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PubMed2006

Molecular epidemiology of pleural and other extrapulmonary tuberculosis: a Maryland state review.

BACKGROUND: Limited information exists about the current epidemiological characteristics of extrapulmonary tuberculosis. However, pleural tuberculosis is usually considered to be a manifestation of primary tuberculosis. Our objective was to use molecular epidemiological techniques to describe the occurrence of pleural and other extrapulmonary tuberculosis in Maryland, a state with moderate tuberculosis incidence. METHODS: We surveyed tuberculosis cases reported with a single site of disease in Maryland from 1996 through 2001. Genotyping of Mycobacterium tuberculosis isolates was performed with an IS6110-based restriction fragment-length polymorphism analysis. DNA clustering of strains with >5 IS6110 bands, with supporting epidemiologic information on patients, served as a proxy for recent transmission. RESULTS: A total of 1811 patients with tuberculosis were reported (incidence, 5.9 cases per 100,000 population). Of 1411 patients (77.9%) with cultures positive for M. tuberculosis, 1246 (88.3%) had a single site of disease, with 934 (75.0%) of these isolates having >5 IS6110 bands. Of the 934 patients included in the analyses, 729 (78.0%) had pulmonary tuberculosis, and 205 (22.0%) had extrapulmonary tuberculosis; of the latter group, 46 patients had pleural disease, and 159 patients had nonrespiratory disease. In multivariate analyses, patients with pleural tuberculosis were not significantly associated with clustered strains, compared with patients with nonrespiratory or pulmonary tuberculosis disease. Having a DNA-clustered strain was negatively associated with nonrespiratory tuberculosis, compared with pulmonary disease (adjusted odds ratio, 0.48; P = .003). CONCLUSIONS: Nonrespiratory extrapulmonary tuberculosis is less likely than pulmonary tuberculosis to be a result of recent infection. Pleural tuberculosis is not an appropriate indicator for recent transmission among our population.

Genotype↗
PubMed1997

Cultivation of Mycobacterium tuberculosis from pleural tissue and its histopathology in suspected cases of tuberculous pleural effusion.

The majority of idiopathic pleural effusion are considered to be of tuberculous etiology. The culture of bacilli provide most authentic evidence of disease process. This study was carried out on 21 cases of suspected tuberculous pleural effusion. The pleural fluid and tissue was subjected for smear examination, and cultivation of tubercle bacilli along with pleural biopsy. Overall the diagnosis could be made out of 8 (38.09%) cases. The cultivation of Mycobacterium tuberculosis from pleural tissue was more sensitive (33.33%) as compared to histopathology (19.05%). However, the triad of cultivation of Mycobacterium tuberculosis from pleural tissue, pleural histopathology and pleural fluid smear examination or culture should be done in each suspected case of tuberculous effusion.

Adolescent↗
PubMed1997

[Exudative pleurisy in children and adolescents].

Among 179 children and adolescents, tuberculous exudative pleurisy was identified in 157 (87.71%), parapneumonic pleurisy in 19 (10.61%), tumoral pleurisy in 2 (1.12%), posttraumatic pleurisy in 1 (0.56%). The histological study of parietal biopsy specimens (n = 103) and the biological test with the specimen (n = 24) provided evidence for pleural tuberculosis in 83.33% of the examined patients with tuberculous pleurisy.

Adolescent↗
PubMed1999

Improved recovery of Mycobacterium tuberculosis from pleural aspirates: bedside inoculation, heparinized containers and liquid culture media.

The effects of bedside inoculation, heparinized containers and liquid culture media on the recovery of Mycobacterium tuberculosis from pleural aspirates were evaluated in this study. Of 155 patients, 63 were diagnosed to have pleural effusion tuberculous in origin. The overall recovery of M. tuberculosis was 57.1%. Bedside inoculation of the specimens produced a significantly higher yield than laboratory inoculation using non-heparinized specimens. When the pleural aspirates were transported in heparinized containers, the recovery rate was comparable to that from bedside inoculation, but lower when non-heparinized containers were used. No significant difference was found in recovery rate between the two liquid media, but the rate was significantly higher with the use of liquid media than conventional solid media. Thus, bedside inoculation of pleural aspirates, use of heparinized containers for transport for delayed inoculation in the laboratory and use of liquid culture media are recommended.

