Diagnostic value of eosinophils in pleural effusion: A prospective study of 26 cases

Abstract

Eosinophilic pleural effusions (EPFs), defined as the presence of 10% or more eosinophils in the pleural fluid, are relatively rare. Their diagnostic and prognostic significance, however, remains controversial, as most of the studies are based almost entirely on retrospective case studies. This prospective study examines 26 eosinophilic pleural effusions from among 444 consecutive pleural effusions investigated at this tertiary health care center from October 1999 to April 2002. This study was attempted to unravel the diagnostic and prognostic significance of these eosinophilic effusions and assess their clinical implications, if any. Koss and Light's criteria were applied in the analysis, which comprised macroscopic, biochemical, cytological, and microbiological examinations. Of the 26 EPFs studied, five were associated with tuberculosis and three with metastatic disease. Nineteen patients had significant associated lymphocytosis. Twenty-four patients have been followed up and are in good health to date and have had no recurrence of effusion. Thus, EPF could be associated with inflammatory, benign, and malignant conditions. Hence, a closer search for a definite etiological agent is warranted in the setting of such an effusion, especially in populations endemic for tuberculosis, as in a developing country like India and in populations with a high prevalence of malignancy.

The Prevalence and Diagnostic Significance of Eosinophilic Pleural Effusions: A Meta-Analysis and Systematic Review

“…The prevalence of EPEs in all pleural effusions was reported in 12 studies [5,[13][14][15][16][17][18][19][20][22][23][24] . The pooled prevalence of EPEs was 9% (random-effects model, 95% CI 7-10).…”

“…The pooled prevalence of EPEs was 9% (random-effects model, 95% CI 7-10). The mean age of patients (56 years, range 48-63) was reported in 6 studies [14,19,[20][21][22][23] . The proportion of male patients (71%, range 45-100) was reported in 9 studies [6,[12][13][14][20][21][22][23] .…”

“…The mean age of patients (56 years, range 48-63) was reported in 6 studies [14,19,[20][21][22][23] . The proportion of male patients (71%, range 45-100) was reported in 9 studies [6,[12][13][14][20][21][22][23] . The mean pleural fluid eosinophil count (27%, range 21-40) was reported in 12 studies [12,[14][15][16][17][18][19][20][21][22][23][24] .…”

“…After a more detailed review, an additional 15 papers did not meet the inclusion criteria and were excluded. The remaining 15 studies were reviewed [1,5,6,[12][13][14][15][16][17][18][19][20][21][22][23] for duplicate publications. We did not find any duplicate publications.…”

Clinicopathologic Significance of Eosinophilic Pleural Effusions in a Population with a High Prevalence of Tuberculosis and Cancer

“…On the other hand, in 14 patients, the RBC count was moderate but < 10,000 cells/mm 3 . Whereas 13 patients' pleural fluid was heavily hemorrhagic, with > 10,000 RBCs/mm 3 (Table II), no pleural fluid count exceeded 100,000 cells/mm 3 when counted on the Coulter machine.…”