Abstract
The T lymphocyte-mediated immune response to Mycobacterium tuberculosis infection in the parietal pleura of patients with tuberculous pleurisy is unknown. The aim of this study was to investigate the immune response in the parietal pleura of tuberculous pleurisy compared with nonspecific pleuritis. We have measured the numbers of inflammatory cells particularly T-cell subsets (Th1/Th2/Th17/Treg cells) in biopsies of parietal pleura obtained from 14 subjects with proven tuberculous pleurisy compared with a control group of 12 subjects with nonspecific pleuritis. The number of CD3+, CD4+ and CCR4+ cells and the expression of RORC2 mRNA were significantly increased in the tuberculous pleurisy patients compared with the nonspecific pleuritis subjects. The number of toluidine blue+ cells, tryptase+ cells and GATA-3+ cells was significantly decreased in the parietal pleura of patients with tuberculous pleurisy compared with the control group of nonspecific pleuritis subjects. Logistic regression with receiver operator characteristic (ROC) analysis for the three single markers was performed and showed a better performance for GATA-3 with a sensitivity of 75%, a specificity of 100% and an AUC of 0.88. There was no significant difference between the two groups of subjects in the number of CD8, CD68, neutrophil elastase, interferon (IFN)-γ, STAT4, T-bet, CCR5, CXCR3, CRTH2, STAT6 and FOXP3 positive cells. Elevated CD3, CD4, CCR4 and Th17 cells and decreased mast cells and GATA-3+ cells in the parietal pleura distinguish patients with untreated tuberculous pleurisy from those with nonspecific pleuritis.
Highlights
Tuberculosis is the second most important cause of death from infectious diseases in the world
Clinical and biological correlations There was no significant correlation, between other clinical and biological data, including age or gender of the patients. This is the first study providing a complete characterization of the inflammatory cell infiltrate in parietal pleural biopsies obtained from adult subjects from a non-endemic country, with a low prevalence of human immunodeficiency virus (HIV) infection, of untreated established Pleural Tuberculosis (PLTB) compared with a control group of non specific pleuritis (NSP)
PLTB patients have significantly increased numbers of CD3+ and CD4+ lymphocytes in their parietal pleura compared with NSP subjects in accordance with previous human and animal data [6]
Summary
Tuberculosis is the second most important cause of death from infectious diseases in the world. From 1990–2003, the incidence of tuberculosis increased globally and currently more than one third of the world’s population is infected with Mycobacterium tuberculosis [1]. Pleural Tuberculosis (PLTB) results from M.tuberculosis infection of the pleura and can be associated with pulmonary tuberculosis [2]. The human immunodeficiency virus (HIV) pandemic has been associated with a doubling of the incidence of extrapulmonary tuberculosis, which has resulted in increased recognition of PLTB even in developed countries [4]. PLTB diagnosis depends on demonstration of M.tuberculosis in sputum, pleural fluid or pleural biopsy specimens [2,4]. A thoracoscopic biopsy of parietal pleura is the most sensitive diagnostic test. Histological examination of pleural biopsy may demonstrate granulomatous inflammation, caseous necrosis and/or acid-fast bacilli [4]. Non specific pleuritis (NSP) is characterized by chronic inflammation and deposits of fibrin in the subpleural compartment [5]
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