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PubMed1997

[Analysis of 90 cases of pleural tuberculosis in relation to adenosine deaminase levels].

BACKGROUND: To analyze the adenosine deaminase (ADA) pleural levels and the possibility of a typical pattern of tuberculous pleuritis (TP) in relation to these values. PATIENTS AND METHODS: We analyzed 90 consecutive cases of TP dividend into two groups on the basis of the pleural ADA measurements: group 1 (less than 43 U/I) and group 2 (equal or higher than 43 U/I). We compared: age, sex, tuberculous risk factors, clinic onset and duration, PPD, chest roentgenogram, biochemical (LDH, glucose and proteins) and cytological examination of the pleural fluid, microbiologic studies on sputum, pleural fluid and biopsies, histologic findings of the biopsies, evolution and sequelae after the treatment. RESULTS: 36 patients in the group 1 (40%) and 54 in the group 2 (60%) (p = 0.01). All the parameters were similar in both groups excluding LDH pleural levels, that were higher in group 2. In 20 cases of the group 1, we obtained a second analysis of pleural ADA and we observed in 11 cases (55%) an ADA value above 43 U/I. CONCLUSIONS: We confirmed that ADA pleural level is increased in the majority of our patients with a low initial sensibility of 60%, that can increase with a second determination (72%). ADA activity below 43 U/I cannot exclude the tuberculous aetiology of an effusion and can persist negative in other analyses. The results suggest a response of different chronology without any relation to initial ADA pleural level.

Adenosine Deaminase↗
PubMed1991

[Three cases of localized pleural tuberculosis which looked exacerbated during antituberculous chemotherapy].

We reported three cases whose pleural tumorous shadows enlarged during the intensive chemotherapy for tuberculosis. The patients were 39 year-old female, 63 year-old female, and 22 year-old male. Their chest X-ray films on admission showed pleural effusion or infiltration, but no tumorous shadows. Eight to 16 weeks after starting the antituberculous therapy with INH, RFP and SM, new tumorous shadows appeared in the right chest wall (case 1, 3) or the left chest wall (case 2). The mass extracted from case 1 contained granuloma with caseous necrosis. The tumorous shadows on chest X-ray films in case 2 and 3 disappeared by continuous antituberculous therapy. We can not definitely conclude that the disease of these 3 cases were same diseases to be called either percostal tuberculosis, peripleural abscess or peripleuritis tuberculosa as observed in case 1. The phenomenon observed in case 2 and 3 is suspected to be caused by some allergic mechanism eg. Jarisch-Herxheimer reaction which is observed during the therapy for syphilis.

Adult↗
PubMed2001

[Local ozone therapy in the complex surgical treatment of pulmonary and pleural tuberculosis patients].

The found bactericidal activity of ozone and oxygen mixture containing ozone, 10 mg/l, and ozoned solutions of furacilin (dilution 1:5000) and chlorohexidine (0.05%) against the nonspecific microflora and Mycobacteria tuberculosis allowed them to be used in the treatment of 55 patients with pleural empyema. Analyzing the outcomes of treatment in these patients versus 59 matched patients indicated that local ozone therapy accelerated sanitation and stimulation of reparative processes in this disease on the average by a fortnight. Local ozone therapy used in the preoperative preparation of patients with pulmonary tuberculosis and pleural empyema reduced the number of purulent postoperative complication to 17.7% versus 30.4% in the controls, enhanced the efficiency of multimodality treatment by 15.6% and reduced mortality by 9.5%. Analyzing the results of prevention of purulent bronchopleural complications after pleuropulmonectomy in 31 patients in the experimental group and in 35 in the control one showed that with local ozone therapy, complications occurred in 16.1 and 28.6%, respectively, and the efficiency of surgical management increased by 13.1% and mortality rates reduced by 9.6%.

Combined Modality Therapy↗
PubMed1989

[A case of localized pleural tuberculosis exacerbated during antituberculous chemotherapy].

