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These data reveal that innate MDSCs are induced not only during active TB at similar levels as found in cancer, but also in healthy individuals after recent exposure to M.tb. These cells diminish protective T-cell responses and may contribute to the inability of hosts to eradicate the infection and add to the subsequent development of TB disease.

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B-Pa-Z, including two novel agents without resistance in prevalent M. tuberculosis strains, is a potential new tuberculosis treatment regimen. C had no measurable activity in the first 14 days of treatment. Clinical trial registered with www.clinicaltrials.gov (NCT 01691534).

Transthoracic ultrasonography is still not utilized to its full potential by respiratory physicians, despite being a well-established and validated imaging modality. It allows for an immediate and mobile assessment that can potentially augment the physical examination of the chest. Ultrasound (US)-assisted procedures can be performed by a single clinician with no sedation and with minimal monitoring, even outside of theatre. The main indications for the use of transthoracic US are: the qualitative and quantitative description of pleu-ral effusions, pleural thickening, diaphragmatic dysfunction and chest-wall and pleural tumours. It may also be used to visualise lung tumours and other parenchymal pulmonary processes provided they abut the pleura. It is at least as sensitive as chest radiographs as far as the detection of a pneumothorax is concerned. It is the ideal tool to assist with thoracocentesis and drainage of effusions. The US-assisted fine-needle aspiration and/or cutting-needle biopsy of extrathoracic lymph nodes, lesions arising from the chest wall, pleura, peripheral lung and mediastinum, are safe and have a high yield in the hands of chest physicians. US may also guide the aspiration and biopsy of diffuse pulmonary infiltrates, consolidations and lung abscesses, provided the chest wall is abutted. Advanced applications of transthoracic US include the diagnosis of pulmonary embolism.

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We prospectively investigated the diagnostic utility of the Xpert MTB/RIF (Mycobacterium tuberculosis/ rifampin [RIF] resistance) assay in 20 cases with confirmed tuberculous pleural effusion. The sensitivity and specificity of the Xpert assay in pleural fluid were 25% and 100%, respectively. All cases positive by the Xpert assay were also positive by pleural fluid culture.The detection of Mycobacterium tuberculosis in sputum samples from suspected pulmonary tuberculosis (TB) patients has been significantly improved by the Xpert MTB/RIF (Mycobacterium tuberculosis/rifampin [RIF] resistance) assay (Xpert; Cepheid, Sunnyvale, CA). This automated system employs real-time PCR and molecular beacon probes to determine the presence of M. tuberculosis complex DNA, as well as rpoB gene mutations conferring rifampin resistance, rapidly and with high accuracy (1, 2, 7). The assay seems predestined for use with other specimens than sputum, such as cerebrospinal fluid or effusions from various sites, but data are still scarce. Pleural TB is the second most frequent form of extrapulmonary TB and the most frequent cause of exudative pleural effusions in areas with a high prevalence of HIV infection. Patients present at all ages with uni-or bilateral pleural effusion and acute to subacute onset of chest pain, fever, weight loss, breathlessness, and cough. The diagnostic workup includes pleural fluid aspiration and pleural biopsy, as pleural fluid smear and culture are often negative due to the paucibacillary nature of pleural TB (9). We investigated the utility of the novel Xpert MTB/ RIF assay for diagnosing pleural TB from pleural fluid.Our prospective series included 25 consecutive patients referred to Tygerberg Hospital, a tertiary medical institution in Cape Town, South Africa, with an undiagnosed pleural effusion and high clinical suspicion of pleural TB for sputum collection, pleural biopsy, and fluid aspiration. Sputum was collected from patients able to produce samples spontaneously and processed with routine methods for smear and culture. Abrams needle biopsy specimens were conducted and the specimens analyzed as published previously (4); specimens were considered positive when granulomatous inflammation with or without necrosis and/or acid-fast bacilli (AFB) were found by Ziehl-Neelsen (ZN) microscopy or when M. tuberculosis was cultured from them. A minimum of 160 ml pleural fluid was collected from each patient and split for two mycobacterial cultures and one Xpert measurement. The samples for culture were centrifuged for 20 min at 3,000 ϫ g and 4°C, and the pellets were decontaminated for 20 min with an equal volume of 2.5% sodium hydroxide-N-acetyl-L-cysteine (NaOH-NALC; Merck, Cape Town, South Africa) and neutralized with sterile phosphate-buffered saline (PBS, pH 6.8) added to a total volume of 40 ml. A second centrifugation step followed (3,000 ϫ g at 4°C for 20 min). The remaining pellets were resuspended in PBS, the bacterial concentrations were titrated to 0.5 McFarland standard, and 0.5 ml of this mixture ...