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Lazović B, Blažić I, Detanac D, Milić R, Šarac S, Detanac D, Žugić V. Tuberculous pleural effusion in the previously healthy man-case report and review of the literature. SANAMED 2019. [DOI: 10.24125/sanamed.v14i2.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Although pleural effusion is a common clinical manifestation, the differential diagnosis of the cause of the pleural effusion is often challenging, especially in the early differentiation of tuberculous pleurisy (TP) from other pleural effusion. Case report: We present a previously healthy man who had no contagious or TB contact but developed massive tuberculous pleural effusion which eventually was unexpected tuberculous. He started with therapy per protocol and feeling well. The purpose of this case and review of literature was to remind the physicians that tuberculosis is not a sickening illness, but on the contrary, it is in the expansion. Discussion: When a patient presents with new pleural effusion, the diagnosis of tuberculous pleuritis should be considered. The patient is at great risk for developing pulmonary or extra pulmonary TB if the diagnosis is not made properly. Between 3% and 25% of patients with TB will have TB pleuritic or more in immunocompromised patients. The treatment for TB pleuritis is the same as that for pulmonary TB. Conclusion: The gold standard for the diagnosis of tuberculous pleural effusion remains the detection of Mycobacterium tuberculosis in pleural fluid, or pleural biopsy specimens, either by microscopy and/or culture, or the histological demonstration of caseating granulomas in the pleura along with acid fast bacilli.
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Usefulness of Adenosine Deaminase Assay in Diagnosis of Patients with HIV Infection and Pleural Tuberculosis. Med Sci (Basel) 2018; 6:medsci6040101. [PMID: 30428535 PMCID: PMC6313798 DOI: 10.3390/medsci6040101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/25/2018] [Accepted: 11/08/2018] [Indexed: 11/26/2022] Open
Abstract
The utility of the adenosine deaminase (ADA) assay in the diagnosis of patients with pleural tuberculosis (TB) and human immunodeficiency virus (HIV) infection is controversial. Forty-eight HIV positive patients with pleural effusion were evaluated; ADA assay was obtained in forty-three of them. Twenty-five patients presented diagnosis of TB. Patients with diagnosis of TB showed a median value of ADA of 70 IU/L (interquartile range (IQR) 41–89) and the non-TB group a median of 27.5 IU/L (IQR 13.5–52). Patients with diagnosis of TB had a median cluster of differentiation 4 (CD4) count of 174 (IQR 86–274) and the non-TB group had a median of 134 (IQR 71–371). Receiver operating characteristic curve was performed with an area under the curve of 0.79. The best cut-off obtained was 35 IU/L with a sensibility of 80% and a specificity of 66%. There was no correlation between CD4 lymphocytes count and the value of ADA in the TB patient group.
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Balkissou AD, Pefura-Yone EW, Netong Gamgne M, Endale Mangamba LM, Onana Ngono I, Poka Mayap V, Evouna Mbarga A, Assamba Mpom SA, Kanko NF, Fodjeu G, Tagne Kamdem PE, Fogang D, Kuaban C. [Residual pleural opacity in patients treated for pleural tuberculosis in Yaounde]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:115-121. [PMID: 26651928 DOI: 10.1016/j.pneumo.2015.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/23/2015] [Accepted: 09/15/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the incidence and risk factors of residual pleural opacity (RPO) at the end and after 6 months (M12) of antituberculosis treatment (ATT) in adults with pleural tuberculosis. METHODS In this prospective cohort study, all patients admitted for pleural tuberculosis between September 2010 and August 2012 in the pneumology A unit of Yaounde Jamot Hospital were included. Each patient was then followed up for 12 months. RPO was considered significant if it was measured 10mm or more on standard chest X-ray. The logistic regression model was used to investigate the risk factors of significant RPO at the end of antituberculosis treatment. RESULTS Of the 193 patients included, median (interquartile range) age of 33 (25-42) years, 115 (59.6%) were men. The incidence (95% CI) of significant RPO was 22.0% (14.9-29.1) and 11.0% (4.9-17.1) at the end of ATT and at M12 respectively. In multivariate analysis, the risk factors of the occurrence of a significant RPO at the end of ATT and at M12 were smoking, associated parenchymal lesions, and hypoglycopleuria. CONCLUSION Cumulative incidence of RPO ≥ 10 mm was 22% at the end of ATT and 11% after 12 months from the beginning of treatment. Patients with risk factors of RPO ≥ 10 mm should benefit from greater surveillance and appropriate management.
