Pleural Tuberculosis in the United States

Baumann, Michael H.; Nolan, Robert L.; Petrini, Marcy F.; Lee, Y. C. Gary; Light, Richard W.; Schneider, Eileen

doi:10.1378/chest.06-2352

Cited by 139 publications

(126 citation statements)

References 15 publications

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“…(22,23) This fact was also reported in the United States (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003), there being a higher percentage of cases of pleural TB in patients older than 65 years (probable reactivation of a previous infection). (18) Regarding the diagnostic criteria for pleural TB in the state of São Paulo, the limitation of this study refers to the analysis of cases reported with unspecified criteria (55.6%), which allows the assumption that diagnoses were based only on clinical-epidemiological or radiological criteria, biochemical criteria and cytological criteria. The analysis of the use of these parameters and mainly of the determination of adenosine deaminase levels is found to be affected in this study, since the reporting forms lacked these data.…”

Section: Discussionmentioning

confidence: 99%

“…(15,16) It is noteworthy that, in countries where there was a reduction in the incidence of TB, the reduction in the incidence of the extrapulmonary forms was found to be less pronounced. (17,18) This fact was also observed in the state of São Paulo, possibly due to multifactorial causes, such as the improvement of diagnostic techniques and the significant number of cases of reactivation. Another factor to be considered is the usual relationship between reactivation and comorbidities, which are present in 32.0% of the patients with pleural TB.…”

Section: Introductionmentioning

confidence: 91%

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Aspectos epidemiológicos da tuberculose pleural no estado de São Paulo (1998-2005)

et al. 2009

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Objective: To analyze the epidemiological characteristics of and trends regarding the incidence of pleural TB. Methods: This was a retrospective descriptive study of TB cases reported between 1998 and 2005 and compiled from the Epidemiological Surveillance Tuberculosis System (Epi-TB database). Results: A total of 144,347 new cases of TB were reported during the period studied. Pulmonary TB was the predominant form (118,575 cases; 82.2%). Among the extrapulmonary forms (25,773 cases; 17.8%), pleural TB was the form most often reported (12,545 cases; 48.7%). For all forms, the incidence (per 100,000 population) decreased (from 49.7 in 1998 to 44.6 in 2005; R 2 = 0.898; p < 0.001), whereas the incidence of pleural TB remained stable (4.1 in 1998 and 3.8 in 2005; R 2 = 0.433; p = 0.076). The highest incidence of pleural TB was found among males (2:1) aged from 30 to 59 years. Of the 12,545 patients with pleural TB, 4,018 (32.0%) presented comorbidities: alcoholism (9.5%); HIV (8.0%); diabetes (3.3%); and mental illness (1.2%). The diagnosis was based on bacteriological (14.2%) and histological (30.2%) methods, as well as on unspecified methods (55.6%). Conclusions: Pleural TB was the predominant extrapulmonary form of TB in the state of São Paulo, with a stable incidence between 1998 and 2005, although there was a trend toward a decrease in the incidence of the pulmonary forms. The diagnosis of pleural TB was confirmed through histology and bacteriology in 44.4% of the cases. A incidência (por 100.000 habitantes) de todas as formas diminuiu, (49,7 em 1998 e 44,6 em 2005; R 2 = 0,898; p < 0,001), enquanto a incidência de TB pleural permaneceu estável (4,1 em 1998 e 3,8 em 2005; R 2 = 0,433; p = 0,076). A maior incidência de TB pleural ocorreu em pacientes do sexo masculino (2:1) entre 30 e 59 anos de idade. Dos 12.545 pacientes com TB pleural, 4.018 (32,0%) apresentaram comorbidades: alcoolismo (9,5%); HIV (8,0%); diabetes (3,3%); e doença mental (1,2%). O diagnóstico referido fundamentou-se em métodos bacteriológicos (14,2%) e histológicos (30,2%), assim como outros não especificados (55,6%). Conclusões: No estado de São Paulo, a TB pleural foi a forma extrapulmonar predominante, apresentando incidência estável no período entre 1998 e 2005, apesar da tendência de diminuição das formas pulmonares. A histologia e a bacteriologia definiram o diagnóstico em 44,4% dos casos. Keywords Original ArticleEpidemiological aspects of pleural tuberculosis in the state of São Paulo, Brazil (1998-2005 MethodsThis was a retrospective, observational, descriptive study carried out in the Pulmonology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Aspectos epidemiológicos da tuberculose pleural no estado de São Paulo (1998-2005)

et al. 2009

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“…Tuberculosis is a common cause of benign pleural effusions and TB-related pleural effusions can occur in approximately 2-10% of patients with TB (Baumann et al, 2007). T cell response is critical in the protective immunity against Mycobacterium tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Interleukin 21 and Carcinoembryonic Antigen Levels in Malignant Pleural Effusions