Anticoagulants↗
PubMedDate not supplied

[Up-to-date indications for surgery in pleural and pulmonary tuberculosis].

Tuberculosis is an "old disease" but still remains a threat in modern days life. Despite human and material efforts, despite the improvements in drug therapy, the treatment of tuberculosis continue to consume a great amount of health care worldwide. A certain percentage among the patients with pleuro-pulmonary tuberculosis represents failures of DOTS therapy. Among them, paraclinical investigations will select candidates eligible for thoracic surgery. In our study we are reviewing the main surgical options and we present our experience regarding surgery in pleuro-pulmonary tuberculosis--what to operate and when is the best moment.

Adult↗
PubMedDate not supplied

Anaerobic infection of the lung and pleural space in tuberculosis.

Prevalence of anaerobic bacterial infection in 120 sputum positive cases of pleuro-pulmonary tuberculosis was found to be 53.3 per cent-either as pure or mixed with aerobes. Bacteroides fragilis and B. Melaninogenicus were isolated in 19 (26.6%) and 12 (18.72%) cases respectively. Sensitivity studies showed that these were most sensitive to metronidazole followed by rifampicin and kanamycin. The possibility of anaerobic infection may be considered in patients of pulmonary tuberculosis who do not respond to routine treatment.

Adolescent↗
PubMed1986

Practical clinical application of the Bi-Digital O-Ring Test in the diagnosis, treatment and follow-up of tuberculosis & parasitic infection.

Using the Bi-Digital O-Ring Test in three clinical cases where standard Western diagnostic methods were not satisfactory; successful diagnosis and treatment were made non-invasively, quickly and inexpensively with the Bi-Digital O-Ring Test. The three cases are as follows: Tuberculosis of the urinary tract; Pleural tuberculosis; Possible parasitic infection of the liver.

Acupuncture Therapy↗
PubMed2003

Monocyte chemotactic protein-1 production in patients with active pulmonary tuberculosis and tuberculous pleurisy.

OBJECTIVE: The role of monocyte chemotactic protein (MCP)-1 in human pulmonary and pleural tuberculosis (TB) was assessed by examining its production in clinical samples from patients with active pulmonary TB and tuberculous pleurisy (TBP). METHODS: Serum was obtained from 26 active pulmonary TB patients [14 early TB (E-TB), and 12 chronic refractory TB (CR-TB)] and 15 healthy tuberculin reactors (HTRs). The monocytes and peripheral blood mononuclear cells (PBMCs) were separated and stimulated with purified protein derivatives (PPD) or the 30-kDa antigen of Mycobacterium tuberculosis. Pleural exudates were isolated from 25 patients with TBP and 24 non-TBP patients [malignancy and congestive heart failure (CHF)]. The MCP-1 levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: In sera, the MCP-1 levels of TB patients were similar to those of HTRs. For monocytes, CR-TB patients spontaneously expressed more MCP-1, compared with HTRs and E-TB patients. In addition, MCP-1 production of PPD- or 30-kDa antigen-stimulated monocytes was significantly elevated in CR-TB patients than that from E-TB. Interestingly, the E-TB patients had significantly depressed MCP-1 production by PBMCs in response to PPD or 30-kDa, compared with HTRs and CR-TB patients. In pleural effusions, MCP-1 levels were significantly higher in patients with TBP than in patients with CHF, but lower than in malignant effusions. CONCLUSIONS: The data suggest that MCP-1 production is not uniquely elevated systemically in TB patients, although MCP-1 production might be elevated by monocytes in the chronic phase of TB or with a local pleural infection.

Adult↗
PubMed1990

Cytologic and bacteriologic analysis of fluid and pleural biopsy specimens with Cope's needle. Study of 414 patients.

