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Journal of Thoracic Disease Jul 2016Although it is curable, tuberculosis remains one of the most frequent causes of pleural effusions on a global scale, especially in developing countries. Tuberculous... (Review)
Review
Although it is curable, tuberculosis remains one of the most frequent causes of pleural effusions on a global scale, especially in developing countries. Tuberculous pleural effusion (TPE) is one of the most common forms of extrapulmonary tuberculosis. TPE usually presents as an acute illness with fever, cough and pleuritic chest pain. The pleural fluid is an exudate that usually has predominantly lymphocytes. The gold standard for the diagnosis of TPE remains the detection of Mycobacterium tuberculosis in pleural fluid, or pleural biopsy specimens, either by microscopy and/or culture, or the histological demonstration of caseating granulomas in the pleura along with acid fast bacilli, Although adenosine deaminase and interferon-γ in pleural fluid have been documented to be useful tests for the diagnosis of TPE. It can be accepted that in areas with high tuberculosis prevalence, the easiest way to establish the diagnosis of TPE in a patient with a lymphocytic pleural effusion is to generally demonstrate a adenosine deaminase level above 40 U/L. The recommended treatment for TPE is a regimen with isoniazid, rifampin, and pyrazinamide for two months followed by four months of two drugs, isoniazid and rifampin.
PubMed: 27499981
DOI: 10.21037/jtd.2016.05.87 -
Panminerva Medica Sep 2019Diseases of the pleura and pleural space are common and present a significant contribution to the workload of respiratory physicians, with most cases resulting from... (Review)
Review
Diseases of the pleura and pleural space are common and present a significant contribution to the workload of respiratory physicians, with most cases resulting from congestive heart failure, pneumonia, and cancer. Although the radiographic and ultrasonographic detection of pleural abnormalities may be obvious, the determination of a specific diagnosis can often represent a challenge. Invasive procedures such as pleural drainage, ultrasound/CT-guided pleural biopsy or medical thoracoscopy can be useful in determining specific diagnosis of pleural diseases. Management of primary and secondary spontaneous pneumothorax is mandatory in an interventional pulmonology training program, while the medical or surgical treatment of the recurrence is still a matter of discussion. Pleural drainage is a diagnostic and therapeutic procedure used in the treatment of pneumothorax and pleural effusions of different etiologies and even in palliation of symptomatic in malignant pleural effusion. Medical thoracoscopy (MT) is a minimally invasive procedure aimed at inspecting the pleural space. It could be a diagnostic procedure in pleural effusions (suspected malignant pleural effusion, infective pleural disease such as empyema or tuberculosis) or therapeutic procedure (chemical pleurodesis or opening of loculation in empyema). Diagnostic yield is 95% in patients with pleural malignancies and higher in pleural tuberculosis. In parapneumonic complex effusion, MT obviates the need for surgery in most cases. Thoracoscopy training should be considered being as important as bronchoscopy training for interventional pulmonology, although prior acquisition of ultrasonography and chest tube insertion skills is essential.
Topics: Bronchoscopy; Chest Tubes; Clinical Competence; Drainage; Humans; Minimally Invasive Surgical Procedures; Pleura; Pleural Effusion; Pleural Effusion, Malignant; Pneumonia; Pneumothorax; Pulmonary Medicine; Reproducibility of Results; Thoracoscopy
PubMed: 30394712
DOI: 10.23736/S0031-0808.18.03564-4 -
EBioMedicine Aug 2020This study aimed to establish and validate a novel scoring system based on a nomogram for the differential diagnosis of malignant pleural effusion (MPE) and benign... (Clinical Trial)
Clinical Trial
BACKGROUND
This study aimed to establish and validate a novel scoring system based on a nomogram for the differential diagnosis of malignant pleural effusion (MPE) and benign pleural effusion (BPE).
METHODS
Patients with PE and confirmed aetiology who underwent diagnostic thoracentesis were included in this study. One retrospective set (N = 1261) was used to develop and internally validate the predictive model. The clinical, radiological and laboratory features were collected and subjected to logistic regression analyses. The primary predictive model was displayed as a nomogram and then modified into a novel scoring system, which was externally validated in an independent set (N = 172).
