Impact of HIV infection on tuberculous pleural effusion

Abstract

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.

Advances in the diagnosis of tuberculous pleuritis

“…In HIV-infected individuals microbiological investigations are more sensitive, presumably due to an impaired bacterial clearance from the pleural space in the context of immunosuppression. For example, in one study the frequency of positive pleural fluid cultures was reported to be 63.6% and 29.5% in 42 HIVpositive and 132 HIV-negative TB patients, respectively (P=0.001) (12).…”

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]…”

Tuberculosis in Pregnancy: Delayed Diagnosis, Lost Lives

“…In some studies a significantly higher proportion of bacterially confirmed pulmonary tuberculosis patients were HIV co-infected patients than HIV negative tuberculosis patients. 10,11 A full blood count is recommended as some patients may be anaemic due to chronic ill-health.…”