Cases Of Tuberculous Effusion Research Articles

STUDY OF EXUDATIVE PLEURAL EFFUSION IN THE AGE GROUP OF 15-40 YEARS WITH SPECIAL REFERENCE TO ADENOSINE DEAMINASE AND TUBERCULIN SKIN TEST IN THE DIAGNOSIS OF TUBERCULOUS ETIOLOGY

Background: A tubercular pleural effusion can either be a sequel to a primary infection acquired 3 to 6 month previously or represent reactivation tuberculousis.
 Two different pathogenic mechanism can lead to tuberculous pleural effusion. By far the more common is the entry of only a few M. tuberculosis into the pleural space; in the presence of specific cell mediated immunity, tubercle bacilli provoke an intense hypersensitivity reaction and outpouring of fluid. Chest radiograph may or may not reveal associated parenchymal involvement. In the second variety, a subpleural caseous focus or cavity rupture into the pleural space and results in a pleural effusion. In this case chest radiograph nearly always shows parenchymal abnormalities.
 A definitive diagnosis of TBPE can be difficult to make because of the low sensitivity and / or specificity of noninvasive traditional diagnostic tools.
 In most series of patients with TBPE the result of pleural fluid staining for acid fast bacilli are virtually always negative and pleural fluid cultures are positive for mycobacteria in <35% of cases. Without underlying lung parenchymal lesion sputum examination may be positive in 4% to 11% of patient with TBPE. On the other hand, pleural biopsy specimen will demonstrate granulomatous pleuritis in 50% to 80% of patients.
 This study was taken whether pleural fluid ADA and tuberculin skin test has any role in the diagnosis of tubercular pleural effusion.
 Methods and Materials: In the present study 120 cases of exudative pleural effusion in the age group of 15-40 years of varying etiology are taken who attended the pulmonary medicine department of Burdwan Medical College and Hospital.
 The study was conducted the period of March 2017 to February 2018 apart from relevant history taking a detail clinical examination, full investigation were done to reach a complete and final diagnosis.
 Result: In our study 120 patient of aged 15-40 years were taken. Different aetiological groups and there frequency as diagnosed by various mean were Tuberculous – 85%, Paraneumonic effusion – 10 %, Malignant effusion – 10%.
 There was male preponderance in all groups of pleural effusion. History of contact was present in 34 % cases of tuberculous effusion. Sputum for AFB was found 10.78% cases of tuberculous effusion. These patients also had pulmonary lesions. 80.39% cases of tuberculous effusion had pale yellow coloured effusion but 13.72 % cases had haemorrhagic fluid. 66.66% malignant effusion had haemorrhagic fluid and 33.37% of malignant effusion had pale yellow coloured fluid. Pleural fluid for malignant cell was positively 66.67% of malignant effusion. Pleural fluid for Z-N stain detect 1.96% cases tubercle bacilli in TBPE group. Plural biopsy was found positive in 68.18% cases of TBPE and 60% cases of MPE.
 Pleural fluid ADA level was significantly higher (P<0.001) in patients of tuberculous effusion than non-tuberculous effusion. Taking a cut off value of 70 U/L sensitivity and specificity is 95.09% and 33.33%. But when parapneumonic effusion was excluded, the specificity increases. Lymphocytic pleural effusion below the age group of 40 years with cut off value of ADA <40 U/L can be used as a screening test for malignant effusion.
 In TBPE tuberculin skin test was positive in 74.50% cases. Taking a cut off value of 10 mm or more induration of tuberculin skin test, "P" value is less than 0.001. Sensitivity and specificity of tuberculin skin test in tuberculous pleural effusion is 74.50% and 50%.
 If we compare the efficacy of ADA > 70 U/L and tuberculin skin test positivity to diagnose tuberculous pleural effusion the former is superior statistically to the later (P value is less than 0.01) specificity of tuberculin skin test is low because it may be positive with infection with NTM and prior BCG vaccination.
 Conclusion: Maximum incidence of tuberculous pleural effusion occurs in the age group of 20-30 years. Malignant pleural effusion is less likely below the age group of 30 years.
 Increased ADA level >70 U/L in pleural fluid is a sensitive, minimally invasive, cost effective, easy method for diagnosis of tuberculous pleural effusion.
 Lower level of pleural fluid ADA level (<40 U /L) is a sensitive, specific, minimally invasive, cost effective easy method for suspecting malignant effusion. Its value is much more important when younger patients (<40 years of age) present with malignant effusion, especially so when the pleural fluid is also appeared pale yellow. A low ADA level will guide us to look for malignancy in this age group.
 Tuberculin skin testing with intermediate strength PPD has a high sensitivity in patients with pleural tuberculosis. It was seen negative in 1/3rd cases of TBPE. This negative tuberculin skin test in TBPE may be due to recent tuberculous infection or may be due to sequestration of PPD reactive T-lymphocytes in the pleural space or patient may be anergic. Our study is insufficient to comment this negative result. More precise study need to comment.

