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PubMed2004

Diagnostic utility of pleural fluid IFN-gamma in tuberculosis pleural effusion.

Pleural fluid interferon-gamma (IFN-gamma) levels are increased in patients with tuberculosis (TB) pleural effusion. Recent studies from the west have found that estimation of pleural fluid IFN-gamma levels is an excellent diagnostic strategy for these patients. The diagnostic utility of pleural effusion IFN-gamma level estimation has not been evaluated in patients from developing countries, however. This work was carried out to study the diagnostic utility of IFN-gamma level estimation in patients with TB pleural effusion and to define the best cutoff of IFN-gamma for diagnosis TB pleural effusion. We studied 101 patients with pleural effusion. Of these, 64 were found to have a TB etiology, established by means of various conventional modalities. Measurement of pleural fluid IFN-gamma levels was done by ELISA technique. The median value of pleural fluid IFN-gamma levels in patients with TB (1480 pg/ml, range 3-14,000 pg/ml) was significantly higher (p < 0.001) compared with the non-TB group (3 pg/ml, range 0-900 pg/ml). The receiver operator characteristic (ROC) curve for IFN-gamma showed an area under the curve (AUC) value of 0.954, and the best cutoff was computed to be 138 pg/ml. Using this cutoff for IFN-gamma levels in pleural fluid for the diagnosis of TB, sensitivity, specificity, negative predictive value, and positive predictive value were found to be 90.2%, 97.3%, 85.7%, and 98.3%, respectively. Estimation of IFN-gamma levels in pleural fluid is a useful diagnostic modality for TB pleural effusion. A cutoff of 138 pg/ml provides the best sensitivity and specificity for diagnosis of TB.

Adult↗
PubMed2005

Does pleural tuberculosis disease pattern differ among developed and developing countries.

BACKGROUND: A number of reports from developed countries have documented a rising age at which pleural tuberculosis occurs and increase in the frequency of reactivation disease being as the main cause of pleural involvement. OBJECTIVE: To determine the age at which pleural tuberculosis occurs, study its clinical pattern, and to determine whether pleural tuberculosis is a result of reactivation of pulmonary tuberculosis or it is a primary one comparing our findings with results from developed countries. METHOD: Retrospective study of 100 cases discharged from Hamad General Hospital with the diagnosis of pleural tuberculosis from January 1996 to December 2002. RESULTS: Pleural tuberculosis tends to affect younger age groups (84% are below the age of 45 years, with mean age of 31.5). The disease tends to be mostly a primary infection. Fever is the most common symptom (90%) and the disease is usually an acute or sub acute one. Weight loss precedes other symptoms. Exudative pleural effusion with predominant lymphocytosis is characteristic. Majority of patients have no predisposing conditions for the disease. CONCLUSION: In contrast to what has been reported in some developed countries, Pleural tuberculosis tends to be a primary disease in the present study. Younger age groups are particularly affected.

AIDS-Related Opportunistic Infections↗
PubMed1996

Pleural tuberculosis in patients infected with HIV in Addis Ababa.

OBJECTIVE: To determine the prevalence of HIV-1 infection in patients with pleural tuberculosis and compare the clinical and radiological characteristics, effects and side effects of drugs, compliance to treatment and outcome by HIV status. DESIGN: A hospital based, prospective study. SUBJECTS: 90 adult patients with pleural tuberculosis. 120 surgical patients admitted for non-HIV related conditions served as controls. SETTING: Black Lion Hospital, a tertiary care referral hospital in Addis Ababa, Ethiopia. RESULTS: 22% of the patients with pleural tuberculosis versus 6.7% for the controls (p < 0.01) were seropositive for HIV-1. Amongst patients with pleural tuberculosis, HIV seropositive patients were more likely to be male, and had longer duration of illness prior to coming to hospital (p < 0.05). They had more disseminated disease (p < 0.01), bilateral pleural effusion (p < 0.05), adverse reaction to anti-tuberculosis drugs (p < 0.05) and increased mortality (p < 0.05). Hepatitis was the most common side effect observed. There was no difference in size of the effusion, clinical improvement, radiographic resolution or defaulter rate. CONCLUSION: HIV associated pleural tuberculosis commonly occurs with other forms of extra pulmonary tuberculosis and responds well to treatment. Hepatitis is a frequent side effect and entails poor prognosis. We therefore recommend careful documentation of a previous history of liver disease and baseline investigation of liver function tests before initiation of treatment. The finding of bilateral pleural effusion may indicate the presence of underlying HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed1995

Rapid diagnosis of pleural tuberculosis by polymerase chain reaction.

