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Thoracic Research and Practice May 2023Intestinal tuberculosis is a rare extrapulmonary condition and mainly involves the ileocecal region. Most of the patients with tuberculosis during the postpartum period...
Intestinal tuberculosis is a rare extrapulmonary condition and mainly involves the ileocecal region. Most of the patients with tuberculosis during the postpartum period present with extrapulmonary involvement. The postpartum period has a higher risk of the reactivation of tuberculosis due to changes in the immune system. We present the case of a 22-year-old postpartum immigrant patient, with pulmonary, pleural, and intestinal tuberculosis with intestinal perforation. Due to the nonspecific symptoms of intestinal tuberculosis, clinical suspicion is extremely important.
PubMed: 37503621
DOI: 10.5152/ThoracResPract.2023.22129 -
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 -
Clinical Imaging Nov 2020Internal thoracic lymphadenopathy (ITL) has been associated with malignancies and non-tuberculous empyema. However, the association between ITL and active pulmonary...
OBJECTIVE
Internal thoracic lymphadenopathy (ITL) has been associated with malignancies and non-tuberculous empyema. However, the association between ITL and active pulmonary tuberculosis (PTB) and the correlation between ITL and other imaging characteristics of active PTB has not been examined.
MATERIALS AND METHODS
A retrospective cohort study comprising 137 adults with active PTB who had a concomitant chest CT over a seven-year period was conducted. Two thoracic radiologists evaluated for ITL as well as nine other imaging characteristics of active tuberculosis, including total lung involvement (as measured by a total severity score), number of nodules, presence of tree-in-bud nodularity, highest extent of tree-in-bud nodularity in a lobe, miliary pattern, cavitary lesions, pleural effusion, lymphadenopathy (excluding internal thoracic lymph nodes), and empyema. The Wilcoxon rank-sum test and chi-squared tests were used to assess the correlation between ITL and additional imaging findings.
RESULTS
Internal thoracic lymphadenopathy was present in 50 of 137 cases (36.5%); most commonly bilateral (19.0%) or isolated on the right side (13.7%), and less commonly isolated on the left side (3.7%). Pleural effusion, lymphadenopathy (apart from internal thoracic compartment), and empyema all showed statistically significant correlations with ITL (p-values of <0.0001).
CONCLUSIONS
While the presence of ITL - particularly when accompanied by other imaging findings such as pleural effusion - may prompt a radiologist to first consider malignancy, active PTB should be an additional consideration in the appropriate clinical context.
Topics: Adult; Female; Humans; Lung; Lymph Nodes; Lymphadenopathy; Male; Middle Aged; Pleural Effusion; Radiography, Thoracic; Retrospective Studies; Tomography, X-Ray Computed; Tuberculosis, Pulmonary
PubMed: 32497996
DOI: 10.1016/j.clinimag.2020.04.033 -
Frontiers in Surgery 2022Pleural effusion (PE) caused by lung cancer is prevalent, and it is difficult to differentiate it from PE caused by tuberculosis. Exosome-based liquid biopsy offers a...
BACKGROUND
Pleural effusion (PE) caused by lung cancer is prevalent, and it is difficult to differentiate it from PE caused by tuberculosis. Exosome-based liquid biopsy offers a non-invasive technique to diagnose benign and malignant PE. Exosomal miRNAs are potential diagnostic markers and play an essential role in signal transduction and biological processes in tumor development. We hypothesized that exosomal miRNA expression profiles in PE would contribute to identifying its diagnostic markers and elucidating the molecular basis of PE formation in lung cancer.
METHODS
The exosomes from PE caused by lung adenocarcinoma (LUAD) and pulmonary tuberculosis were isolated and verified by transmission electron microscopy. The exosomal miRNA profiles were identified using deep sequencing and validated with quantitative real-time PCR (qRT-PCR). We performed bioinformatic analysis for differentially expressed miRNAs to explore how exosomal miRNAs regulate pleural effusion.
RESULTS
We identified 99 upregulated and 91 downregulated miRNAs in malignant pleural effusion (MPE) compared to tuberculous pleural effusion (TPE). Seven differentially expressed miRNAs (DEmiRNAs) were validated by qRT-PCR, out of which 5 (71.4%) were confirmed through sequencing. Gene Ontology (GO) analysis revealed that most exosomal miRNAs target genes were involved in regulating cellular processes and nitrogen compound metabolism. According to the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, the exosomal miRNAs target genes were mainly involved in Fc gamma R-mediated phagocytosis, Rap1 signaling pathway, and breast cancer. The hub genes, including ITGAM, FOXO1, MAPK14, YWHAB, GRIN1, and PRF1, were screened through plug-in cytoHubba. The PFR1 was identified as a critical gene in MPE formation using single-cell sequencing analysis. Additionally, we hypothesized that tumor cells affected natural killer cells and promoted the generation of PE in LUAD the exosomal hsa-miR-3120-5p-PRF1 axis.
