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International Journal of Clinical... 2023Tuberculosis (TB), a multisystemic disease with protean presentation, remains a major global health problem. Although concurrent pulmonary tuberculosis (PTB) and... (Observational Study)
Observational Study
Epidemiology and Association Rules Analysis for Pulmonary Tuberculosis Cases with Extrapulmonary Tuberculosis from Age and Gender Perspective: A Large-Scale Retrospective Multicenter Observational Study in China.
BACKGROUND
Tuberculosis (TB), a multisystemic disease with protean presentation, remains a major global health problem. Although concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) cases are commonly observed clinically, knowledge regarding concurrent PTB-EPTB is limited. Here, a large-scale multicenter observational study conducted in China aimed to study the epidemiology of concurrent PTB-EPTB cases by diagnostically defining TB types and then implementing association rules analysis.
METHODS
The retrospective study was conducted at 21 hospitals in 15 provinces in China and included all inpatients with confirmed TB diagnoses admitted from Jan 2011 to Dec 2017. Association rules analysis was conducted for cases with concurrent PTB and various types of EPTB using the Apriori algorithm.
RESULTS
Evaluation of 438,979TB inpatients indicated PTB was the most commonly diagnosed (82.05%) followed by tuberculous pleurisy (23.62%). Concurrent PTB-EPTB was found in 129,422 cases (29.48%) of which tuberculous pleurisy was the most common concurrent EPTB type observed. The multivariable logistic regression models demonstrated that odds ratios of concurrent PTB-EPTB cases varied by gender and age group. For PTB cases with concurrent EPTB, the strongest association was found between PTB and concurrent bronchial tuberculosis (lift = 1.09). For EPTB cases with concurrent PTB, the strongest association was found between pharyngeal/laryngeal tuberculosis and concurrent PTB (lift = 1.11). Confidence and lift values of concurrent PTB-EPTB cases varied with gender and age.
CONCLUSIONS
Numerous concurrent PTB-EPTB case types were observed, with confidence and lift values varying with gender and age. Clinicians should screen for concurrent PTB-EPTB in order to improve treatment outcomes.
Topics: Humans; Tuberculosis, Extrapulmonary; Tuberculosis, Pleural; Retrospective Studies; Tuberculosis, Pulmonary; China
PubMed: 37609664
DOI: 10.1155/2023/5562495 -
International Journal of Environmental... May 2021Tuberculosis (TB) pleural effusion (TPE) is the second most common manifestation of extrapulmonary TB (EPTB), which remains a great diagnostic challenge worldwide. In...
Tuberculosis (TB) pleural effusion (TPE) is the second most common manifestation of extrapulmonary TB (EPTB), which remains a great diagnostic challenge worldwide. In Uzbekistan, there has been no formal evaluation of the actual practices of diagnosing and treating TPE. Our cohort study therefore aimed to describe the frequency and types of different diagnostic procedures of TPE during 2017-2018 and assess the association of baseline characteristics and establish diagnostic methods with TB treatment outcomes. In total, 187 patients with presumptive TPE were assessed, and 149 had a confirmed diagnosis of TPE (other diagnoses included cancer = 8, pneumonia = 17, and 13 cases were unspecified). TB was bacteriologically confirmed in 22 (14.8%), cytologically confirmed in 64 (43.0%), and histologically confirmed in 16 (10.7%) patients. Hepatitis was the only co-morbidity significantly associated with unsuccessful treatment outcomes (RR 4.8; 95%CI: 1.44-15.98, value 0.011). Multivariable regression analysis showed that drug-resistant TB was independently associated with unsuccessful TB treatment outcome. (RR 3.83; 95%CI: 1.05-14.02, value 0.04). Multidisciplinary approaches are required to maximize the diagnostic accuracy of TPE and minimize the chances of misdiagnosis. TPE patients with co-infections and those with drug resistance should be more closely monitored to try and ensure successful TB treatment outcomes.
Topics: Cohort Studies; Humans; Pleural Effusion; Sensitivity and Specificity; Treatment Outcome; Tuberculosis, Pleural; Uzbekistan
PubMed: 34072161
DOI: 10.3390/ijerph18115769 -
BMC Infectious Diseases Aug 2021To investigate the correlation between pleural fluid interleukin-33 (IL-33) and adenosine deaminase (ADA) and peripheral blood tuberculosis T cell spot detection...
