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

Bueno, C. Escudero

doi:10.1001/archinte.150.6.1190

Cited by 137 publications

(49 citation statements)

References 16 publications

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“…Pleural fluid smears for mycobacteria in immunocompetent patients are not routinely indicated, because they are almost always negative, unless the patient has a TB empyema [21,61]. Cultures of pleural fluid should be taken, but in most series, the cultures are positive in less than 40% of immunocompetent patients [7,20].…”

Section: Pleural Fluid Stain and Culturementioning

confidence: 99%

Tuberculous Pleural Effusion

Cohen

Light

2015

Tur Toraks Der

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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. KEY WORDS:Tuberculosis, pleural effusions, adenosine deaminase, gamma interferon, pleural biopsy, empyema INTRODUCTION Tuberculosis (TB) remains a major public health problem in developing countries. Most patients with TB have pulmonary TB; however, 25% of adults can present with extrapulmonary TB, which mainly involves the lymph nodes and pleura but can affect any organ system, including the central nervous system (CNS), cardiovascular system, and gastrointestinal (GI) tract [1]. The most common form of extrapulmonary TB is infection of the pleura. In a patient who presents with undiagnosed pleural effusion, the diagnosis of TB pleuritis should be considered. Pleural effusion, as an isolated manifestation of TB, may be selflimited and of little immediate concern, but untreated, it can lead to serious disease many years later. Pathogenesis and Pathologic FeaturesTuberculous pleural effusion may occur in the absence of radiologically apparent TB [2]. The effusion may result as a sequela to a primary infection from 6-12 weeks earlier, or it may represent the reactivation of TB [2]. In developed countries, TB pleural effusions present more often in older patients. The median age in one North American study was 56, suggesting reactivation of the disease [3]. However, a study from 2004 in San Francisco showed that pleural TB cases were 2 times more likely to be clustered (when assessed by genotyping of the mycobacterial organisms) than pulmonary TB and 3 times more likely to be clustered than nonrespiratory TB cases [4]. The observations made in the San Francisco study suggest that the majority of patients has a postprimary infection [4]. This was not confirmed in studies performed in both Houston [5] and Baltimore [6] or in a study in sub-Saharan Africa, in which the prevalence of pleural TB was 63.2% in patients with a primary TB infection [7].The pathogenesis of TB pleural effusion is thought to be related to the rupture of a subpleural caseous focus in the lung into the pleural space [8]. The basis for this was the observation that a caseous TB focus could be demonstrated in the lung, contiguous with the diseased pleural, in 12 to 15 patients with TB pleuritis [9]. The 3 other patients in this study had parenchymal disease but did not have caseous foci adjacent...

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Section: Pleural Fluid Stain and Culturementioning

confidence: 99%

Tuberculous Pleural Effusion

Cohen

Light

2015

Tur Toraks Der

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“…Most of the current guidelines recommend the addition of a biopsy procedure when a first cytology of effusions of unknown origin is negative [11,12,13]. Percutaneous needle pleural biopsy is frequently advised in those cases [14, 15], but with the recent advances of image techniques some authors prefer CT-guided needle biopsy that could replace blind needle biopsy in more than two thirds of the cases [16]. …”

Section: Indications For Thoracoscopymentioning

confidence: 99%

Medical Thoracoscopy

Rodríguez-Panadero¹

2008

Respiration

103

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As opposed to ‘video-assisted thoracoscopic surgery’ which requires general anesthesia, double-lumen tracheal intubation and single lung ventilation, medical thoracoscopy (or ‘pleuroscopy’) is frequently performed in the respiratory endoscopy suite using local anesthesia. It can be done by well-trained physicians, either pulmonologists or thoracic surgeons, and its main indication is related to diagnosis and treatment of pleural effusions. Also, pneumothorax can be managed in most cases using medical thoracoscopy. This article focuses in particular on technical aspects of medical thoracoscopy, including the selection and preparation of the patient, the choice of equipment, specific details of the procedure itself, and other technical details aimed at preventing complications.