FINDINGS
The novel scoring system was composed of fever (3 points), erythrocyte sedimentation rate (4 points), effusion adenosine deaminase (7 points), serum carcinoembryonic antigen (CEA) (4 points), effusion CEA (10 points) and effusion/serum CEA (8 points). With a cutoff value of 15 points, the area under the curve, specificity and sensitivity for identifying MPE were 0.913, 89.10%, and 82.63%, respectively, in the training set, 0.922, 93.48%, 81.51%, respectively, in the internal validation set and 0.912, 87.61%, 81.36%, respectively, in the external validation set. Moreover, this scoring system was exclusively applied to distinguish lung cancer with PE from tuberculous pleurisy and showed a favourable diagnostic performance in the training and validation sets.
INTERPRETATION
This novel scoring system was developed from a retrospective study and externally validated in an independent set based on six easily accessible clinical variables, and it exhibited good diagnostic performance for identifying MPE.
FUNDING
NFSC grants (no. 81572942, no. 81800094).
Topics: Adenosine Deaminase; Adult; Aged; Blood Sedimentation; Carcinoembryonic Antigen; Diagnosis, Differential; Female; Fever; Humans; Logistic Models; Lung Neoplasms; Male; Middle Aged; Nomograms; Pleural Effusion; Pleural Effusion, Malignant; Retrospective Studies; Sensitivity and Specificity; Thoracentesis; Tuberculosis, Pleural
PubMed: 32739872
DOI: 10.1016/j.ebiom.2020.102924 -
Cureus Dec 2020A bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree or the lung parenchyma. Despite being a rare entity, a BPF may carry a...
A bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree or the lung parenchyma. Despite being a rare entity, a BPF may carry a high mortality rate. Symptoms of BPF are often nonspecific and subtle, so a high index of clinical suspicion is essential for its correct diagnosis, with imaging playing an extremely important role both in the diagnosis and in the selection of the most appropriate therapeutic approach for each patient. This paper reports a case of a 60-year-old male admitted to the hospital for an etiological investigation of a unilateral pleural effusion. The patient underwent several procedures, among them a video-assisted thoracic surgery, complicated by a peripheral BPF. Therapeutic approach for BPFs must be adapted to each particular case. In this patient, a conservative approach proved to be effective. Meanwhile, the patient was diagnosed with pleural tuberculosis, being discharged on antibacillary medication and while improving BPF's manifestations.
PubMed: 33489597
DOI: 10.7759/cureus.12187 -
BMC Infectious Diseases Nov 2023Pleural effusion (PE) is a common clinical feature that presents a diagnostic challenge for clinicians. In this retrospective study, we aimed to assess the biomarkers,...
BACKGROUND
Pleural effusion (PE) is a common clinical feature that presents a diagnostic challenge for clinicians. In this retrospective study, we aimed to assess the biomarkers, ratios, and multiple indicators in serum and Pleural effusion for the differential diagnosis of tuberculous pleural effusion (TPE) from non-tuberculosis effusion (non-TPE).
METHODS
The participants, who were divided into two groups: TPE and non-TPE (MPE and PPE), from Ningbo First Hospital, were incorporated in this study. The clinical and laboratory features were collected and analyzed using logistic regression analysis. Twelve biomarkers and their ratios in serum and PE were investigated for TPE versus non-TPE. Additionally, the value of multiple indicators for joint diagnosis was estimated.
RESULTS
Biomarkers and ratios showed good diagnostic performance. The five variables including Serum ADA, IGRA, Effusion ADA, Effusion ADA/Serum ADA and Effusion LDH/Effusion ADA were identified as valuable parameters for differential diagnosis of TPE from non-TPE. The combined diagnosis of the five indexes yielded the highest diagnostic accuracy for TPE with an AUC (0.919), sensitivity (90.30%), and specificity (94.50%).
CONCLUSIONS
The biomarkers and ratios demonstrated strong diagnostic performance, and the utilization of multiple indicators for joint diagnosis can improve the diagnostic efficacy of tuberculous pleurisy.