BACKGROUND
To investigate the correlation between pleural fluid interleukin-33 (IL-33) and adenosine deaminase (ADA) and peripheral blood tuberculosis T cell spot detection (T-SPOT.TB), and the combined value of the three tests for the diagnosis of tuberculous pleurisy.
METHODS
79 patients with pleural effusion admitted from June 2017 to December 2018 were enrolled. They were divided into tuberculous pleural effusion (TPE) group (57 cases, 72.2%) and malignant pleural effusion group (17 cases, 21.5%), pneumonia-like pleural effusion group (5 cases, 6.3%). Correlation between pleural fluid IL-33, pleural effusion ADA and peripheral blood T-SPOT.TB was analyzed, comparison of the three separate and combined diagnostic efficacy was also performed.
RESULTS
The levels of IL-33, ADA and peripheral blood T-SPOT.TB in patients with TPE were significantly higher than those in non-TPE (P < 0.001). The level of pleural fluid IL-33 was positively correlated with pleural effusion ADA and peripheral blood T-SPOT.TB. The Area under the ROC curve (AUC) of TPE diagnosed by pleural IL-33, ADA and peripheral blood T-SPOT.TB were 0.753, 0.912 and 0.865, respectively. AUC for combined detection of pleural effusion IL-33, ADA and peripheral blood T-SPOT.TB is the largest, with a value of 0.962. Specificity is 100% and sensitivity is 88.5%.
CONCLUSION
Combined detection of pleural effusion IL-33, ADA and peripheral blood T-SPOT.TB can improve the diagnostic efficacy of tuberculous pleurisy.
Topics: Adenosine Deaminase; Biomarkers; Humans; Interleukin-33; Pleural Effusion; Sensitivity and Specificity; T-Lymphocytes; Tuberculosis, Pleural
PubMed: 34425761
DOI: 10.1186/s12879-021-06575-w -
Deutsches Arzteblatt International Dec 2018
Topics: Aged; Antitubercular Agents; Exudates and Transudates; Humans; Image-Guided Biopsy; Male; Pleural Effusion; Thoracentesis; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Pleural
PubMed: 30722838
DOI: 10.3238/arztebl.2018.0839 -
Canadian Medical Association Journal Jun 1947
Topics: Humans; Pleura; Pleural Effusion; Tuberculosis; Tuberculosis, Pleural; Tuberculosis, Pulmonary
PubMed: 20240925
DOI: No ID Found -
The European Respiratory Journal May 2017
Topics: Humans; Pleural Effusion; Pleurisy; Tuberculosis, Pleural
PubMed: 28546275
DOI: 10.1183/13993003.00356-2017 -
The European Respiratory Journal May 2017
Topics: Humans; Pleural Effusion; Pleurisy; Tuberculosis, Pleural
PubMed: 28546270
DOI: 10.1183/13993003.02472-2016 -
Respiratory Medicine Jun 2008Tuberculosis remains a major cause of mortality and morbidity on a global scale. Effective anti-tuberculous chemotherapy has improved outcomes for individuals suffering... (Review)
Review
Tuberculosis remains a major cause of mortality and morbidity on a global scale. Effective anti-tuberculous chemotherapy has improved outcomes for individuals suffering from tuberculosis, although the disease often results in significant and permanent damage to organs. The use of adjunctive corticosteroid treatment has been studied with a view to demonstrating a reduction in inflammatory events that may improve outcomes for both mortality and morbidity. Cochrane reviews have summarized the evidence for adjunctive corticosteroids in the treatment of tuberculous pericarditis, meningitis and pleural effusion. These reviews have shown improved mortality for pericarditis and meningitis, but inconclusive effects for pericardial constriction and ongoing neurological disability. Rapid improvements in clinical parameters for pleural effusion were not supported by any lasting improved outcomes for these patients.
Topics: Antitubercular Agents; Drug Therapy, Combination; Evidence-Based Medicine; Glucocorticoids; Humans; Pericarditis, Tuberculous; Treatment Outcome; Tuberculosis, Meningeal; Tuberculosis, Pleural
PubMed: 18407484
DOI: 10.1016/j.rmed.2008.01.018 -
World Journal of Surgical Oncology May 2014Fibroblast specific protein-1 (S100A4) is related with many fibrotic diseases, but its role in the pathogenesis of pleural fibrosis has not been fully elucidated. Then... (Comparative Study)
Comparative Study
BACKGROUND
Fibroblast specific protein-1 (S100A4) is related with many fibrotic diseases, but its role in the pathogenesis of pleural fibrosis has not been fully elucidated. Then we aim to investigate the expression and effect of fibroblast specific protein-1 (S100A4) in pleural tuberculosis and, subsequently, pleural fibrosis.
