&lt;i&gt;Mycobacterium avium&lt;/i&gt; Complex Pleuritis

Yanagihara, Katsunori; Tomono, Kazunori; Sawai, Toyomitsu; Miyazaki, Yoshitsugu; Hirakata, Yoichi; Kadota, Jun‐ichi; Kohno, Shigeru

doi:10.1159/000066463

Cited by 19 publications

(11 citation statements)

References 4 publications

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“…One limitation of this study is that we can exclude infection with nontuberculous mycobacteria (NTM) in our TBP patients, although this is a rare phenomenon (31,32), since the presence of AFB in tissue specimens cannot differentiate M. tuberculosis from NTM and most of our TBP patients (249/281) either were negative for pleural fluid M. tuberculosis culture or were not tested by pleural fluid culture. Nevertheless, we routinely performed a 16S rRNA gene-derived probe hybridization assay (Yaneng Biotechnology Co., Shenzhen, China) to identify M. tuberculosis and other NTM among clinical M. tuberculosis isolates.…”

Section: Discussionmentioning

confidence: 99%

Gamma Interferon Immunospot Assay of Pleural Effusion Mononuclear Cells for Diagnosis of Tuberculous Pleurisy

Liao¹,

Yang²,

Zhang³

et al. 2014

Clin. Vaccine Immunol.

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e Diagnosis of tuberculous pleurisy remains a challenge in the clinic. In this study, we evaluated the usefulness of a previously developed Mycobacterium tuberculosis antigen-specific gamma interferon enzyme-linked immunospot (ELISPOT) assay in the diagnosis of tuberculous pleurisy by testing a cohort of 352 patients with pleural effusion. We found that M. tuberculosis antigen-specific gamma interferon-producing cells were enriched four to five times in pleural fluid compared with their levels in peripheral blood from patients with tuberuclous pleurisy assayed in parallel. The sensitivity, specificity, positive predictive value, and negative predictive value of the pleural fluid mononuclear cell ELISPOT assay for the diagnosis of tuberculous pleurisy were 95.7%, 100%, 100%, and 81.0%, respectively. In comparison, the sensitivity and specificity of the ELISPOT assay using peripheral blood mononuclear cells were 78.3% and 86.3%, respectively. The sensitivity and specificity of the pleural fluid adenosine deaminase activity test were 55.5% and 86.3%, respectively. These results demonstrate that the M. tuberculosis antigen-specific ELISPOT assay performed on pleural fluid mononuclear cells provides an accurate, rapid diagnosis of tuberculous pleurisy.T uberculosis (TB) is a leading cause of morbidity and mortality throughout the world, with 95% of cases and 97% of all deaths occurring in high-prevalence countries such as China, where the prevalence of active TB is as high as 367/100,000 population (1). Tuberculous pleurisy (TBP) is a common clinical manifestation of active TB disease and may account for up to 50% of all pleural effusions in areas with a high incidence of TB (2). Standard diagnostic assays for TBP, including microbiological examination, adenosine deaminase (ADA) levels, cell infiltrate profile, and certain other biochemical tests, do not provide satisfactory sensitivity and specificity (3). As an example, ADA determination has been recognized as a relatively sensitive diagnostic test for TBP; increased ADA levels are observed in a number of other diseases, such as parapneumonic effusions and noninfectious inflammatory diseases (4). High pleural fluid ADA levels do not necessarily indicate the presence of TBP, especially when pleural fluid potassium levels exceed 5.0 mEq/liter (5).Infection with Mycobacterium tuberculosis elicits a strong antigen-specific gamma interferon (IFN-␥) response from host T cells, which is used as an indicator to diagnose latent M. tuberculosis infection in clinical practice (6, 7). In addition, we and others have applied the M. tuberculosis antigen-specific IFN-␥ enzymelinked immunosorbent spot (ELISPOT) assay to peripheral blood mononuclear cells (PBMC) to diagnose active TB (8, 9). Although the sensitivity of the peripheral blood ELISPOT assay for the diagnosis of active pulmonary TB is significantly higher than those of routine tests such as sputum M. tuberculosis culture, the specificity is not satisfactory, mostly due to its inability to discriminate active TB disease ...

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Section: Discussionmentioning

confidence: 99%

Gamma Interferon Immunospot Assay of Pleural Effusion Mononuclear Cells for Diagnosis of Tuberculous Pleurisy

Liao¹,

Yang²,

Zhang³

et al. 2014

Clin. Vaccine Immunol.

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“…There have been a few case reports of pleural effusion caused by NTM such as MAC (10)(11)(12)(13)(14)(15), M. kansasii (16)(17)(18), and M. scrofulaceum (19). In addition, two cases of chronic empyema due to MAC were reported and these cases were managed with surgical treatment including pleuropneumonectomy or thoracoplasty (20,21 (22).…”

Section: Although the Clinical And Radiological Features Of Ntm Infecmentioning

confidence: 99%

Acute Pneumonia and Empyema Caused by Mycobacterium Intracellulare

et al. 2006

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“…To our knowledge, this is the first case of haemorrhagic pleurisy caused by M. fortuitum in an immunocompetent patient, although rare cases of pleuritis with massive nonhaemorrhagic pleural effusion caused by the Mycobacterium avium-Mycobacterium intracellulare complex, or thoracic empyema by Mycobacterium chelonae, have been described in non-compromised women (Yanagihara et al, 2002;Hsieh et al, 2008). Thus, NTM should henceforth always be included in the differential diagnosis of a patient with pleural exudate, whether it be haemorrhagic or not, small or massive (Sarma & Thakur, 2008;Polverosi et al, 2010), and especially when microbiology fails to detect the more usual pathogens.…”

Section: Discussionmentioning

confidence: 82%

Pleural effusion in an immunocompetent woman caused by Mycobacterium fortuitum

Fabbian

Giorgi

Pala

et al. 2011

Journal of Medical Microbiology

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Mycobacterium fortuitum is a non-tuberculous mycobacterium that can cause pneumonia, abscess and empyema in subjects with predisposing lung diseases. However, pleurisy with effusion is rare. Herein, we report the case of a 74-year-old immunocompetent female patient without apparent risk factors, who suffered haemorrhagic pleural effusion as the main clinical manifestation. Pleural nodules were detected by computed tomography scan, and microbiological analysis revealed M. fortuitum in the absence of other pathogens. The patient was treated with ceftriaxone and ciprofloxacin, and full recovery ensued in 4 weeks. To our knowledge, this is the first reported case of haemorrhagic pleural effusion in an immunocompetent patient without underlying diseases. Although non-tuberculous mycobacterial infections are rarely accompanied by pleural involvement, M. fortuitum should be considered in such cases, especially when microbiology fails to detect the usual pathogens, and when the clinical picture is unclear.

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<i>Mycobacterium avium</i> Complex Pleuritis

Cited by 19 publications

References 4 publications

Gamma Interferon Immunospot Assay of Pleural Effusion Mononuclear Cells for Diagnosis of Tuberculous Pleurisy

Gamma Interferon Immunospot Assay of Pleural Effusion Mononuclear Cells for Diagnosis of Tuberculous Pleurisy

Acute Pneumonia and Empyema Caused by Mycobacterium Intracellulare

Pleural effusion in an immunocompetent woman caused by Mycobacterium fortuitum

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