A 24 year-old male with pulmonary tuberculosis in right upper lobe developed two lesions of extrapulmonary pleural tuberculoma during the course of antituberculous therapy. He had no history of lung tuberculosis nor pleurisy. However, the chest X-ray film on first admission showed scattered nodular shadows in right upper lung field. He had no subjective symptoms and no abnormalities of laboratory findings except mild iron deficiency anemia, from which he recovered completely without specific therapy. Three months after starting the antituberculous therapy including SM, INH, and RFP, a new round homogeneous opacity appeared in the right lower lung field (S4). Chest CT scan revealed the lesions in S10 as well as in S4. Microscopic examination of the specimen obtained by ultrasound-guided needle aspiration biopsy disclosed positive acid-fast bacilli. Because of the lack of effect of drug therapy on pleural lesions, surgical treatment was performed. The visceral pleura was found adherent fibrously to parietal pleura, which was easily separated by hand. However, at the site of lesions, the adhesion was so tight that extrapleural resection was needed. Because lung tissue and tumor were connected tightly, the lung had to be partially resected. Most content of tumors were caseous necrosis. Although main lesion was located outside of the lung, intrapulmonary invasion was also noticed. Double lesions of this kind of disease seem to be very rare. There is no evidence of relapse until eight months after surgery.

Adult↗
PubMed1998

[Purulent pleurisy and empyema. With the exception of pleural tuberculosis].

CLINICAL SETTING: Purulent collections in the pleural cavity usually occur as complications of pneumonia in immunodeficient or socially underprivileged patients. PUNCTURE ASPIRATION: The key to diagnosis, pleural aspiration is indicated in case of sufficiently abundant collections, especially in patients with fever. Exploratory puncture is a therapeutic emergency, allowing optimal antibiotic therapy when a causal germ is isolated and drainage of the purulent collection. If there is the slightest doubt, imaging techniques should be used to guide the puncture. DRAINAGE: Drainage is essential and is indicated whenever the aspiration fluid is purulent, contains, germs or the chemistry suggests major bacterial colonisation (acid pH, low glucose, high lactic acid dehydrogenase). Local injections of fibrinolytic agents improve drainage. PROGNOSIS: Complete recovery without sequellae is usually achieved. Physical therapy, provided early and for a prolonged period, helps improve the prognosis. Early care reduces the risk of recurrence of this potentially severe condition.

Empyema, Pleural↗
PubMed2002

[VEGF (vascular endothelial growth factor) concentration in serum and pleural fluid of patients with pleural malignancy and pleural tuberculosis].

The purpose of this study was comparison of VEGF (vascular endothelial growth factor) levels in serum and pleural fluid and estimation of this test usefulness in diagnosis of pleural effusions. VEGF levels were measured by ELISA method in 68 patients (45 males and 23 females) aged 19-81 years. By Light's criteria in 16 cases transudate and in 52 cases exudate was recognized. By means of fluid cytology, pleural biopsy, microbiology or thoracoscopy in 10 cases pleural metastases from distant organs, in 15 cases coexisting pulmonary neoplasm, in 11 cases mesothelioma and in 16 cases tuberculosis were determined as a cause of fluid accumulation in pleural space. The mean VEGF levels were significantly higher (p < 0.001) in patients with exudates than in patients with transudates (3833 pg/ml and 325 pg/ml respectively). Based on likelihood ratios analysis, as a cut off value in differentiation of exudates and transudates a value 700 pg/ml was accepted. The sensitivity of this test was 75% and the specificity 93% and likelihood ratio (LR) 12.5. The mean VEGF level in exudates was seven times higher than mean VEGF level in serum (3833 pg/ml and 573 pg/ml respectively). Mean VEGF levels in malignant exudates (4615 pg/ml) were significantly higher than in tuberculous exudates (2073 pg/ml). As a cut off value in differentiation between malignant and tuberculous exudates a value of 4500 pg/ml was accepted. We conclude that our results suggests the local VEGF production in pleural cavity and the significant role of this cytokine in pleural exudates accumulations and also suggests the usefulness of VEGF estimation in pleural fluid in differentiation transudates from exudates and malignant from tuberculous pleural fluids.

Adult↗
PubMed1998

Pleural tuberculosis in Harare, Zimbabwe: the relationship between human immunodeficiency virus, CD4 lymphocyte count, granuloma formation and disseminated disease.

