Comparison of polymorphonuclear- and lymphocyte-rich tuberculous pleural effusions

Bielsa, Silvia; Palma, Rosa; Pardina, Marina; Esquerda, Aureli; Rw, Light; Porcel, J.M.

doi:10.5588/ijtld.12.0236

Cited by 65 publications

(73 citation statements)

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“…The present study confirmed that this neutrophilic predominance usually shifts to lymphocytic predominance within a week, as shown in a few previous studies (9)(10)(11). However, the current study showed that 18% of neutrophilic PPE cases also shifted to lymphocytic predominance, although this rate was significantly lower than that of neutrophilic TPE.…”

Section: Discussionsupporting

confidence: 92%

“…In TPE cases with these atypical pleural fluid profiles, a few previous studies have observed that neutrophilic predominance or low ADA levels in the initial pleural fluid shifted to lymphocytic predominance or increased ADA levels above the cutoff value for TPE at subsequent thoracentesis (9)(10)(11)(12). Such findings may provide useful information for the presumptive diagnosis of TPE, based on the subsequent pleural fluid results.…”

Section: Introductionmentioning

confidence: 99%

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Atypical Pleural Fluid Profiles in Tuberculous Pleural Effusion: Sequential Changes Compared with Parapneumonic and Malignant Pleural Effusions

Kim

Lee

et al. 2016

Intern. Med.

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Objective Although tuberculous pleural effusion (TPE) is commonly characterized by lymphocytic predominance and high adenosine deaminase (ADA) levels, it may present with neutrophilic predominance or low ADA levels, which are more commonly found in parapneumonic effusion (PPE) or malignant pleural effusion (MPE), respectively. A few studies have observed that the atypical pleural fluid profiles of these cases of TPE may resolve at follow-up thoracentesis. However, these observations were incompletely analyzed and lacked comparison with proper control groups. Thus, limited data are available comparing the sequential pleural fluid changes between TPE and PPE or MPE with similar pleural fluid profiles. Methods TPE, PPE, and MPE patients who underwent sequential thoracentesis were retrospectively reviewed. The sequential changes in the pleural fluid profiles were compared between neutrophilic TPE and PPE, and lymphocytic TPE and MPE with low ADA levels. Results Twenty-three TPE patients (16 with neutrophilic exudates, seven with lymphocytic exudates), 72 cases of PPE with neutrophilic exudates, and 18 cases of MPE with lymphocytic exudates were included in the analysis. A sequential shift to lymphocytic exudates occurred significantly more often in TPE than in PPE cases. The initial and follow-up ADA levels in TPE cases with a lymphocytic shift were significantly higher than those in PPE cases with a lymphocytic shift. The ADA levels in the TPE cases with initial lymphocytic exudates and low ADA levels significantly increased at follow-up thoracentesis. For the TPE and MPE cases with initial lymphocytic exudates and ADA levels <40 U/L, the frequency of effusion with ADA levels ! 40 U/L at the second thoracentesis was significantly higher in the TPE cases. Conclusion Follow-up thoracentesis may provide useful information for clinical decision-making in suspected atypical TPE cases with neutrophilic exudates or low ADA levels.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Atypical Pleural Fluid Profiles in Tuberculous Pleural Effusion: Sequential Changes Compared with Parapneumonic and Malignant Pleural Effusions

Kim

Lee

et al. 2016

Intern. Med.

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Section: Discussionsupporting

confidence: 83%

“…This finding is consistent with those of previous studies using solid or liquid media (10,13,14). It has been suggested that PMNL-rich effusion appears in early phase, when the immune system has not yet developed an effective defense against the bacillus (14,15). The proportion of PMNL-dominant effusion was reported to be about 10% of TB pleurisy (16), which was related to higher mortality mainly because of delayed diagnosis (13,17).…”

Section: Discussionsupporting

confidence: 82%

Impact of Implementation of an Automated Liquid Culture System on the Diagnosis of Tuberculous Pleurisy

Jeon

Yoon

Yeo

et al. 2015

Chest

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“…TPE is generally characterized by lymphocytic exudates. However, around 10% of TPE cases are characterized by neutrophilic exudates (6,7). Neutrophilic predominance can be observed…”

Section: Introductionmentioning

confidence: 99%

Different characteristics of tuberculous pleural effusion according to pleural fluid cellular predominance and loculation

et al. 2016

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Background: Tuberculous pleural effusion (TPE) exhibits different characteristics according to pleural fluid cellular predominance or whether the pleural fluid is free-flowing or loculated. However, its categorization based on either of these factors alone may be insufficient to properly reflect the heterogeneous manifestation of TPE. We evaluated the characteristics of the four TPE groups classified according to cellular predominance and whether the fluid is free-flowing or loculated.Methods: A cohort of 375 patients with TPE was retrospectively reviewed. Clinical, radiological, and laboratory findings were compared between neutrophilic and lymphocytic TPE, and between free-flowing and loculated effusion for both neutrophilic and lymphocytic TPE.Results: Lymphocytic TPE and neutrophilic TPE were observed in 336 (90%) and 39 (10%) patients, respectively. Pleural fluid loculation was present in 36% and 31% of the patients in the lymphocytic and neutrophilic groups, respectively. A few parameters of the laboratory findings between neutrophilic and lymphocytic TPE patients showed significant differences. However, these significant differences were prominently observed when comparing free-flowing and loculated subgroups of the respective neutrophilic and lymphocytic groups. Pleural fluid pH, lactate dehydrogenase, and adenosine deaminase levels were significantly different among the four subgroups. The neutrophilic loculated subgroup exhibited the most intense pleural inflammation and the highest mycobacterial yields when compared to the other subgroups.However, the percentage of neutrophils in the pleural fluid was not positively associated with the probability of culture-positive effusion. Conclusions:The heterogeneous manifestation of TPE would be better characterized by using a classification system based on combined pleural fluid cellular predominance and loculation, with the neutrophilic loculated subgroup contributing to most of the clinically significant differences.

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Comparison of polymorphonuclear- and lymphocyte-rich tuberculous pleural effusions

Cited by 65 publications

References 0 publications

Atypical Pleural Fluid Profiles in Tuberculous Pleural Effusion: Sequential Changes Compared with Parapneumonic and Malignant Pleural Effusions

Atypical Pleural Fluid Profiles in Tuberculous Pleural Effusion: Sequential Changes Compared with Parapneumonic and Malignant Pleural Effusions

Impact of Implementation of an Automated Liquid Culture System on the Diagnosis of Tuberculous Pleurisy

Different characteristics of tuberculous pleural effusion according to pleural fluid cellular predominance and loculation

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