontiers in Medicine 2021Endometriosis-related pleural effusion (PE) is a relatively rare but treatable cause of bloody PE. The clinical characteristics and outcome of patients with...
Endometriosis-related pleural effusion (PE) is a relatively rare but treatable cause of bloody PE. The clinical characteristics and outcome of patients with endometriosis-related PE remain unknown. We present a case of endometriosis-related PE diagnosed on pleural fluid cytology. A systematic review of all endometriosis-related PE cases in literature was conducted to elucidate the clinical characteristics, explore the diagnostic yield of pathological examinations, and to summarize the outcomes of therapeutic approaches in this disease. A case of endometriosis-related PE diagnosed in study hospital was reported. PubMed, Web of Science, and EMBASE were searched for publications pertaining to cases of endometriosis-related PE using predefined search terms. This case and those identified from PubMed, Web of Science, and EMBASE were analyzed. A total of 67 patients were included. Catamential symptoms were presented in 30 (44.8%) patients. Dyspnea was presented in 50 patients (74.6%), followed by right chest/shoulder pain in 34 (50.7%) and cough in 18 (26.9%). 82.8% of the patients had concomitant pelvic endometriosis and 76.7% was infertile or nulliparous. The diagnostic yield of pleural fluid cytological examination, percutaneous pleural biopsy, and surgical biopsy was 9.0, 45.5, and 78.7%, respectively. The patients who received surgery-based therapy had a significantly longer time to relapse than those who received progestational agents or GnRH analogs alone ( = 0.025) or hysterectomy and bilateral salpingoophorectomy (HBSO) ( = 0.040). High clinical awareness of pleural endometriosis is essential in all female with hemorrhagic PE, especially in young females who have infertility and/or pelvic endometriosis. Plerual fluid cytology might be a simple minimally invasive and cost-effective modality in the diagnosis of endometriosis-related PE. Treatment is challenging due to high recurrence and the optimal management of endometriosis-related PE needs further evaluation. The combined approach by surgery and hormonal therapy may achieve the best relapse-free survival.
PubMed: 33859990
DOI: 10.3389/fmed.2021.631048 -
BMC Pulmonary Medicine Apr 2021Complicated parapneumonic effusions and empyema represent advanced stages of pleural infections and are characterized by a high mortality. Medical thoracoscopy is a safe... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Complicated parapneumonic effusions and empyema represent advanced stages of pleural infections and are characterized by a high mortality. Medical thoracoscopy is a safe and minimally invasive endoscopic technique prescribed to treat severe pleural infections. However, only a few studies evaluated its success rate. A systematic review of observational studies was performed to assess the efficacy of medical thoracoscopy in patients with complicated parapneumonic effusions and empyema, as well as its predictive factors.
METHODS
A search of the scientific evidence was carried out using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Articles describing observational studies on medical thoracoscopy in patients with parapneumonic effusions and empyema were selected.
RESULTS
Eight studies met the inclusion criteria. The pooled treatment success rate of thoracoscopy was 85% (95% CI 80.0-90.0%; I: 61.8%) when used as first-line intervention or after failure of chest tube. The pooled complication rate was 9.0% (95% CI 6.0-14.0%; I: 58.8%). A pooled difference of treatment success of 9.0% (95% CI 1.0-18.0%) was found when post-thoracoscopy intra-pleural fibrinolysis was prescribed. Pooled success rate was higher in cases with pleural fluid culture negativity (pooled difference: 14.0%; 95% CI 4.0-24.0%).
CONCLUSIONS
Medical thoracoscopy is effective and safe when prescribed for complicated parapneumonic effusions and empyema. Bacteriological negativity of pleural effusion specimens and administration of adjuvant intra-pleural fibrinolysis after the procedure are associated with a higher success rate.
Topics: Empyema, Pleural; Exudates and Transudates; Humans; Pleural Effusion; Randomized Controlled Trials as Topic; Thoracoscopy; Treatment Outcome
PubMed: 33879116
DOI: 10.1186/s12890-021-01492-9 -
Physiological Reports Dec 2016Conventional methods may fail to identify the cause of pleural effusion (PE), thus establishing reliable biomarkers is deemed necessary. This study aimed at examining... (Meta-Analysis)
Meta-Analysis Review
Conventional methods may fail to identify the cause of pleural effusion (PE), thus establishing reliable biomarkers is deemed necessary. This study aimed at examining the role of vascular endothelial growth factor (VEGF) as a biomarker in the differentiation between malignant and benign PEs in adults. A comprehensive literature search in PubMed (Medline), Scopus (ELSEVIER), and Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted using keywords. We included studies that evaluated pleural and/or serum levels of VEGF among patients presenting with undiagnosed PE and the association between these levels and the final diagnosis. We performed a meta-analysis to calculate the summary effect using the random effects model. Statistical analysis was performed with the statistical package for meta-analysis Comprehensive Meta-Analysis. Twenty studies were included in the systematic review, while 11 of them in the meta-analysis. Pleural fluid VEGF levels among patients with malignant PE were increased by 1.93 ng/mL as compared to patients with benign PE (95% CI: 1.32-2.54, Q = 173, df (Q): 10, I = 94.2%, P < 0.05). Serum VEGF levels among patients with malignant PE were increased respectively by 1.90 ng/mL (95% CI: 0.93-2.88, Q = 182, df (Q): 6, I = 96.7%, P < 0.05). This study showed that malignant PEs were associated with higher levels of both pleural fluid and serum VEGF VEGF appears to represent a promising biomarker for the differential diagnosis between benign and malignant PEs.