OBJECTIVE: To elucidate the relationship between HIV, CD4+ count and pleural TB. METHOD: In a prospective study, 94 patients presenting at two large Harare hospitals with clinically suspected pleural TB were enrolled over a 10-month period. All underwent standardized evaluation, closed pleural aspiration and biopsy. Patients receiving directly observed anti-TB therapy were followed-up. RESULTS: Pleural TB was diagnosed in 90 individuals (median age 33 years; range 18-65; 64 males); the seroprevalence of HIV was 85%. HIV-positive patients were older than HIV-negative individuals (median age 33 vs 23 years, P = 0.013) and had a significantly lower median CD4+ count (191 vs 1106 x 10(6)/l respectively, P = 0.004). A CD4+ count of <200 x 10(6)/l was associated with a length of illness >30 days (65% vs 37%; P = 0.05), a positive pleural fluid smear (37% vs 0%; P = 0.0006) and a positive pleural biopsy Ziehl-Neelsen stain (35% vs 7%; P = 0.021). However, a relationship between CD4+ count and either pleural granuloma formation or radiological evidence of disseminated disease was not observed. CONCLUSION: In sub-Saharan Africa, TB pleural effusions have become associated with older age, a chronic onset, and an increased mycobacterial load. These data emphasize the complex relationship between pleural TB, HIV infection and a low CD4+ count.

Adult↗
PubMed1996

Pleural tuberculosis: incidence, pathogenesis, diagnosis, and treatment.

Recent studies in populations with a high prevalence of tuberculosis and HIV infection report that tuberculous pleurisy occurs in approximately 30% of patients with tuberculosis. However, the fraction of patients with tuberculosis who have tuberculous pleurisy is comparable in HIV-positive and HIV-negative individuals. It appears that tuberculous pleurisy mostly develops in patients with HIV who have CD4 counts above 200/microL. Primary tuberculous pleurisy is thought to occur as a result of a delayed hypersensitivity reaction to mycobacterial antigens. Recent studies highlight the way in which pleural cells become activated and produce cytokines as a response to mycobacteria. Intramacrophage and direct cytotoxic elimination of mycobacteria, granuloma formation, and fibrosis are the main facets of this reaction. Many studies have investigated the usefulness of measuring different parameters in pleural fluid for an early diagnosis of tuberculous pleurisy. It has been shown that the most useful diagnostic tests are the levels of adenosine deaminase and interferon gamma in the pleural fluid. Elevation of either of these compounds in lymphocytic pleural effusions is virtually diagnostic of tuberculous pleurisy. Although theoretically, detection of mycobacterial DNA in the pleural fluid by the polymerase chain reaction would appear to be useful, the usefulness of this test still needs further demonstration. Patients with tuberculous pleurisy must receive antituberculous treatment. The current recommendation for immunocompetent patients is a 6-month regimen of isoniazid and rifampin supplemented in the first 2 months by pyrazinamide. HIV-infected patients should be treated with this same regimen for a longer time period. Serial thoracentesis or corticosteroid treatment are not warranted for the majority of patients.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Pleural tuberculosis: analysis of 105 cases].

BACKGROUND: We present the results of a retrospective study with patients diagnosed of tuberculous pleuritis (TP) to offer a view and a perspective of this entity in our area. METHODS: We reviewed 105 cases of TP according to age, tuberculous risk factors, clinical onset, tuberculin test, chest roentgenogram, pleural fluid analysis (ADA, LDH, glucose and proteins) and pleural biopsy, and the evolution or sequels of the pleural effusion after a specific treatment. RESULTS: TP was a disease of younger patients (62% less than 30 years old) with tuberculous risk factors (34.3%), positive tuberculin test (81%) and an acute or subacute onset (88.5%). The pleural effusion was unilateral (98.1%), small-sized (61%), with pulmonary infiltrates in the 22.4%. All of the effusions were exudates with the exception of a transudative case. The levels of LDH, glucose and ADA were increased and the white cell counts below 6000/mm2, predominantly mononuclear. ADA was below 40 U/L in the 17% of cases. Pleural biopsy established the diagnosis in the 92.2% and the diagnosis was obtained in the 98.6% when we associated the analysis of ADA, pleural fluid and pleural biopsy. Specific treatment was accompanied with a good response. CONCLUSIONS: Our findings supported that TP maintained the predilection for younger patients with tuberculous risk factors. The clinical onset, radiographies, pleural fluid analysis and the utility of all diagnostic examinations were similar to other previous studies with the exception of few atypical cases. We confirmed a good prognosis with a correct treatment.

