Pulmonary Changes of Pleural TB

Ko, Jeong Min; Park, Hyun Jin; Kim, Chi Hong

doi:10.1378/chest.14-0196

Cited by 34 publications

(33 citation statements)

References 26 publications

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“…Younger age2,4,18–20 and lower lymphocyte count5,19,21,22 at the time of the TB diagnosis have been identified as risk factors for a PUR in previous cohort studies, and are mechanistically plausible mediators of the host immune response in a PUR. We also found having an AFB-positive diagnostic sample and multiple sites of TB disease at diagnosis to be risk factors for a PUR.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical upgrading reaction in extra-pulmonary tuberculosis: association with vitamin D therapy

Barr

Coussens

Irvine

et al. 2017

int j tuberc lung dis

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SUMMARYSETTING:Glasgow, Scotland, UK.BACKGROUND:Paradoxical reactions in tuberculosis (TB) are a notable example of our incomplete understanding of host-pathogen interactions during anti-tuberculosis treatment.OBJECTIVES:To determine risk factors for a TB paradoxical reaction, and specifically to assess for an independent association with vitamin D use.DESIGN:Consecutive human immunodeficiency virus (HIV) negative adult patients treated for extra-pulmonary TB were identified from an Extended Surveillance of Mycobacterial Infections database. In our setting, vitamin D was variably prescribed for newly diagnosed TB patients. A previously published definition of paradoxical TB reaction was retrospectively applied to, and data on all previously described risk factors were extracted from, centralised electronic patient records. The association with vitamin D use was assessed using multivariate logistic regression.RESULTS:Of the 249 patients included, most had TB adenopathy; 222/249 had microbiologically and/or histologically confirmed TB. Vitamin D was prescribed for 57/249 (23%) patients; 37/249 (15%) were classified as having paradoxical reactions. Younger age, acid-fast bacilli-positive invasive samples, multiple disease sites, lower lymphocyte count and vitamin D use were found to be independent risk factors.CONCLUSION:We speculate that vitamin D-mediated signalling of pro-inflammatory innate immune cells, along with high antigenic load, may mediate paradoxical reactions in anti-tuberculosis treatment.

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Section: Discussionmentioning

confidence: 99%

Paradoxical upgrading reaction in extra-pulmonary tuberculosis: association with vitamin D therapy

Barr

Coussens

Irvine

et al. 2017

int j tuberc lung dis

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“…Interestingly, our patient showed no lung parenchymal disease on cross-sectional imaging, which is found in over 80% of pleural TB cases 10. In such cases, induced sputum is an important and often underutilised diagnostic approach,2 and bronchoscopy can also be considered.…”

Section: Discussionmentioning

confidence: 66%

Pleural tuberculosis: a key differential diagnosis for pleural thickening, even without obvious risk factors for tuberculosis in a low incidence setting

Philip¹,

Kon

Roddie

et al. 2018

BMJ Case Reports

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We report the case of a 64-year-old woman, presenting with pleuritic chest pain and weight loss. She had a previous history of breast malignancy and no clear risk factors for tuberculosis (TB). Initial investigations showed a right-sided pleural effusion and pleural thickening suggestive of malignancy, which would have been in keeping with the clinical presentation. Initial pleural biopsy showed features suggestive of possible TB infection, though no growth on cultures. A repeat biopsy was negative on initial microscopy, but was culture positive for Mycobacterium tuberculosis, also identifying isoniazid resistance. This case highlights that TB remains an important differential even in the absence of classical risk factors, and illustrates the diagnostic challenges it poses. It also highlights the value of culture positivity in identification of drug resistance and facilitation of appropriate treatment.

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“…It is known that concurrent PTB and TBPE is not as uncommon as previously believed, and PTB can be diagnosed by induced sputum in approximately 52% of cases of TBPE232425. However, in the remaining cases of TBPE, it is necessary to cultivate the MTB in the TBPE rather than in respiratory specimens to identify it as the pathogen.…”

Section: Discussionmentioning

confidence: 99%

Loculated Tuberculous Pleural Effusion: Easily Identifiable and Clinically Useful Predictor of Positive Mycobacterial Culture from Pleural Fluid

Kim

Chang

et al. 2017

Tuberc Respir Dis

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BackgroundIsolation of M. tuberculosis (MTB) is required in cases of Tuberculous pleural effusion (TBPE) for confirming diagnosis and successful therapy based on drug sensitivity test. Several studies have focused on predictors of MTB culture positivity in TBPE. However, the clinical role of loculated TBPE as a predictor of MTB cultivation from TBPE remains unclear. The aim of this study was to examine possible predictors including loculation of TBPE of MTB culture positivity in TBPE.MethodsWe retrospectively examined associations between clinical, radiological, microbiological, and laboratory characteristics and positive MTB culture from TBPE to determine a potent predictor of culture positivity.ResultsFrom January 2011 to August 2015, 232 patients with TBPE were identified. Of these, 219 were finally analyzed. Among them, 69 (31.5%) were culture positive for MTB in TBPE and 86 (39.3%) had loculated TBPE. In multivariate logistic regression analysis, the loculation of TBPE was independently associated with culture positivity for MTB in TBPE (adjusted odds ratio [OR], 40.062; 95% confidence interval [CI], 9.355–171.556; p<0.001). In contrast, the lymphocyte percentage of TBPE (adjusted OR, 0.934; 95% CI, 0.899–0.971; p=0.001) was inversely associated with culture positivity for MTB in TBPE.ConclusionIn clinical practice, identification of loculation in TBPE is easy, reliable to measure, not uncommon and may be helpful to predict the possibility of positive mycobacterial culture.

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Pulmonary Changes of Pleural TB

Cited by 34 publications

References 26 publications

Paradoxical upgrading reaction in extra-pulmonary tuberculosis: association with vitamin D therapy

Paradoxical upgrading reaction in extra-pulmonary tuberculosis: association with vitamin D therapy

Pleural tuberculosis: a key differential diagnosis for pleural thickening, even without obvious risk factors for tuberculosis in a low incidence setting

Loculated Tuberculous Pleural Effusion: Easily Identifiable and Clinically Useful Predictor of Positive Mycobacterial Culture from Pleural Fluid

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