CONCLUSIONS
We identified exosomal miRNA profiles in LUAD-MPE and TPE, which may help in the differential diagnosis of MPE and TPE. Bioinformatic analysis revealed that these miRNAs might affect PE generation through tumor immune response in LUAD. Our results provided a new theoretical basis for understanding the function of exosomal miRNAs in LUAD-MPE.
PubMed: 36684253
DOI: 10.3389/fsurg.2022.1050242 -
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 -
Cell Reports Dec 2020Mycobacterium tuberculosis (Mtb) regulates the macrophage metabolic state to thrive in the host, yet the responsible mechanisms remain elusive. Macrophage activation...
Mycobacterium tuberculosis (Mtb) regulates the macrophage metabolic state to thrive in the host, yet the responsible mechanisms remain elusive. Macrophage activation toward the microbicidal (M1) program depends on the HIF-1α-mediated metabolic shift from oxidative phosphorylation (OXPHOS) toward glycolysis. Here, we ask whether a tuberculosis (TB) microenvironment changes the M1 macrophage metabolic state. We expose M1 macrophages to the acellular fraction of tuberculous pleural effusions (TB-PEs) and find lower glycolytic activity, accompanied by elevated levels of OXPHOS and bacillary load, compared to controls. The eicosanoid fraction of TB-PE drives these metabolic alterations. HIF-1α stabilization reverts the effect of TB-PE by restoring M1 metabolism. Furthermore, Mtb-infected mice with stabilized HIF-1α display lower bacillary loads and a pronounced M1-like metabolic profile in alveolar macrophages (AMs). Collectively, we demonstrate that lipids from a TB-associated microenvironment alter the M1 macrophage metabolic reprogramming by hampering HIF-1α functions, thereby impairing control of Mtb infection.
Topics: Animals; Bacterial Load; Eicosanoids; Female; Glycolysis; Host-Pathogen Interactions; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Lipids; Macrophage Activation; Macrophages; Mice; Mice, Inbred C57BL; Mitochondria; Mycobacterium tuberculosis; Oxidative Phosphorylation; Oxygen Consumption; Pleural Effusion; Tuberculosis, Pleural
PubMed: 33378679
DOI: 10.1016/j.celrep.2020.108547 -
Frontiers in Immunology 2023Pleural tuberculosis (PlTB), the most common site of extrapulmonary TB, is characterized by a paucibacillary nature and a compartmentalized inflammatory response in the...
INTRODUCTION
Pleural tuberculosis (PlTB), the most common site of extrapulmonary TB, is characterized by a paucibacillary nature and a compartmentalized inflammatory response in the pleural cavity, both of which make diagnosis and management extremely challenging. Although transcriptional signatures for pulmonary TB have already been described, data obtained by using this approach for extrapulmonary tuberculosis and, specifically, for pleural tuberculosis are scarce and heterogeneous. In the present study, a set of candidate genes previously described in pulmonary TB was evaluated to identify and validate a transcriptional signature in clinical samples from a Brazilian cohort of PlTB patients and those with other exudative causes of pleural effusion.
METHODS
As a first step, target genes were selected by a random forest algorithm with recursive feature elimination (RFE) from public microarray datasets. Then, peripheral blood (PB) and pleural fluid (PF) samples from recruited patients presenting exudative pleural effusion were collected during the thoracentesis procedure. Transcriptional analysis of the selected top 10 genes was performed by quantitative RT-PCR (RT-qPCR).
RESULTS
Reanalysis of the public datasets identified a set of candidate genes (, and ) that demonstrated a global accuracy of 89.5% in discriminating pulmonary TB cases from other respiratory diseases. Our validation cohort consisted of PlTB ( = 35) patients and non-TB ( = 34) ones. The gene expressions of , , and in PF at diagnosis were significantly different between the two (PlTB and non-TB) groups ( < 0.0001). It was observed that the gene expressions of and were higher in PlTB PF than in non-TB patients. showed the opposite behavior, being higher in the non-TB PF. After anti-TB therapy, however, gene expression was significantly reduced in PlTB patients ( < 0.001). Finally, the accuracy of the three above-cited highlighted genes in the PF was analyzed, showing AUCs of 91%, 90%, and 85%, respectively. was above 80% (sensitivity = 0.89/specificity = 0.81), and showed significant specificity (Se = 0.69/Sp = 0.95) in its capacity to discriminate the groups.
CONCLUSION
, , and showed promise in discriminating PlTB from other causes of exudative pleural effusion by providing accurate diagnoses, thus accelerating the initiation of anti-TB therapy.