Adolescent↗
PubMed1995

[Treatment of pleural tuberculosis with a short 4-month regimen: preliminary results].

The aim of this prospective study was to evaluate the results of a four-month regimen (2HRZ/2HR) in the treatment of isolated tuberculous pleurisy with effusion. It included 68 patients presenting with histologically confirmed tuberculous pleurisy treated with 2HRZ/2HR, physiotherapy and aspiration of the pleura. Patients were seen every 2 months during treatment, and then 1, 3, 4, 6, 12, and 24 months after the end of treatment. Preliminary results show a favourable response in 58 patients (85%) and minimal pleural thickening in 10 patients. There were no failures, no relapses nor any extrapleural dissemination after a follow-up period of on average 20 months. These encouraging results need to be evaluated in a long-term study.

Adult↗
PubMed2001

Anatomically compartmentalized human immunodeficiency virus replication in HLA-DR+ cells and CD14+ macrophages at the site of pleural tuberculosis coinfection.

This study examined the impact of the host inflammatory microenvironment associated with localized tuberculosis (TB) on human immunodeficiency virus type 1 (HIV-1) replication within lymphocytes and macrophages in vivo. Paired plasma and pleural fluid samples from HIV-1-infected individuals with pleural TB (n=9) were analyzed. Detection of host proteins incorporated into the HIV-1 envelope by immunomagnetic capture analysis provided insight into the phenotype of cells supporting HIV-1 replication. The results indicated that the 4.0-fold greater median HIV-1 load in pleural fluid, compared with median load in plasma (P<.01), was derived in part from viral replication within HLA-DR+ cells, CD26+ lymphocytes, and, importantly, CD14+ macrophages. Greatly increased local concentrations of proinflammatory cytokines and immune activation markers in the pleural space correlated with the virologic findings. In summary, HIV-1 replication was increased at sites of Mycobacterium tuberculosis coinfection within activated cells, including lymphocytes and CD14+ macrophages.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

The cytologic diagnosis of tuberculosis in pleural effusions.

This paper reports on eight patients who had cytologic findings suggestive of florid pleural tuberculosis in pleural exudates. The suggestive diagnosis in each case was confirmed either by a pleural biopsy, culture of Mycobacterium tuberculosis from the aspirated fluids or clinical improvement from the administration of tuberculotherapy. The pleural effusion from tuberculosis is characterized by the presence of abundant lymphocytes in the smear. The nuclei of the lymphocytes show characteristic morphologic features. The two most important differential diagnoses are those effusions rich in lymphocytes due to nonspecific causes and effusions containing numerous tumor cells from a well-differentiated lymphosarcoma.

Adolescent↗
PubMed2004

Simple method for rapid diagnosis of tuberculosis pleuritis: a statistical approach.

Among the extrapulmonary presentations of tuberculosis, pleural tuberculosis is the second most frequent. Failure to diagnose and treat pleural tuberculosis can result in progressive disease with involvement of other organs in as many as 65% of patients. Conventional methods such as direct examination of pleural fluid, pleural fluid culture and pleural biopsy have proven to be insufficient for diagnoses of pleural tuberculosis. In this study, we examined a statistical method by combining the diagnostic efficiency of adenosine deaminase activity, pleural fluid protein, lactate dehydrogenase and cellular components in patients with tuberculous pleural effusions. Eighty eight patients over 12 years of age presenting with pleural effusions were included. A positive result by either three of the methods was considered to be indicative of a positive diagnosis of pleural tuberculosis. The determination of adenosine deaminase activity, lactate dehydrogenase levels, and lymphocyte to neutrophil ratio in the pleural fluid yielded a sensitivity of 100% for pleural tuberculosis. A patient was considered positive if any of the three tests was positive, with a specificity of 100%. A positive diagnosis was made when all three tests were positive. Similarly, these different approaches to the combination of pleural adenosine deaminase and lactate dehydrogenase result in sensitivity and specificity of 91.4% and 100% respectively.

Adenosine Deaminase↗