Topics: Biomarkers, Tumor; Female; Humans; Male; Pleural Effusion, Malignant; Vascular Endothelial Growth Factor A
PubMed: 28039396
DOI: 10.14814/phy2.12978 -
Clinical Nephrology Oct 2016Wide ranges of sodium concentrations for different body fluid losses have been noted with minimal substantiating data and variability among sources, leading to use of... (Review)
Review
BACKGROUND
Wide ranges of sodium concentrations for different body fluid losses have been noted with minimal substantiating data and variability among sources, leading to use of "cumulative fluid balance" regardless of composition in hospitalized patients.
AIMS
To define the sodium concentrations of fluid losses from the body.
METHOD
We performed a systematic search and literature review in adult humans using PubMed database.
RESULTS
Inclusion criteria were met for 107 full-text articles. Mean sodium concentrations were significantly lower for acidic (mean ± SD: 44 ± 12 mEq/L) than for alkaline (55 ± 13 mEq/L) gastric fluid, higher for bile (185 ± 24 mEq/L) or pancreatic fluid (156 ± 3 mEq/L) than for all other body fluids, and similar for intact small bowel (119 ± 14 mEq/L) and ileostomy outputs (116 ± 25 mEq/L). Sodium concentrations were significantly greater for cholera-induced diarrhea (128 ± 18 mEq/L) and lower for osmotic-induced diarrhea (28 ± 16 mEq/L) than all other causes of diarrhea. For osmotic diarrheas, sorbitol-induced diarrhea sodium concentration was higher (63 ± 17 mEq/L) than for carbohydrate malabsorption (43 ± 20 mEq/L), lactulose (26 ± 19 mEq/L), Idolax (16 ± 13 mEq/L), or polyethylene glycol (13 ± 7 mEq/L). For secretory diarrheas, sodium concentration for idiopathic causes (53 ± 22 mEq/L) was lower than for neuroendocrine and villous tumors (75 ± 13 mEq/L) or nonosmotic laxatives (88 ± 33 mEq/L). For pleural, peritoneal, and edema fluid, sodium concentrations (137 ± 13 mEq/L) were similar to plasma. No data were found for wound fluid. Sodium concentration for sweat was 44 ± 17 mEq/L.
CONCLUSIONS
This is the first in-depth review of verifiable sodium concentrations of body fluids most commonly lost in hospitalized patients. Sodium concentrations are fluid-specific and consistent. Sodium concentrations for diarrhea are associated with specific mechanisms/causes. These data should be useful to more accurately replace sodium and water content for specific body fluid losses. .
Topics: Adult; Body Fluids; Dehydration; Female; Humans; Male; Sodium; Water-Electrolyte Balance
PubMed: 27616761
DOI: 10.5414/CN108721 -
Journal of Tropical Medicine 2022Several studies have assessed the diagnostic accuracy of pleural fluid soluble interleukin-2 receptor (sIL-2R) for tuberculous pleural effusion (TPE) but with varied... (Review)
Review
BACKGROUND
Several studies have assessed the diagnostic accuracy of pleural fluid soluble interleukin-2 receptor (sIL-2R) for tuberculous pleural effusion (TPE) but with varied results. Therefore, we conducted this systematic review and meta-analysis to evaluate the accuracy of sIL-2R for TPE.
METHODS
PubMed, Ovid, and Web of Science databases were searched from inception to 23 March 2021 to identify eligible studies concerning the diagnostic accuracy of fluid sIL-2R for TPE. The sensitivity and specificity of sIL-2R for TPE were pooled with a bivariate model. We estimated the global diagnostic accuracy of PE sIL-2R with a summary receiver operating characteristic (sROC) curve. The revised Quality Assessment for Diagnostic Accuracy Studies tool (QUADAS-2) was used to assess the quality of eligible studies.
RESULTS
A total of nine studies with 270 TPEs and 586 non-TPEs were included in the final analysis. The pooled sensitivity and specificity were 0.81 (95% CI: 0.76-0.86) and 0.92 (95% CI: 0.77-0.98), respectively. The area under the sROC curve (AUC) was 0.82 (95% CI: 0.79-0.86). No significant publication bias was observed.
CONCLUSIONS
Pleural fluid sIL-2R is a useful diagnostic marker for TPE. However, the diagnostic accuracies of already available biomarkers such as pleural fluid adenosine deaminase, interferon-, and interleukin-27 appear to be superior relative to sIL-2R. Therefore, it might not be preferable to use sIL-2R for diagnosing TPE.
PubMed: 35356490
DOI: 10.1155/2022/4348063