Topics: Humans; Tuberculosis, Pleural; Exudates and Transudates; Tuberculosis, Pulmonary; Pleural Effusion; Brazil; Butyrophilins; Antigens, CD
PubMed: 38288122
DOI: 10.3389/fimmu.2023.1256558 -
Expert Review of Respiratory Medicine Aug 2022Pleural tuberculosis (TB) is the archetype of extrapulmonary TB (EPTB), which mainly affects the pleural space and leads to exudative pleural effusion. Diagnosis of... (Review)
Review
INTRODUCTION
Pleural tuberculosis (TB) is the archetype of extrapulmonary TB (EPTB), which mainly affects the pleural space and leads to exudative pleural effusion. Diagnosis of pleural TB is a difficult task predominantly due to atypical clinical presentations and sparse bacillary load in clinical specimens.
AREA COVERED
We reviewed the current literature on the globally existing conventional/latest modalities for diagnosing pleural TB. Bacteriological examination (smear/culture), tuberculin skin testing/interferon-γ release assays, biochemical testing, imaging and histopathological/cytological examination are the main modalities. Moreover, nucleic acid amplification tests (NAATs), . loop-mediated isothermal amplification, PCR/multiplex-PCR, nested-PCR, real-time PCR and GeneXpert MTB/RIF are being utilized. Currently, GeneXpert Ultra, Truenat MTB, detection of circulating () cell-free DNA by NAATs, aptamer-linked immobilized sorbent assay and immuno-PCR (I-PCR) have also been exploited.
EXPERT OPINION
Routine tests are not adequate for effective pleural TB diagnosis. The latest molecular/immunological tests as discussed above, and the other tools, . real-time I-PCR/nanoparticle-based I-PCR and identification of biomarkers within urinary/serum extracellular vesicles being utilized for pulmonary TB and other EPTB types may also be explored to diagnose pleural TB. Reliable diagnosis and early therapy would reduce the serious complications associated with pleural TB, . TB empyema, pleural fibrosis, etc.
Topics: Cell-Free Nucleic Acids; Humans; Mycobacterium tuberculosis; Nucleic Acid Amplification Techniques; Sensitivity and Specificity; Tuberculin; Tuberculosis, Pleural
PubMed: 35728039
DOI: 10.1080/17476348.2022.2093189 -
Respiratory Medicine Nov 2021Tuberculous pleural effusion (TPE) is the second most common presentation of extrapulmonary tuberculosis. The paucibacillary nature of the effusion poses diagnostic... (Review)
Review
Tuberculous pleural effusion (TPE) is the second most common presentation of extrapulmonary tuberculosis. The paucibacillary nature of the effusion poses diagnostic challenges. Biomarkers like adenosine deaminase and interferon-γ have some utility for diagnosing TPEs, as do cartridge-based polymerase chain reaction (PCR) methods. When these fluid studies remain indeterminate, pleural biopsies must be performed to confirm the diagnosis. This review article elaborates on the scientific evidence available for various diagnostic tests and presents a practical approach to the diagnosis of TPEs.
Topics: Biomarkers; Biopsy; Diagnosis, Differential; Humans; Pleural Effusion; Polymerase Chain Reaction; Sensitivity and Specificity; Tuberculosis, Pleural
PubMed: 34536698
DOI: 10.1016/j.rmed.2021.106607 -
Expert Review of Respiratory Medicine Oct 2020Developing a feasible and accurate means of evaluating pleural pathology has been an ongoing effort for over 150 years. Pleural fluid cellular and biomarker analyses... (Review)
Review
INTRODUCTION
Developing a feasible and accurate means of evaluating pleural pathology has been an ongoing effort for over 150 years. Pleural fluid cellular and biomarker analyses are simple ways of characterizing and uncovering pathologic entities of pleural disease. However, obtaining samples of pleural tissue has become increasingly important. In cases of suspected malignancy and certain infections histopathology, culture, and molecular testing are necessary to profile diseases more effectively. The pleura is sampled via several techniques including blind transthoracic biopsy, image-guided biopsy, and surgical thoracotomy. Given the heterogeneity of pleural disease, low diagnostic yields, or invasiveness no procedural gold standard has been established in pleural diagnostics.
AREAS COVERED
Herein, we provide a review of the literature on medical thoracoscopy (MT), its development, technical approach, indications, risks, current and future role in the evaluation of thoracic disease. Pubmed was searched for articles published on MT, awake thoracoscopy, and pleuroscopy with a focus on reviewing literature published in the past 5 years.
EXPERT OPINION
As the proficiency and number of interventional pulmonologists continues to grow, MT is ideally positioned to become a front-line diagnostic tool in pleural disease and play an increasingly prominent role in the treatment algorithm of various pleural pathologies.
Topics: Humans; Pleural Diseases; Practice Guidelines as Topic; Thoracoscopy
PubMed: 32588676
DOI: 10.1080/17476348.2020.1788940