Different characteristics of tuberculous pleural effusion according to pleural fluid cellular predominance and loculation

Abstract

Background: Tuberculous pleural effusion (TPE) exhibits different characteristics according to pleural fluid cellular predominance or whether the pleural fluid is free-flowing or loculated. However, its categorization based on either of these factors alone may be insufficient to properly reflect the heterogeneous manifestation of TPE. We evaluated the characteristics of the four TPE groups classified according to cellular predominance and whether the fluid is free-flowing or loculated.Methods: A cohort of 375 patients with TPE was retrospectively reviewed. Clinical, radiological, and laboratory findings were compared between neutrophilic and lymphocytic TPE, and between free-flowing and loculated effusion for both neutrophilic and lymphocytic TPE.Results: Lymphocytic TPE and neutrophilic TPE were observed in 336 (90%) and 39 (10%) patients, respectively. Pleural fluid loculation was present in 36% and 31% of the patients in the lymphocytic and neutrophilic groups, respectively. A few parameters of the laboratory findings between neutrophilic and lymphocytic TPE patients showed significant differences. However, these significant differences were prominently observed when comparing free-flowing and loculated subgroups of the respective neutrophilic and lymphocytic groups. Pleural fluid pH, lactate dehydrogenase, and adenosine deaminase levels were significantly different among the four subgroups. The neutrophilic loculated subgroup exhibited the most intense pleural inflammation and the highest mycobacterial yields when compared to the other subgroups.However, the percentage of neutrophils in the pleural fluid was not positively associated with the probability of culture-positive effusion. Conclusions:The heterogeneous manifestation of TPE would be better characterized by using a classification system based on combined pleural fluid cellular predominance and loculation, with the neutrophilic loculated subgroup contributing to most of the clinically significant differences.

Biomarkers in the diagnosis of pleural diseases: a 2018 update

“…Pleural TB has traditionally been considered a paucibacillary disease. The results of 14 studies, 13–26 comprising more than 4800 patients with tuberculous PEs, give the following approximate mean sensitivities for the microbiological studies: acid-fast smears (Ziehl-Neelsen or auramine) of sputum 11%, 13,14,18,21–23,25 cultures of sputum on solid (Lowenstein-Jensen or Ogawa) or liquid media 42%, 13–15,18,21–23,25 acid-fast smears of PF 4%, 13,17,18,20–23,25,26 cultures of PF on solid or liquid media 13–22,24–26 31%. The higher superiority claims of liquid culture media reported in two studies which summed up 440 TB pleuritis 15,16 (63% of positive cultures on PF 15,16 and 55% on sputum samples 15 ) contrast with a later study of 354 patients with TB pleurisy in which the sensitivity of a BACTEC MGIT culture method on PF was just 18%.…”

“…Pleural TB has traditionally been considered a paucibacillary disease. The results of 14 studies, [13][14][15][16][17][18][19][20][21][22][23][24][25][26] comprising more than 4800 patients with tuberculous PEs, give the following approximate mean sensitivities for the microbiological studies: acid-fast smears (Ziehl-Neelsen or auramine) of sputum 11%, 13,14,18,[21][22][23]25 cultures of sputum on solid (Lowenstein-Jensen or Ogawa) or liquid media 42%, [13][14][15]18,[21][22][23]25 acid-fast smears of PF 4%, 13,17,18,[20][21][22][23]25,26 cultures of PF on solid or liquid media [13][14][15][16][17][18][19][20][21][22]…”

Single-cell immune profiling reveals functional diversity of T cells in tuberculous pleural effusion

“…Lymphocytes have been shown to dominate the leukocyte infiltrates in TPE, although neutrophils and macrophages may also be presented ( Mitra et al, 2005 ). Lymphocytic pleural fluid (PF) is observed in ∼90% of TPE cases ( Lee et al, 2016 ). The inflammation can resolve spontaneously within a few weeks or months without chemotherapy ( San José et al, 1999 ; Shaw et al, 2019 ).…”

Does repeated pleural culture increase the diagnostic yield of Mycobacterium tuberculosis from tuberculous pleural effusion in HIV-negative individuals?

“…Previous studies have reported that low lymphocyte percentage, high neutrophil percentage, low glucose and pH levels, and high LDH level of TBPE, which suggest ongoing inflammation, are associated with MTB culture in TBPE [ 4 , 13 , 21 , 22 ]. Moreover, loculation of TBPE is well-known as an intense intra-pleural inflammation and clinical predictor of MTB culture [ 23 – 25 ]. Similarly, loculation and a high neutrophil percentage were independently associated with culture-positivity for MTB in TBPE in our study.…”

“…However, most studies in Korea showed a similar culture-positive rate (15.0–41.3%). It should be noted that some of the other studies included cases of TBPE with PTB [ 4 , 13 , 14 , 23 , 30 ]. Fourth, this study was performed in an area with an intermediate TB rate and low human immunodeficiency virus (HIV) infection burden.…”