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Affiliation(s)
- A D Balkissou
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Hôpital Jamot de Yaoundé, Yaoundé, Cameroun.
| | - E W Pefura-Yone
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Hôpital Jamot de Yaoundé, Yaoundé, Cameroun
| | - M Netong Gamgne
- Centre de diagnostic d'imagerie médicale et de conseils en radioprotection, Yaoundé, Cameroun
| | - L-M Endale Mangamba
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Hôpital Laquintinie, Douala, Cameroun
| | - I Onana Ngono
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - V Poka Mayap
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - A Evouna Mbarga
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - S A Assamba Mpom
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - N F Kanko
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - G Fodjeu
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - P E Tagne Kamdem
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - D Fogang
- Hôpital Jamot de Yaoundé, Yaoundé, Cameroun
| | - C Kuaban
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Faculté de sciences de la santé, Bamenda, Cameroun
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Marjani M, Yousefzadeh A, Baghaei P, Tabarsi P, Moniri A, Masjedi MR, Velayati AA. Impact of HIV infection on tuberculous pleural effusion. Int J STD AIDS 2015; 27:363-9. [PMID: 25957323 DOI: 10.1177/0956462415581738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 03/23/2015] [Indexed: 11/15/2022]
Abstract
The nature of tuberculosis (TB), being one of the most common opportunistic infections, is different among HIV-infected patients than HIV-negative patients. A retrospective study was conducted on HIV-positive and HIV-negative patients with new TB pleural effusion who were admitted to the National Research Institute of Tuberculosis and Lung Diseases in Tehran, Iran from 2005 to 2012. The two groups were compared with respect to clinical, imaging, mycobacteriologic and histopathologic characteristics of TB pleural effusion. In all, 42 HIV-positive and 132 HIV-negative cases of TB pleural effusion were included. Bilateral pleural effusion was statistically more common in the HIV-positive group (p = 0.004, OR = 3.81, 95% CI: 1.46-9.94) without any correlation with CD4 cell count. Pulmonary infiltration was found in 81% of HIV-positive and 49.2% of HIV-negative patients (p = 0.001, OR = 4.38, 95% CI: 1.88-10.1). Mycobacteriologic studies led to the diagnosis of TB in 66.6% of HIV-infected and 49.2% of HIV-negative patients. In 23.8% of HIV-positive and 50.7% of HIV-negative patients TB was ultimately diagnosed by pleural biopsy. HIV remained significantly associated with positive culture of pleural fluid in multivariate analysis. The diagnostic approach to TB pleural effusion in HIV-infected patients may be different. The diagnostic yield of mycobacteriologic studies was higher among HIV-positive patients, which may help in reducing the need for invasive procedures like pleural biopsy.
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Affiliation(s)
- Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Yousefzadeh
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Moniri
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Masjedi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Velayati
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Cohen LA, Light RW. Tuberculous Pleural Effusion. Turk Thorac J 2015; 16:1-9. [PMID: 29404070 DOI: 10.5152/ttd.2014.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/11/2014] [Indexed: 12/12/2022]
Abstract
When a patient presents with new pleural effusion, the diagnosis of tuberculous (TB) pleuritis should be considered. The patient is at risk for developing pulmonary or extrapulmonary TB if the diagnosis is not made. Between 3% and 25% of patients with TB will have TB pleuritis. The incidence of TB pleuritis is higher in patients who are human immunodeficiency virus (HIV)-positive. Pleural fluid is an exudate that usually has a predominance of lymphocytes. The easiest way to diagnose TB pleuritis in a patient with lymphocytic pleural effusion is to demonstrate a pleural fluid adenosine deaminase level above 40 IU/L. The treatment for TB pleuritis is the same as that for pulmonary TB. Tuberculous empyema is a rare occurrence, and the treatment is difficult.