Bunjhoo¹,

Wang²,

Chen³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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The aim of this study was to evaluate the diagnostic value of interleukin 21(IL-21) and carcinoembryonic antigen (CEA) in tuberculous pleural effusions (TPEs) and malignant pleural effusions (MPEs). Pleural effusion samples from 103 patients were classified on the basis of diagnosis as TPE (n=51) and MPE (n=52). The concentration of IL-21 was determined by ELISA. Lactate dehydrogenase (LDH), adenosine dehydrogenase (ADA) and CEA levels were also determined in all patients. A significant difference was observed in the levels of ADA and CEA (P<0.01), but not in the levels of LDH (P>0.05) between TPE and MPE. The concentration of IL-21 in MPE was significantly higher compared to TPE (P<0.01). With a threshold value of 4.32 pg/ml, IL-21 had a sensitivity of 76.9% (40/52) and a specificity of 80.4% (41/51). Combined detection of IL-21 and CEA had a sensitivity of 69.2% (36/52) and a specificity of 92.2% (47/51). These two markers can contribute to the differential diagnosis of MPEs.

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“…Accounting for roughly 4% of all TB cases, pleural TB is the second leading cause of extrapulmonary TB. 40 In addition to constitutional symptoms, patients may present with nonproductive cough and pleuritic chest pain. 41 Chest radiography typically shows a unilateral effusion, and pleural fluid analysis shows lymphocyte-predominant exudative features with low glucose levels and low pH.…”

Section: Pulmonary Tbmentioning

confidence: 99%

Current Concepts in the Management of Tuberculosis

Sia

Wieland

2011

Mayo Clinic Proceedings

159

108

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E ffective medical therapy for tuberculosis (TB) has existed for more than half a century, yet TB remains among the most pressing public health issues of our day. Tuberculosis is, in part, a disease of poverty. 1 The fact that it remains the eighth leading cause of death in the world speaks to the challenges facing practitioners and public health officials as they try to control a disease that is so entwined in the cultural and economic fabric of society. Challenges to effective solutions include lack of access to diagnosis and treatment, the frequent coexistence of epidemics of TB and human immunodeficiency virus (HIV), and the Tuberculosis (TB) poses a serious threat to public health throughout the world but disproportionately afflicts low-income nations. Persons in close contact with a patient with active pulmonary TB and those from endemic regions of the world are at highest risk of primary infection, whereas patients with compromised immune systems are at highest risk of reactivation of latent TB infection (LTBI). Tuberculosis can affect any organ system. Clinical manifestations vary accordingly but often include fever, night sweats, and weight loss. Positive results on either a tuberculin skin test or an interferon-γ release assay in the absence of active TB establish a diagnosis of LTBI. A combination of epidemiological, clinical, radiographic, microbiological, and histopathologic features is used to establish the diagnosis of active TB. Patients with suspected active pulmonary TB should submit 3 sputum specimens for acidfast bacilli smears and culture, with nucleic acid amplification testing performed on at least 1 specimen. For patients with LTBI, treatment with isoniazid for 9 months is preferred. Patients with active TB should be treated with multiple agents to achieve bacterial clearance, to reduce the risk of transmission, and to prevent the emergence of drug resistance. Directly observed therapy is recommended for the treatment of active TB. Health care professionals should collaborate, when possible, with local and state public health departments to care for patients with TB. Patients with drug-resistant TB or coinfection with human immunodeficiency virus should be treated in collaboration with TB specialists. Public health measures to prevent the spread of TB include appropriate respiratory isolation of patients with active pulmonary TB, contact investigation, and reduction of the LTBI burden. Proc. 2011;86(4):348-361 AFB = acid-fast bacilli; BCG = bacille Calmette-Guérin; CFP-10 = culture filtrate protein 10; DOT = directly observed therapy; EMB = ethambutol; ESAT-6 = early-secreted antigenic target 6; HIV = human immuno deficiency virus; IFN-γ = interferon-γ; IGRA = IFN-γ release assay; INH = isoniazid; LTBI = latent TBI; MDR-TB = multidrug-resistant TB; NAA = nucleic acid amplification; PZA = pyrazinamide; RIF = rifampin; TB = tuberculosis; TBI = TB infection; TST = tuberculin skin test; XDR-TB = extensively drug-resistant TB Mayo Clin

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Pleural Tuberculosis in the United States

Cited by 139 publications

References 15 publications

Aspectos epidemiológicos da tuberculose pleural no estado de São Paulo (1998-2005)

Aspectos epidemiológicos da tuberculose pleural no estado de São Paulo (1998-2005)

Diagnostic Value of Interleukin 21 and Carcinoembryonic Antigen Levels in Malignant Pleural Effusions

Current Concepts in the Management of Tuberculosis

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