A Systematic Review of the Epidemiology, Immunopathogenesis, Diagnosis, and Treatment of Pleural TB in HIV- Infected Patients

Aljohaney, Ahmed A.; Amjadi, Kayvan; Alvarez, Gonzalo G.

doi:10.1155/2012/842045

Cited by 13 publications

(12 citation statements)

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“…6,[8][9][10][11] However, some authors have found HIV-positive patients less symptomatic. 5 In comparing the radiologic findings of TPE in HIVpositive and HIV-negative patients, we found bilateral pleural effusion more frequent among HIV-infected patients, consistent to what was reported by most authors.…”

Section: Discussionmentioning

confidence: 99%

Impact of HIV infection on tuberculous pleural effusion

et al. 2015

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The nature of tuberculosis (TB), being one of the most common opportunistic infections, is different among HIV-infected patients than HIV-negative patients. A retrospective study was conducted on HIV-positive and HIV-negative patients with new TB pleural effusion who were admitted to the National Research Institute of Tuberculosis and Lung Diseases in Tehran, Iran from 2005 to 2012. The two groups were compared with respect to clinical, imaging, mycobacteriologic and histopathologic characteristics of TB pleural effusion. In all, 42 HIV-positive and 132 HIV-negative cases of TB pleural effusion were included. Bilateral pleural effusion was statistically more common in the HIV-positive group (p = 0.004, OR = 3.81, 95% CI: 1.46-9.94) without any correlation with CD4 cell count. Pulmonary infiltration was found in 81% of HIV-positive and 49.2% of HIV-negative patients (p = 0.001, OR = 4.38, 95% CI: 1.88-10.1). Mycobacteriologic studies led to the diagnosis of TB in 66.6% of HIV-infected and 49.2% of HIV-negative patients. In 23.8% of HIV-positive and 50.7% of HIV-negative patients TB was ultimately diagnosed by pleural biopsy. HIV remained significantly associated with positive culture of pleural fluid in multivariate analysis. The diagnostic approach to TB pleural effusion in HIV-infected patients may be different. The diagnostic yield of mycobacteriologic studies was higher among HIV-positive patients, which may help in reducing the need for invasive procedures like pleural biopsy.

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Section: Discussionmentioning

confidence: 99%

Impact of HIV infection on tuberculous pleural effusion

et al. 2015

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“…We investigated diseases that could lead patients to an immunocompromised state in which TB can develop. The AIDS epidemic caused TB recrudescence not only in developing countries, but also in developed countries . It has been reported that 25–50% of HIV‐infected people worldwide have active tuberculosis .…”

Section: Discussionmentioning

confidence: 99%

“…The AIDS epidemic caused TB recrudescence not only in developing countries, but also in developed countries. 15,[17][18][19][20][21] It has been reported that 25-50% of HIV-infected people worldwide have active tuberculosis. 15 In the present study, there were no UTB patients who had HIV.…”

Section: Discussionmentioning

confidence: 99%

Nationwide survey of urogenital tuberculosis in Japan

et al. 2014

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Objectives: To determine current epidemiology and treatment patterns of urogenital tuberculosis in Japan. Methods: A questionnaire was sent to the urological departments of 1203 Japanese hospitals. Clinical data was reviewed retrospectively; no time range was specified. Results: Of the 1203 hospitals, 399 returned questionnaires with information about 355 urogenital tuberculosis patients. Of the 399, 153 institutions reported at least one patient, and 201 patients were identified between 2000 and 2007. Infections were located in the kidneys (n = 242), ureter (n = 96), bladder (n = 100), epididymis or testes (n = 81) and prostate (n = 9). Conclusions: Urogenital tuberculosis is rare in Japan, but patients do exist, and we should not ignore them.Key words: nationwide survey, urinary tract infection, urogenital tuberculosis. IntroductionThere are various symptoms of TB, some of which indicate a delayed allergic reaction to Mycobacterium tuberculosis. As tuberculosis is primarily a sinopulmonary infection, the lungs are most commonly affected, but other infection sites are also possible. Tuberculosis is thus classified into two categories: PTB and EPTB.1 Most EPTB, including UTB, develop after PTB. In Japan, TB incidence has decreased from 698.4 patients per 100 000 people per year in 1951 to 19.0 patients per 100 000 people per year in 2009. 2 In 2008, just 121 urinary tract TB patients and 34 genital TB patients were reported.3 Therefore, Japanese urologists seldom encounter UTB patients in common practice. However, UTB can occur several decades after the initial TB infection. 4 The Tuberculosis Surveillance Center, which is part of the Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association, provides epidemiological data on TB incidence in Japan, the number of EPTB patients and modes of treatment of all EPTB (including UTB).5 However, there is generally very little information about UTB patients. The present study examined the following: the number of recent UTB patients, the social and medical background of UTB patients, the role of urinary examination in UTB diagnosis, the incidence of drug-resistant UTB, the causes of doctor's delay, and UTB treatment options. The academic committee of the Japanese Urological Association approved the study. MethodsA questionnaire was sent to 1203 Japanese hospitals with urological departments in April 2007. Clinical data was reviewed retrospectively; no time range was specified. The questionnaire collected information in the following seven categories: (i) patient background; (ii) clinical examinations; (iii) grounds for diagnosis; (iv) patient and doctor delay; (v) mode of therapy; (vi) prognosis; and (vii) infection control. In the "patient background" category, we collected the following information: patient's sex, age at diagnosis, mode of symptoms, history of tuberculosis (lung, pleura, lymph nodes, bone and others); underlying disease (diabetes mellitus, end stage renal disease, HIV infection and others), socioeconomic backgrounds (coming from other coun...

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“…However, this does not appear to be the case. In regions, like Zimbabwe, with a high prevalence rate of pleural TB, 85% of patients with TB pleuritis patients are human immunodeficiency virus (HIV)-positive [16]. The percentage of patients with TB pleuritis was higher in HIV-positive patients than in immunocompetent patients in reports from South Africa (38% vs. 20%) [17] and Uganda (23% vs. 11%) [18].…”

Section: Incidencementioning

confidence: 99%

“…HIV-infected patients more commonly present with systemic symptoms, such as fatigue, night sweats, diarrhea, lymphadenopathy, splenomegaly, and hepatomegaly. They are also more likely to have bilateral pleural effusions [16]. They also have a longer duration of illness and a lower incidence of chest pain [26].…”

Section: Clinical Manifestations In Hiv-positive Patientsmentioning

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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A Systematic Review of the Epidemiology, Immunopathogenesis, Diagnosis, and Treatment of Pleural TB in HIV- Infected Patients

Cited by 13 publications

References 50 publications

Impact of HIV infection on tuberculous pleural effusion

Impact of HIV infection on tuberculous pleural effusion

Nationwide survey of urogenital tuberculosis in Japan

Tuberculous Pleural Effusion

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