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Affiliation(s)
- Leah A Cohen
- Internal Medicine Resident, Department of Medicine Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard W Light
- Division of Allergy, Pulmonary, and Critical Care Medicine Vanderbilt University Medical Center, Nashville, TN, USA
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Lusiba JK, Nakiyingi L, Kirenga BJ, Kiragga A, Lukande R, Nsereko M, Ssengooba W, Katamba A, Worodria W, Joloba ML, Mayanja-Kizza H. Evaluation of Cepheid's Xpert MTB/Rif test on pleural fluid in the diagnosis of pleural tuberculosis in a high prevalence HIV/TB setting. PLoS One 2014; 9:e102702. [PMID: 25051491 PMCID: PMC4106856 DOI: 10.1371/journal.pone.0102702] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/22/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Diagnosis of pleural tuberculosis (TB) using routinely available diagnostic methods is challenging due to the paucibacillary nature of the disease. Histopathology and pleural tissue TB culture involves an invasive procedure which requires expertise and appropriate equipment, both often unavailable in many health units. Xpert MTB/Rif test has been widely evaluated in sputum specimens but data on its performance in pleural TB is scarce. We evaluated the accuracy of Cepheid's Xpert MTB/Rif test on pleural fluid in the diagnosis of pleural TB in Uganda. METHODS Consenting adult patients with exudative pleural effusions underwent pleural biopsy and the tissue obtained subjected to Lowenstein-Jensen and mycobacterial growth indicator tube MTB cultures and histopathology. Pleural fluid for Xpert MTB/Rif testing was also collected. Data on socio-demographic characteristics, clinical symptoms, HIV status and CD4 count were also collected. Sensitivity, specificity, positive and negative predictive values of Xpert MTB/Rif test on pleural fluid in pleural TB diagnosis were calculated using pleural tissue MTB culture and/or histopathology as the reference standard. RESULTS Of the 116 participants [female 50%, mean age 34 (SD ±13], 87/116 (75%) had pleural TB confirmed on pleural tissue culture and/or histopathology. The Xpert MTB/Rif test identified 25 (28.7%) of the 87 confirmed pleural TB cases. The sensitivity and specificity of Xpert MTB/Rif test were 28.7% and 96.6% respectively while the positive and negative predictive values were 96.1% and 31.1% respectively. CONCLUSION Xpert MTB/Rif test on pleural fluid does not accurately diagnose pleural TB and therefore cannot be used as an initial evaluation test in patients with suspected pleural TB. New, rapid and accurate tests for the diagnosis of pleural TB are still warranted.
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Affiliation(s)
- John K Lusiba
- Makerere University College of Heath Sciences, Kampala, Uganda
| | - Lydia Nakiyingi
- Makerere University College of Heath Sciences, Kampala, Uganda; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Bruce J Kirenga
- Makerere University College of Heath Sciences, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Lukande
- Makerere University College of Heath Sciences, Kampala, Uganda
| | - Maria Nsereko
- Makerere University College of Heath Sciences, Kampala, Uganda
| | - Willy Ssengooba
- Makerere University College of Heath Sciences, Kampala, Uganda
| | | | | | - Moses L Joloba
- Makerere University College of Heath Sciences, Kampala, Uganda
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Nakane K, Yasuda M, Deguchi T, Takahashi S, Tanaka K, Hayami H, Hamasuna R, Yamamoto S, Arakawa S, Matsumoto T. Nationwide survey of urogenital tuberculosis in Japan. Int J Urol 2014; 21:1171-7. [PMID: 25040540 DOI: 10.1111/iju.12549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 05/29/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine current epidemiology and treatment patterns of urogenital tuberculosis in Japan. METHODS A questionnaire was sent to the urological departments of 1203 Japanese hospitals. Clinical data was reviewed retrospectively; no time range was specified. RESULTS Of the 1203 hospitals, 399 returned questionnaires with information about 355 urogenital tuberculosis patients. Of the 399, 153 institutions reported at least one patient, and 201 patients were identified between 2000 and 2007. Infections were located in the kidneys (n = 242), ureter (n = 96), bladder (n = 100), epididymis or testes (n = 81) and prostate (n = 9). CONCLUSIONS Urogenital tuberculosis is rare in Japan, but patients do exist, and we should not ignore them.
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Affiliation(s)
- Keita Nakane
- Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan; Japanese Research Group for UTI, Japan
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