Tuberculose pleural

Abstract

INTRODUÇÃOO comprometimento pleural representa a forma mais freqüente da tuberculose (TB) extrapulmonar. Freqüências variáveis são observadas em diferentes países, de acordo com a prevalência da TB e da sorologia positiva para o vírus da imunodeficiência humana (HIV).(1)A TB pleural pode ser uma manifestação tanto da forma primária da doença (primo-infecção) quanto da reativação de uma infecção latente pelo Mycobacterium tuberculosis. Em ambas a TB pleural está freqüentemente associada à forma pulmonar.(2) Nos países com alta prevalência, a TB ocorre mais em jovens como manifestação da TB primária, enquanto que nos países com baixa pre- RESUMOO derrame pleural tuberculoso pode ser devido a uma manifestação da forma primária da doença ou da reativação de uma infecção latente pelo M. tuberculosis. Os avanços nos métodos laboratoriais contribuíram sobremaneira para um melhor diagnóstico e para a compreensão da fisiopatologia desta doença. No entanto, embora o derrame pleural predominante linfocítico seja indicativo de tuberculose em nosso meio, uma rotina de abordagem diagnóstica deve ser instituída a fim de orientar o tratamento precoce e evitar seqüelas.Descritores: Tuberculose pleural/fisiopatologia; Derrame pleural/fisiopatologia; Tuberculose pleural/epidemiologia; Derrame pleural/epidemiologia; Biopsia ABSTRACTTuberculous pleural effusion is a common manifestation of the primary form of the disease or consequence of the reactivation of a latent infection due to the M. tuberculosis. Advances in the laboratory methods have contributed to better diagnose and understand the pathophysiology of the effusion secondary to tuberculosis. However, although a predominant lymphocytic pleural effusion is suspicious of tuberculosis, a diagnostic routine shall be instituted to orient treatment and prevent undesirable sequels.Keywords: Tuberculosis, pleural/physiopathology; Pleural effusion/physiopathology; Tuberculosis, pleural/epidemiology; Pleural effusion/epidemiology; Biopsy valência ela atinje mais a população idosa, como conseqüência da reativação de um foco de infecção latente, caracterizando a reativação endógena da doença. EPIDEMIOLOGIAEm todo o mundo, cerca de nove milhões de pessoas desenvolvem TB a cada ano. Aproximadamente 80% delas vivem em 22 diferentes países, sendo que o Brasil ocupa o 15º lugar, com cerca de 80 mil casos notificados a cada ano. Em alguns estados, a incidência da doença supera 100 casos por 100 mil habitantes. Além disto, há uma estimativa de 50 milhões de pessoas infectadas.

Assessment of the IgA Immunoassay Diagnostic Potential of the Mycobacterium tuberculosis MT10.3-MPT64 Fusion Protein in Tuberculous Pleural Fluid

“…Nonetheless, among the patients with nonspecific results, the ELISA IgA fusion protein MT10.3-MPT64 was able to identify all PL-TBs except one. The discovery of specific antibodies to mycobacterial antigens in PL-TB in the absence of histopathological changes could be supportive of the hypothesis that, in some cases, pleural effusion may also be caused by the possible entry of mycobacterial antigens into the pleural space, thereby stimulating the presence of IgA at this site (34). Conversely, only 23.5% (12/51) of the PL-TB patients diagnosed via histopathology had false-negative ELISA IgA fusion protein MT10.3-MPT64 results.…”

“…Furthermore, it is known that empyema also has its genesis in the rupture of a lung injury, with a significant burden of the M. tuberculosis bacillus in the pleural space representing active disease with pleural contamination by caseous material (34). It is possible that this patient had tuberculous empyema but was wrongly included in the PL-NTB group because all the available resources for TB diagnosis were not utilized.…”

Effect of continuous positive airway pressure on fluid absorption among patients with pleural effusion due to tuberculosis

“…Dyspnea was evaluated before and after treatment through a Modified Borg Scale 11 . Both groups received standard TB treatment with rifampin and isoniazid for six months, with the addition of pyrazinamide during the first two months of treatment 3 . Anti-TB drug ingestion was monitored in both groups through daily phone contact.…”

“…Pleural TB is the consequence of a delayed-type hypersensitivity reaction in response to the rupture of a subpleural focus of Mycobacterium tuberculosis infection 3 . The main clinical finding is pleural effusion and its diagnosis should be considered in any patient with an exudative effusion 4 .…”

Response to: Necessity of co-operation between pulmonologists and internists in tuberculous pleurisy diagnosis

“…We do not have the exact prevalence of PT. According to data published by Seiscento et al [4], approximately 8% of new cases are due to PT, which would give an estimate incidence of 5040 cases. In a cross-sectional study involving all TB cases reported to the Brazilian Notifiable Diseases Surveillance System (SINAN) between 2007 and 2011, it was estimated that PT represented 6.9% of TB cases [5].…”