We have investigated the use of polymerase chain reaction (PCR) for the rapid diagnosis of pleural tuberculosis. The study was composed of 21 patients with pleural tuberculosis, confirmed by culture or pleural biopsy, and 86 control subjects. The PCR assay was based on detecting a 123-bp DNA segment belonging to the insertion sequence IS6110, specific of Mycobacterium tuberculosis complex. In 21 patients diagnosed with pleural tuberculosis, Ziehl-Neelsen staining was positive in three (14%) (95% CI, 7 to 21%) and pleural fluid culture in 11 (52%) (95% CI, 43 to 61%). Pleural biopsy revealed granulomas with caseous necrosis in 72%, and the culture was positive in 67% of the patients. Adenosine deaminase activity determination was positive (> 45 IU/L) in 86% (95% CI, 79 to 93%). The sensitivity and specificity for PCR was 81% (95% CI, 74 to 88%) and 100% (95% CI, 95 to 100%), respectively. All culture-positive specimens were PCR positive. We conclude that PCR is a rapid, sensitive, and specific method for the diagnosis of pleural tuberculosis. However, further prospective studies are required to properly evaluate the yield of the technique.

Adolescent↗
PubMed1990

Pleural tuberculosis in patients with and without AIDS.

We retrospectively reviewed the records of 71 patients to determine the epidemiologic and clinical features of pleural tuberculosis in patients with and without AIDS and compared the composition of pleural fluid in these two groups of patients. By age, race, sex, and country of birth, the 21 AIDS and 50 non-AIDS patients with pleural tuberculosis were comparable. However, the AIDS patients were more likely to be intravenous drug abusers than the non-AIDS patients (15/21 vs 6/50, p less than .001). The clinical presentation of each group was similar except that the AIDS patients were more likely to present without respiratory symptoms (4/21 vs 0/50, p less than .001). Pleural fluid and pleural biopsy analyses were not different in the two groups. However, AIDS patients had significantly more chest roentgenographic infiltrates (10/21 vs 11/50, p less than .05), hilar/mediastinal adenopathy (4/21 vs 1/51, p less than .007) and a higher prevalence of bilateral effusions (6/21 vs 5/50, p less than 0.05). AIDS patients were also more likely to have sputum smear/culture positive (10/19 vs 9/49, p less than .001) for mycobacteria. The yield for acid-fast bacilli culture of pleural fluid was higher than previously reported (60%) regardless of AIDS status. Thus, AIDS patients with pleural tuberculosis may present without respiratory symptoms, but otherwise do not differ clinically and epidemiologically from non-AIDS patients. Radiologic and mycobacterial data suggest that pleural tuberculosis in AIDS patients is often part of disseminated mycobacterial infection.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Pleural tuberculosis and HIV infection.

Human immunodeficiency virus infection changes the clinical presentation of tuberculosis infection with atypical radiographs and more common extra-pulmonary involvement. We retrospectively studied pleural tuberculosis in HIV-positive patients over a 5-year period. We identified 70 patients with pleural tuberculosis by positive Mycobacterium tuberculosis cultures of pleural fluid and/or pleural tissue, including 43 HIV-positive and 27 HIV-negative patients. The HIV-positive patients were significantly younger (mean age, 38 +/- 1 years in HIV-positive vs 52 +/- 3 years in HIV-negative patients, p < 0.05). There were more intravenous drug abusers in the HIV-positive group (74 vs 30 percent, p < 0.01). The HIV-positive group had significantly fewer positive tuberculin skin tests (41 percent vs 76 percent, p < 0.03). Both groups had similar pleural fluid cellularity and pleural biopsy histologic conditions, but the HIV-positive patients demonstrated significantly more acid-fast bacteria identifiable in pleural tissue (69 percent vs 21 percent, p < 0.01), and a higher incidence of positive M tuberculosis cultures of sputum (53 percent vs 23 percent, p = 0.02). Pleural tuberculosis in HIV-positive patients presented more often as a manifestation of a greater burden of microorganisms and impaired host response.

AIDS-Related Opportunistic Infections↗
PubMed2004

A randomized, double-blind, placebo-controlled trial of the use of prednisolone as an adjunct to treatment in HIV-1-associated pleural tuberculosis.