Topics: Humans; Retrospective Studies; Adenosine Deaminase; Pleural Effusion; Biomarkers; Tuberculosis, Pleural; Diagnosis, Differential
PubMed: 37940883
DOI: 10.1186/s12879-023-08781-0 -
Annals of Translational Medicine Aug 2016Pleural tuberculosis (TB) remains difficult to diagnose. In about two-thirds of the cases the diagnosis is reliant upon clinical suspicion along with consistent fluid... (Review)
Review
Pleural tuberculosis (TB) remains difficult to diagnose. In about two-thirds of the cases the diagnosis is reliant upon clinical suspicion along with consistent fluid biochemistries (i.e., lymphocytic predominant exudates) and exclusion of other potential causes for the effusion. Microbiological methods for a confirmatory diagnosis of pleural TB, which include acid-fast smears (Ziehl-Nelseen), cultures on solid media (Lowenstein-Jensen) and polymerase chain reaction tests from either pleural fluid or sputum samples, remain suboptimal since they are positive in only a minority of patients. Liquid media, however, significantly increase sensitivity while shortening culture positivity as compared with solid cultures. A number of pleural fluid biomarkers such as adenosine deaminase (ADA), interferon-Ƴ, interferon-Ƴ-induced protein of 10 KDa (IP-10) and interleukin-27 (IL-27), have shown promise for the rapid diagnosis of TB, but only ADA combines the accuracy and simplicity required to be considered a mainstay investigative tool for clinical decisions, particularly in areas with medium to high TB prevalence. In countries where ADA is not available, pleural biopsies to evaluate for caseating granulomas are a standard diagnostic approach. They are now frequently performed under ultrasound guidance to optimize yield and patient safety.
PubMed: 27570776
DOI: 10.21037/atm.2016.07.23 -
Journal of Thoracic Disease Jun 2015On a global scale, tuberculosis (TB) remains one of the most frequent causes of pleural effusions. Our understanding of the pathogenesis of the disease has evolved and... (Review)
Review
On a global scale, tuberculosis (TB) remains one of the most frequent causes of pleural effusions. Our understanding of the pathogenesis of the disease has evolved and what was once thought to be an effusion as a result of a pure delayed hypersensitivity reaction is now believed to be the consequence of direct infection of the pleural space with a cascade of events including an immunological response. Pulmonary involvement is more common than previously believed and induced sputum, which is grossly underutilised, can be diagnostic in approximately 50%. The gold standard for the diagnosis of tuberculous pleuritis remains the detection of Mycobacterium tuberculosis in pleural fluid, or pleural biopsy specimens, either by microscopy and/or culture, or the histological demonstration of caseating granulomas in the pleura along with acid fast bacilli (AFB). In high burden settings, however, the diagnosis is frequently inferred in patients who present with a lymphocytic predominant exudate and a high adenosine deaminase (ADA) level, which is a valuable adjunct in the diagnostic evaluation. ADA is generally readily accessible, and together with lymphocyte predominance justifies treatment initiation in patients with a high pre-test probability. Still, false-negative and false-positive results remain an issue. When adding closed pleural biopsy to ADA and lymphocyte count, diagnostic accuracy approaches that of thoracoscopy. The role of other biomarkers is less well described. Early pleural drainage may have a role in selected cases, but more research is required to validate its use and to define the subpopulation that may benefit from such interventions.
PubMed: 26150911
DOI: 10.3978/j.issn.2072-1439.2015.02.18 -
Frontiers in Pediatrics 2021Pleural loculation in childhood pleural tuberculosis (TB) remains a problem in practice, it is usually associated with failure drainage. Therefore, to improve the...
Pleural loculation in childhood pleural tuberculosis (TB) remains a problem in practice, it is usually associated with failure drainage. Therefore, to improve the management of childhood pleural TB, a retrospective study was conducted to identify the risk factors associated with loculated effusion in childhood pleural TB. Between January 2006 and December 2019, consecutive children (≤15 years old) with tuberculous pleural effusion (definite and possible) were included for further analysis. The demographic, clinical, laboratory, and radiographic features were collected from the medical records. Univariate and multivariate logistic regressions were used to explore the factors associated with the presence of pleural loculation in children with pleural TB. A total of 154 children with pleural TB (definite, 123 cases; possible, 31 cases) were included in our study and then were classified as loculated effusion ( = 27) and non-loculated effusion ( = 127) groups by chest X-ray or ultrasonography. Multivariate analysis revealed that male gender (age-adjusted OR = 3.903, 95% CI: 1.201, 12.683), empyema (age-adjusted OR = 4.499, 95% CI: 1.597, 12.673), peripheral monocytes ≤0.46 × 10/L (age-adjusted OR = 4.122, 95% CI: 1.518, 11.193) were associated with the presence of loculated effusion in children with pleural TB. In conclusion, several characteristics, such as male gender, empyema, and peripheral monocyte count have been identified as risk factors for pleural loculation in children with pleural TB. Our findings may be helpful to improve the management of pleural loculation in childhood pleural TB.