This article describes the results of a dual diagnostic procedure, thoracentesis and pleural biopsy with a Cope's needle, in 414 patients with pleural effusion of unknown origin. A diagnosis of neoplasia or pleural tuberculosis was obtained in 241 subjects (149 with neoplasias and 92 with pleural tuberculosis). In an additional 55 patients, a diagnosis of tuberculosis or neoplasia was obtained using other procedures (15 with tuberculosis and 40 with neoplasias). In 105 subjects, the effusion was neither tuberculosis nor neoplasia. Thirteen patients were excluded from this study due to the impossibility of follow-up. The diagnostic process was repeated in 64 patients. Complications occurred in 46 patients (11%), of which 42 were pneumothorax. The dual diagnostic sensitivity in our series of thoracenteses and pleural biopsies made with a Cope's needle was 86% in tuberculosis and 79% in neoplasia with 100% specificity. The probability of a case being neither tuberculosis nor pleural neoplasia (negative predictive value) when the liquid and the pleural biopsy specimen are nonspecific (each procedure having been applied only once on each patient) is 56%, although a negative result does not exclude these diagnoses. In our opinion, the repetition of the dual procedure is indicated considering the scant morbidity and zero mortality.

Adolescent↗
PubMed1994

Tuberculosis in young adults and the elderly. A prospective comparison study.

OBJECTIVES: To compare the clinical, bacteriologic, and radiologic features of pulmonary and pleural tuberculosis in young adults and the elderly and determine if any differences exist between both groups. DESIGN: Prospective recruitment of all patients diagnosed as having pulmonary and pleural tuberculosis in British Columbia, Canada. SETTING: A population-based sample from a provincial control program TB registry. PATIENTS: A total of 218 consecutive patients whose conditions were diagnosed between January 1990 and May 1991. We excluded 15 HIV-positive patients whose conditions were diagnosed during this study. INTERVENTION: Standardized data collection of symptoms, bacteriology, and review of radiology by two readers blind to the clinical and epidemiologic data. MAIN RESULTS: There were 142 young adult patients and 76 elderly patients. The young adults had a mean age of 41.2 years and the elderly group had a mean age of 75 years of age. Fever (p = 0.002) and night sweats (p = 0.02) were more common in young adults. In culture-proven disease, hemoptysis, fever, and cough were more common in young adult (p = 0.03, 0.02, and 0.01, respectively). There was no difference in the duration of symptoms between the two groups. The odds ratio for cancers other than lung cancer, 3.98 (confidence interval, 1.49, 10.65) in the elderly group was the only significant risk factor to differ between the two groups. Skin test responses to 5TU PPD were positive in 86.2 percent of young adults and 67.6 percent of elderly patients tested (p = 0.03). A total of 79.6 percent of young adults and 88.15 percent of the elderly patients (not significant) were culture positive. Comparison of radiologic findings in young adults vs elderly patients showed no significant differences apart from those with miliary TB 0.7 percent vs 6.7 percent (p = 0.04). CONCLUSIONS: In this population-based study, young adults were more likely to have hemoptysis, fever, and cough and to have a positive PPD response. Cancer was significantly associated as a risk factor in the older age group. There was no difference in bacteriologically proven disease or radiologic findings between the two groups, apart from the more common occurrence of miliary TB in the elderly.

Adult↗
PubMedDate not supplied

Extrapulmonary tuberculosis in an immigrant society: clinical and demographic aspects of 92 cases.

Extrapulmonary tuberculosis accounted for 33% of all new cases of tuberculosis identified at the Soroka Medical Center in Beer Sheva, Israel, during a 10-year period. The most common types of extrapulmonary infection diagnosed were genitourinary tuberculosis (54% of patients), lymphadenitis (13%), pleural tuberculosis (9%), and tuberculosis of bones and joints (8%). Of 92 patients, 51% were Jews of Ethiopian origin, 29% were Jews of non-Ethiopian origin, and 20% were Bedouins. Thus, extrapulmonary tuberculosis remains a significant problem for Israel's heterogeneous population.

Ethiopia↗
PubMed1986

[Diagnosis of tuberculous pleurisy with special reference to thoracoscopic biopsy findings].