METHODS
The expression of S100A4 in pleura was examined in 30 patients with pleural tuberculosis and 5 control (disease-free) patients by immunohistochemistry using the streptavidin-peroxidase (S-P) conjugated method.
RESULTS
The expression of S100A4 in pleura was mainly distributed in the nucleus and cytoplasm of fibroblasts and vascular endothelial cells, and the positive rate was 90.0% (27 out of 30 patients with pleural tuberculosis). There were no expressions of S100A4 in the control group. In the pleura of all 30 patients with pleural tuberculosis, S100A4 had a higher expression in the two- to eight-week duration of the disease.
CONCLUSIONS
S100A4 plays an important role in the phenotypic transformation of pleural mesothelial cells and the development of pleural fibrosis.
Topics: Adolescent; Adult; Biomarkers, Tumor; Case-Control Studies; Cell Nucleus; Cytoplasm; Double-Blind Method; Endothelium, Vascular; Epithelial Cells; Female; Fibroblasts; Fibrosis; Follow-Up Studies; Humans; Immunoenzyme Techniques; Male; Middle Aged; Neoplasm Staging; Pleura; Prognosis; S100 Calcium-Binding Protein A4; S100 Proteins; Survival Rate; Tuberculosis, Pleural; Young Adult
PubMed: 24885536
DOI: 10.1186/1477-7819-12-151 -
Microbiology Spectrum Dec 2022The diagnosis of pleural tuberculosis (TB) remains difficult due to the paucity of Mycobacterium tuberculosis in pleural fluid (PF). This study aimed to improve pleural...
The diagnosis of pleural tuberculosis (TB) remains difficult due to the paucity of Mycobacterium tuberculosis in pleural fluid (PF). This study aimed to improve pleural TB diagnosis using highly sensitive digital PCR (dPCR) technique. A total of 310 patients with evidence of PF were consecutively enrolled, 183 of whom suffered from pleural TB and 127 from non-TB. PF samples were prospectively collected and total DNA was extracted. The copy numbers of M. tuberculosis insertion sequence (IS) and IS in DNA were quantified using dPCR. The overall area under the curve of ISdPCR was greater than that of ISdPCR (0.85 versus 0.79). PF IS OR ISdPCR (according to their cut-off values, "positive" was defined as either of them was positive, while "negative" was defined as both of them were negative) had higher sensitivity and equal specificity compared with single target-dPCR. The sensitivity of PF IS OR ISdPCR for total, definite, and probable pleural TB was 59.0% (95% CI = 51.5% to 66.2%), 72.8% (95% CI = 62.6% to 81.6%), and 45.1% (95% CI = 34.6% to 55.8%), respectively. Its specificity was 100% (95% CI = 97.1% to 100.0%). PF IS OR ISdPCR showed a higher sensitivity than smear microscopy (57.4% versus 7.1%), mycobacterial culture (55.3% versus 31.8%), and Xpert MTB/RIF (57.6% versus 23.0%). Long antituberculosis treatment time (>1 month) was found to be associated with negative dPCR results in pleural TB patients. This study indicates that PF IS OR IS-dPCR is an accurate molecular assay, which is more sensitive than routine etiological tests and has the potential to enhance the definite diagnosis of pleural TB. Pleural TB is one of the most frequent causes of pleural effusion, especially in areas with high burden of TB. Due to the paucibacillary nature of the disease, the diagnostic sensitivities of all available bacteriological and molecular tests remain poor. There is an urgent need to develop new efficient methods. Digital PCR (dPCR) is the third generation of PCR that enables the exact quantification of trace nucleic acids in samples. This study evaluates the diagnostic performance of pleural fluid (PF) dPCR analysis for pleural TB, and shows that PF IS OR ISdPCR has a higher sensitivity than routine etiological tests such as smear microscopy, mycobacterial culture, and Xpert MTB/RIF. This work provides a new choice for improving the definite diagnosis of pleural TB.
Topics: Humans; Tuberculosis, Pleural; Sensitivity and Specificity; Mycobacterium tuberculosis; Polymerase Chain Reaction; Nucleic Acid Amplification Techniques
PubMed: 36264250
DOI: 10.1128/spectrum.01632-22