Tuberculous Pleurisy: An Update

Jeon, Doosoo

doi:10.4046/trd.2014.76.4.153

Cited by 77 publications

(75 citation statements)

References 62 publications

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“…[1] Definitive diagnosis of TB pleurisy depends on the identification of Mycobacterium tuberculosis in the sputum, pleural fluid, or pleural biopsy specimens. [2] Hence, its diagnosis can be established by acid fast bacilli (AFB) staining, polymerase chain reaction (PCR) for M. tuberculosis, or mycobacterial culture from pleural fluid.…”

Section: Introductionmentioning

confidence: 99%

“…[3,4] However, diagnosis of TB pleurisy remains problematic because of the low sensitivities of the AFB smear, PCR, and mycobacterial culture. [1][2][3][4] Pleural biopsy occasionally gives highly suggestive findings for tuberculosis, but it is invasive and could accompany the complications such as pneumothorax. The adenosine deaminase (ADA) level in pleural fluid has been used as a helpful non-invasive measure for diagnosing TB pleurisy.…”

Section: Introductionmentioning

confidence: 99%

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A diagnostic algorithm for tuberculous pleurisy using the ELISPOT assay on peripheral blood and pleural effusion

Kim

Lee

et al. 2016

Infectious Diseases

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A diagnostic algorithm for tuberculous pleurisy using the ELISPOT assay on peripheral blood and pleural effusion

Kim

Lee

et al. 2016

Infectious Diseases

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“…However, the TBPE is now believed to be the consequence of direct infection of the pleural space by paucibacillary MTB related to serial immunologic responses by various pro-inflammatory cytokines based on recent studies131323334. After inoculation of MTB into pleural space, TBPE is initially developed as a result of rapid neutrophilic inflammatory reaction and followed by a CD4 + -lymphocyte driven immunologic response of delayed hypersensitivity response over time131.…”

Section: Discussionmentioning

confidence: 99%

Loculated Tuberculous Pleural Effusion: Easily Identifiable and Clinically Useful Predictor of Positive Mycobacterial Culture from Pleural Fluid

Kim

Chang

et al. 2017

Tuberc Respir Dis

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BackgroundIsolation of M. tuberculosis (MTB) is required in cases of Tuberculous pleural effusion (TBPE) for confirming diagnosis and successful therapy based on drug sensitivity test. Several studies have focused on predictors of MTB culture positivity in TBPE. However, the clinical role of loculated TBPE as a predictor of MTB cultivation from TBPE remains unclear. The aim of this study was to examine possible predictors including loculation of TBPE of MTB culture positivity in TBPE.MethodsWe retrospectively examined associations between clinical, radiological, microbiological, and laboratory characteristics and positive MTB culture from TBPE to determine a potent predictor of culture positivity.ResultsFrom January 2011 to August 2015, 232 patients with TBPE were identified. Of these, 219 were finally analyzed. Among them, 69 (31.5%) were culture positive for MTB in TBPE and 86 (39.3%) had loculated TBPE. In multivariate logistic regression analysis, the loculation of TBPE was independently associated with culture positivity for MTB in TBPE (adjusted odds ratio [OR], 40.062; 95% confidence interval [CI], 9.355–171.556; p<0.001). In contrast, the lymphocyte percentage of TBPE (adjusted OR, 0.934; 95% CI, 0.899–0.971; p=0.001) was inversely associated with culture positivity for MTB in TBPE.ConclusionIn clinical practice, identification of loculation in TBPE is easy, reliable to measure, not uncommon and may be helpful to predict the possibility of positive mycobacterial culture.

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“…It is well known that delayed hypersensitivity plays a large role in the pathogenesis of tuberculous pleural effusion (TPE)12. After acquiring adaptive immunity to Mycobacterium tuberculosis (MTB) infection, MTB proteins exposed to the pleural space initiates this delayed hypersensitivity reaction 345.…”

Section: Introductionmentioning

confidence: 99%

“…As an alternative tool for mycobacterial culture, adenosine deaminase (ADA) activity has been widely used to diagnose TPE in TB-prevalent areas26. Among the two different forms of ADA, ADA1, and ADA2, ADA2 is elevated in TPE.…”

Section: Introductionmentioning

confidence: 99%

Mycobacterium tuberculosisESAT6 and CPF10 Induce Adenosine Deaminase 2 mRNA Expression in Monocyte-Derived Macrophages

et al. 2017

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BackgroundDelayed hypersensitivity plays a large role in the pathogenesis of tuberculous pleural effusion (TPE). Macrophages infected with live Mycobacterium tuberculosis (MTB) increase the levels of adenosine deaminase2 (ADA2) in the pleural fluid of TPE patients. However, it is as yet unclear whether ADA2 can be produced by macrophages when challenged with MTB antigens alone. This study therefore evaluated the levels of ADA2 mRNA expression, using monocyte-derived macrophages (MDMs) stimulated with MTB antigens.MethodsPurified monocytes from the peripheral blood mononuclear cells of healthy volunteers were differentiated into macrophages using granulocyte-macrophage colony-stimulating factor (GM-CSF) or macrophage colony-stimulating factor (M-CSF). The MDMs were stimulated with early secretory antigenic target protein 6 (ESAT6) and culture filtrate protein 10 (CFP10). The mRNA expression levels for the cat eye syndrome chromosome region, candidate 1 (CECR1) gene encoding ADA2 were then measured.ResultsCECR1 mRNA expression levels were significantly higher in MDMs stimulated with ESAT6 and CFP10, than in the unstimulated MDMs. When stimulated with ESAT6, M-CSF-treated MDMs showed more pronounced CECR1 mRNA expression than GM-CSF-treated MDMs. Interferon-γ decreased the ESAT6- and CFP10-induced CECR1 mRNA expression in MDMs. CECR1 mRNA expression levels were positively correlated with mRNA expression of tumor necrosis factor α and interleukin 10, respectively.ConclusionADA2 mRNA expression increased when MDMs were stimulated with MTB antigens alone. This partly indicates that pleural fluid ADA levels could increase in patients with culture-negative TPE. Our results may be helpful in improving the understanding of TPE pathogenesis.

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Tuberculous Pleurisy: An Update

Cited by 77 publications

References 62 publications

A diagnostic algorithm for tuberculous pleurisy using the ELISPOT assay on peripheral blood and pleural effusion

A diagnostic algorithm for tuberculous pleurisy using the ELISPOT assay on peripheral blood and pleural effusion

Loculated Tuberculous Pleural Effusion: Easily Identifiable and Clinically Useful Predictor of Positive Mycobacterial Culture from Pleural Fluid

Mycobacterium tuberculosisESAT6 and CPF10 Induce Adenosine Deaminase 2 mRNA Expression in Monocyte-Derived Macrophages

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