PubMed: 34976895
DOI: 10.3389/fped.2021.781042 -
Journal of Clinical Tuberculosis and... May 2023Tuberculosis (TB) is among the most common cause of serositis. There are many uncertainties in diagnostic and therapeutic approach to serous membranes tuberculosis. Our... (Review)
Review
Tuberculosis (TB) is among the most common cause of serositis. There are many uncertainties in diagnostic and therapeutic approach to serous membranes tuberculosis. Our aim in the present review is to discuss the regional facilities for timely diagnosis, rapid decision-making and appropriate treatment regarding to serous membranes tuberculosis; with emphasis on situation in Iran. A comprehensive literature searches about the status of serous membranes tuberculosis in Iran were performed in English databases including Google Scholar, Science Direct, Scopus, Pub Med, and Web of Sciences, Persian SID databases, between 2000 and 2021. The main findings of the present review are as follow: a) pleural tuberculosis is more common than pericardial or peritoneal tuberculosis. b) Clinical manifestations are non-specific and so non-diagnostic. c) Smear and culture, PCR and characteristic granulomatous reaction have been used for definitive TB diagnosis by physicians. d) With Adenosine Deaminase Assays and Interferon-Gamma Release Assays in mononuclear dominant fluid, a possible diagnosis of TB is proposed by experienced physicians in Iran. e) In area of endemic for tuberculosis including Iran, a possible diagnosis of TB is enough to begin empirical treatment. f) In patients with uncomplicated tuberculosis serositis, treatment is similar to pulmonary tuberculosis. First line drugs are prescribed unless evidence of MDR-TB is detected. g) The prevalence of drug resistant tuberculosis (MDR-TB) in Iran is between 1% and 6%, and are treated by empirical standardized treatment. h) It is not known whether adjuvant corticosteroids are effective in preventing long term complication. i) Surgery may be recommended for MDR-TB. Tamponade or constrictive pericarditis and intestinal obstruction. In conclusion, it is recommended to consider serosal tuberculosis in patients who have unknown mononuclear dominant effusion and prolonged constitutional symptoms. Experimental treatment with first line anti-TB drugs can be started based on possible diagnostic findings.
PubMed: 36874623
DOI: 10.1016/j.jctube.2023.100354 -
Frontiers in Immunology 2023Tuberculosis (TB) is caused by () and remains a major health threat worldwide. However, a detailed understanding of the immune cells and inflammatory mediators in...
BACKGROUND
Tuberculosis (TB) is caused by () and remains a major health threat worldwide. However, a detailed understanding of the immune cells and inflammatory mediators in -infected tissues is still lacking. Tuberculous pleural effusion (TPE), which is characterized by an influx of immune cells to the pleural space, is thus a suitable platform for dissecting complex tissue responses to infection.
METHODS
We employed singe-cell RNA sequencing to 10 pleural fluid (PF) samples from 6 patients with TPE and 4 non-TPEs including 2 samples from patients with TSPE (transudative pleural effusion) and 2 samples with MPE (malignant pleural effusion).
RESULT
Compared to TSPE and MPE, TPE displayed obvious difference in the abundance of major cell types (e.g., NK, CD4+T, Macrophages), which showed notable associations with disease type. Further analyses revealed that the CD4 lymphocyte population in TPE favored a Th1 and Th17 response. Tumor necrosis factors (TNF)-, and XIAP related factor 1 (XAF1)-pathways induced T cell apoptosis in patients with TPE. Immune exhaustion in NK cells was an important feature in TPE. Myeloid cells in TPE displayed stronger functional capacity for phagocytosis, antigen presentation and IFN-γ response, than TSPE and MPE. Systemic elevation of inflammatory response genes and pro-inflammatory cytokines were mainly driven by macrophages in patients with TPE.
CONCLUSION
We provide a tissue immune landscape of PF immune cells, and revealed a distinct local immune response in TPE and non-TPE (TSPE and MPE). These findings will improve our understanding of local TB immunopathogenesis and provide potential targets for TB therapy.
Topics: Humans; Pleural Effusion; Tuberculosis; Antigen Presentation; Mycobacterium tuberculosis; Pleural Cavity
PubMed: 37435066
DOI: 10.3389/fimmu.2023.1191357