Pleural tuberculosis: is radiological evidence of pulmonary-associated disease related to the exacerbation of the inflammatory response?

Abstract

OBJECTIVE:Pleural tuberculosis is the most frequently occurring form of extra pulmonary disease in adults. In up to 40% of cases, the lung parenchyma is concomitantly involved, which can have an epidemiological impact. This study aims to evaluate the pleural and systemic inflammatory response of patients with pleural or pleuropulmonary tuberculosis.METHODS:A prospective study of 39 patients with confirmed pleural tuberculosis. After thoracentesis, a high resolution chest tomography was performed to evaluate the pulmonary involvement. Of the 39 patients, 20 exhibited only pleural effusion, and high resolution chest tomography revealed active associated-pulmonary disease in 19 patients. The total protein, lactic dehydrogenase, adenosine deaminase, vascular endothelial growth factor, interleukin-8, tumor necrosis factor-α, and transforming growth factor-β1 levels were quantified in the patient serum and pleural fluid.RESULTS:All of the effusions were exudates with high levels of adenosine deaminase. The levels of vascular endothelial growth factor and transforming growth factor-β1 were increased in the blood and pleural fluid of all of the patients with pleural tuberculosis, with no differences between the two forms of tuberculosis. The tumor necrosis factor-α levels were significantly higher in the pleural fluid of the patients with the pleuropulmonary form of tuberculosis. The interleukin-8 levels were high in the pleural fluid of all of the patients, without any differences between the forms of tuberculosis.CONCLUSION:Tumor necrosis factor-α was the single cytokine that significantly increased in the pleural fluid of the patients with pulmonary involvement. However, an overlap in the results does not permit us to suggest that cytokine is a biological marker of concomitant parenchymal involvement. Although high resolution chest tomography can be useful in identifying these patients, the investigation of fast acid bacilli and cultures for M. tuberculosis in the sputum is recommended for all patients who are diagnosed with pleural tuberculosis.

A Field-Validated Approach Using Surveillance and Genotyping Data to Estimate Tuberculosis Attributable to Recent Transmission in the United States

“…We included pleural TB as a respiratory form of disease because of the high probability that a case reported as pleural also has pulmonary involvement (36–38). …”

Uji Diagnostik Pemeriksaan Kadar Transforming Growth Factor Beta 1 Cairan Pleura pada Pleuritis Tuberkulosis

“…16 menunjukkan bahwa kadar TGF-β1 pada penderita pleuritis TB dengan keterlibatan paru lebih tinggi: 653 (426-1.011) pg/mL apabila dibanding dengan kelompok pleuritis TB tanpa keterlibatan paru: 492 (196-1.088) pg/mL. Pada penelitian ini terdapat 3 subjek penelitian yang menunjukkan kadar TGF-β1 yang melebihi cut-off dengan menunjukkan keterlibatan paru berdasar atas pemeriksaan rontgen toraks.…”

Can pleural adenosine deaminase (ADA) levels in pleural tuberculosis predict the presence of pulmonary tuberculosis? A CT analysis

“…3 Although pleural and pulmonary lesions are considered to be independent events, approximately 40% of pleural tuberculosis cases involve lung parenchyma. 5 Culture of pleural fluid or sputum is a confirmative diagnostic tool for tuberculosis, but it requires considerable time and has a sensitivity of approximately 36%, and sometimes decision making has to be undertaken before the result of culture. 6,7 Pleural biopsy has a sensitivity of approximately 90%, but is invasive and also takes time.…”