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“…A prevalência da tuberculose na idade adulta é maior entre os homens (11)(12)(13)(14) . Não há explicação aparente para esta ocorrên-cia, porém a maior exposição deles ao risco do contágio se explique pelo fato de serem os homens que saem de casa para atividades sociais ou profissionais, ou então, porque há uma freqüência maior, entre eles, de tabagismo, de alcoolismo, que são fatores facilitadores do desenvolvimento da doença.…”

Section: Discussionunclassified

“…A ausência de calcificação da adrenal não exclui a tuberculose (28) . Mesmo que a adrenal possa aumentar de tamanho na infecção tuberculosa ativa, com conseqüente atrofia com o processo inflamatório em evolução, não se pode determinar a necessidade do tratamento antituberculoso baseado apenas no tamanho das glândulas (5) , no entanto, é um indício de atividade da doença (12,29) . A revisão de trabalhos para avaliar o tamanho da adrenal pela TC sugere que o aumento da adrenal demanda sempre uma boa investigação dessa glândula (30) .…”

Section: Emprego Da Tc Na Detecção De Alterações Das Adrenais Em Doenunclassified

Emprego da tomografia computadorizada na detecção de alterações das adrenais em doentes com tuberculose

2004

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167detectados fragmentos de DNA do bacilo tuberculoso em múmias egípcias com mais de 5.400 anos (4) . Antes da existência do tratamento específico, a tuberculose era a causa mais comum de insuficiência da adrenal, e 70% a 80% dos casos de doença de Addison eram causados pelo M. tuberculosis (5,6) . A tuberculose das adrenais associa-se freqüen-temente com outros focos da infecção, principalmente com as formas pulmonar e geniturinária, e raramente é manifestação isolada da doença Neste estudo foram avaliadas, por meio de tomografia computadorizada, as adrenais em indivíduos sem tuberculose (grupo 1 G1) e com tuberculose (grupo 2 G2). A dimensão ântero-posterior, a espessura e o comprimento das adrenais foram comparados no G1 e no G2. Foram também avaliadas a duração da doença com a ocorrência de alteração morfológica no G2, e a distribuição segundo o sexo, a idade e a cor da pele no G1 e no G2. Neste estudo houve diferença nas dimensões ântero-posterior e espessura da adrenal direita entre o G1 e o G2. Observou-se maior ocorrência do sexo masculino e de indivíduos de pele branca no G2. Não houve associação entre a duração da doença e a ocorrência de alteração morfológica no G2. Maior ocorrência da alteração morfológica tipo alargamento foi observada no G2. Os principais achados pela tomografia computadorizada, nos pacientes com tuberculose, foram alargamento da adrenal sem calcificação, alargamento da adrenal com calcificação puntiforme e calcificação de aspecto residual da adrenal. Unitermos: Adrenais; Tuberculose; Tomografia computadorizada.Computed tomography of the adrenals in patients with tuberculosis. We evaluated the adrenals of individuals without tuberculosis (group 1 G1) and with tuberculosis (group 2 G2) using computed tomography. The antero-posterior length, the thickness, and the longitudinal length of the adrenals were compared in G1 and G2. The duration of the disease, the occurrence of morphologic abnormalities in G2, the distribution according to sex, age and skin color were also studied. There was difference in the antero-posterior length and thickness of right adrenal between G1 and G2. A higher prevalence of white skin male individuals was observed in G2. There was no association between duration of the disease and the occurrence of morphologic abnormalities in G2. A higher occurrence of adrenal enlargement was observed in G2. The main computed tomography findings in patients with tuberculosis were enlargement of the adrenal without calcification, enlargement of the adrenal with punctiform calcifications, and residual calcification of the adrenal.

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

Cited by 137 publications

References 16 publications

Tuberculous Pleural Effusion

Tuberculous Pleural Effusion

Medical Thoracoscopy

Emprego da tomografia computadorizada na detecção de alterações das adrenais em doentes com tuberculose

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