132 tuberculous pleurisies were diagnosed between 578 thoracoscopies from 1970 to June 1985. A histological confirmation of diagnosis was achieved in 51.5% of the specific pleurisies, whereas in 15.2% typical endoscopic findings were present. 33.3% of the diseases were diagnosed based on the clinical and roentgenological appearance or ex juvantibus after antituberculous therapy. An increase of histologically negative biopsies was noted after a pretreatment of more than 4 weeks before thoracoscopy. This fact is interpreted as caused by an increasing exudation of fibrin, which permits to perform a probe-excision only without optical control. If there were macroscopic findings suspicious for pleural tuberculosis a histological confirmation succeeded in 68.8%. In cases with the uncharacteristic picture of "fibrinous pleurisies" the diagnosis of tuberculosis was confirmed morphologically in 33.9%. These investigations support the diagnostic value of the macroscopic criteria in case of pleural tuberculosis which are reported by Sattler.

Biopsy↗
PubMed1989

Identification of antigens of Mycobacterium tuberculosis using human monoclonal antibodies.

Pleural tuberculosis constitutes a human model of local protective immunity to mycobacterial infection as the disease is usually self-limited and recurrent pleurisy is rare. To identify potentially protective antigens of Mycobacterium tuberculosis, 37 human pleural fluid B cell clones were established using EBV and their supernatants assayed by ELISA and Western blot for antibody reactivity with M. tuberculosis sonicate and culture filtrate. One antibody identified 29,000, 31,000, and 33,000 bands in culture filtrate, and 31,000, 33,000, and 47,000 bands in sonicate; its species reactivity by ELISA was limited to M. tuberculosis. Eight antibodies identified a 31,000 band in culture filtrate and a 68,000 band in M. tuberculosis sonicate, suggesting recognition of a secreted antigen. The species crossreactivity of these eight antibodies extended to M. avium. Six antibodies identified multiple bands and had crossreactivity that included M. avium and M. kansasii. There was no reactivity with recombinant M. tuberculosis 65,000 antigen. Tuberculous pleurisy may prove useful in the identification of potentially protective mycobacterial antigens, particularly those secreted during active infection, and thus accessible to the human immune response.

Antibodies, Monoclonal↗
PubMed2003

Assay of pleural fluid interleukin-6, tumour necrosis factor-alpha and interferon-gamma in the diagnosis and outcome correlation of tuberculous effusion.

OBJECTIVE: To assess the usefulness of interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) in the diagnosis and prediction of outcome of pleural tuberculosis. PATIENTS AND METHODS: Pleural fluid from 32 TB and 34 non-TB patients was sent for assay of IL-6, TNF-alpha and IFN-gamma. Clinical parameters at presentation and residual pleural scarring at completion of treatment were assessed for pleural TB cases. RESULTS: The pleural fluid Levels of IL-6, TNF-alpha and IFN-gamma in TB patients were significantly higher than those with non-TB effusions (P values of <0.001, 0.018 and <0.001, respectively by independent t-test). Utility of these cytokines for diagnosis of pleural TB was evaluated using receiver operating characteristic (ROC) curve analysis. The cut-off values for IL-6, TNF-alpha and IFN-gamma determined in this analysis were 4000, 4 and 60 pg/ml respectively, and their sensitivity and specificity were 90.6% and 76.5%, 90.6% and 79.4%, 100% and 100%, respectively. The pretreatment pleural fluid IL-6 levels had a positive correlation with the number of febrile days after treatment (Pearson correlation test: r=0.60, P=0.009). A negative correlation was found between the percentage reduction in pleural fluid cytokines after 2 weeks treatment and the extent of residual pleural scarring (IL-6: r=-0.62, P=0.041; TNF-alpha: r=-0.65, P=0.030; IFN-gamma: r=0.83, P=0.002). CONCLUSION: Pleural fluid IL-6, TNF-alpha and IFN-gamma assays are useful in the diagnosis of pleural TB. The initial IL-6 level correlates with the number of febrile days. The percentage change of cytokines after 2 weeks of treatment also helps to predict residual pleural scarring.

Adolescent↗