BACKGROUND: Active tuberculosis may accelerate progression of human immunodeficiency virus (HIV) infection by promoting viral replication in activated lymphocytes. Glucocorticoids are used in pleural tuberculosis to reduce inflammation-induced pathology, and their use also might reduce progression of HIV by suppressing immune activation. We examined the effect that prednisolone has on survival in HIV-1-associated pleural tuberculosis. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of prednisolone as an adjunct to tuberculosis treatment, in adults with HIV-1-associated pleural tuberculosis. The primary outcome was death. Analysis was by intention to treat. RESULTS: Of 197 participants, 99 were assigned to the prednisolone group and 98 to the placebo group. The mortality rate was 21 deaths/100 person-years (pyr) in the prednisolone group and 25 deaths/100 pyr in the placebo group (age-, sex-, and initial CD4+ T cell count-adjusted mortality rate ratio, 0.99 [95% confidence interval, 0.62-1.56] [P =.95]). Resolution of tuberculosis was faster in the prednisolone group, but recurrence rates were slightly (though not significantly) higher, and use of prednisolone was associated with a significantly higher incidence of Kaposi sarcoma (4.2 cases/100 pyr, compared with 0 cases/100 pyr [P =.02]). CONCLUSIONS: In view of the lack of survival benefit and the increased risk of Kaposi sarcoma, the use of prednisolone in HIV-associated tuberculous pleurisy is not recommended.

AIDS-Related Opportunistic Infections↗
PubMed2000

Atypical presentation of pleural tuberculosis: CT findings.

Contrast enhanced CT examination of a 22-year-old male with pleuritic chest pain showed pleural-based nodular thickening and masses without any parenchymal involvement or mediastinal lymphadenopathy. Pathological examination following right parietal pleural decortication showed multiple granulomas with caseation necrosis typical of tuberculosis. Pleural tuberculosis presenting with multiple pleural nodules and masses without parenchymal involvement or lymphadenopathy has, to our knowledge, never been reported in the English literature.

Adult↗
PubMed1993

Predictors of AIDS in a cohort of HIV-infected patients with pulmonary or pleural tuberculosis. AIDS-TB Group.

We estimated the cumulative probability of AIDS in a cohort of 191 HIV-positive patients with pulmonary or pleural tuberculosis, as well as the role of age, sex, district of residence, risk group, alcoholism, homelessness, prison history, site of tuberculosis, radiology, tuberculin skin test and lymphocyte subsets as predictive factors for AIDS development. The 1 year cumulative probability of AIDS for all patients was 27.7% (95% CI:21.7-35.0) and 38.6% (95% CI:31.5-46.7) at 2 years. In the univariate analysis (Kaplan Meier method) the following categories were associated with a higher probability of AIDS: older age group (P = 0.014), exclusively homosexual risk group (P = 0.005), radiology without cavitary pattern (P < 0.001), negative tuberculin skin test (P < 0.001), low CD4 percentage (P = 0.068) and low CD4-CD8 ratio (P = 0.002). At the multivariate level (Cox method), older age group (risk ratio = 24.45, 95% CI = 2.1-286.1), radiology without cavitary pattern (risk ratio = 15.68, 95% CI = 1.1-211.0), and low CD4-CD8 ratio (risk ratio = 50.77, 95% CI = 3.9-645.0) were associated with a higher probability of AIDS. A positive tuberculin skin test had a protective effect (risk ratio = 0.009, 95% CI = 0.01-0.61). Findings from this cohort study suggest that pulmonary and/or pleural tuberculosis in HIV infected patients should be seriously considered as criteria for AIDS when a negative tuberculin skin test and/or low T4/T8 ratio is present, especially in older people without cavitary radiologic pattern.

AIDS-Related Opportunistic Infections↗
PubMed2001

[Primary pleural lymphoma: a rare complication of tuberculosis pleural sequelae].

We report two cases of malignant lymphoma of B phenotype occurring after therapeutic pneumothorax for tuberculosis. In both cases, outcome was fatal without time for specific treatment. Mainly reported in Japan, this pathology seems to be less frequent in western countries. As for B phenotype lymphoma associated with immunodeficiency, association with Epstein Barr virus is reported. Definite diagnosis is difficult and requires surgical biopsy. Prognosis remains poor with a survival ranging from 3 to 6 month.

Aged↗