CORRELATING BIOCHEMICAL, RADIOLOGICAL AND CYTOLOGICAL OUTCOMES OF PLEURAL EFFUSION

Introduction: The research emphasises on the association bond of correlation of biochemical radiological and cytological outcomes of pleural effusion
 Material and Methods: The samples for the study were collected from the diagnostic centre, out-patient department and in-patient department of Department of Biochemistry, Internal Medicine, Respiratory Medicine at Rabindranath Tagore Medical College, Udaipur, Rajasthan The research was carried out on a total of 100 patients .The observations took about a year’s time. The research was carried out on a total of 100 patients,
 Results: 100 patients with pleural effusion were studied of which 60.00% were cases of tuberculous effusion and 40.00% were cases of non tuberculous effusion. This was reflective of the high prevalence of tuberculosis in the area being studied. The remaining 40 cases were of malignant effusion (15 cases), Transudative effusion (13 cases), synpneumonic effusion (8 cases) and 4 cases of empyema.. In patients of age more than 40 years, malignant effusion was more common; It was found more common in lower socioeconomic class such people live in crowded, unhygienic conditions. The commonest symptoms were cough (81.32%) and breathlessness (78.76%), followed by fever 69.20%, weight loss 64.64%, chest pain 45.50%, loss of appetite 63.30% and hemoptysis 15.80%.
 Conclusion: Thus it can be concluded that ADA is elevated in tubercular pleural effusion. Exudatives had decreased glucose but increased protein, LDH and cholesterol compared to transudatives Pleural fluid cytology revealed elevated Lymphocytes in tubercular and polymorphs in acute infections
 Keywords: Lactate dehydrogenase, Adenosine Deaminase biochemical, radiological and cytological outcomes of pleural effusion

Osteopontin and C-reactive protein in Egyptian patients affected with tuberculous and malignant pleural effusion

The first step in the evaluation of patients with pleural effusion is to determine whether the effusion is a transudate or an exudate. Osteopontin (OPN) is a pleiotropic integrin-binding protein with many functions. We assessed pleural effusion and serum concentrations of OPN and C-reactive protein (CRP) in patients with different types of pleural effusions. The current study comprised three groups: 20 patients with transudative effusion, 30 patients with malignant effusion and 30 patients with tuberculous effusion. OPN was analysed using a commercially available enzyme-linked immunosorbent assay kit. OPN effusion values were significantly higher in exudates (both malignant and tuberculous effusion cases) compared with transudative effusion. Also when compared separately, patients with tuberculous effusion and those with malignant effusion had a significantly higher fluid and OPN effusion/serum ratio than those with transudative effusion. Patients with tuberculous effusion had a significantly higher serum CRP effusion and effusion/serum ratio of CRP than those with malignant or transudative effusion. OPN is significantly increased in exudative effusion compared with transudative ones. However, serum OPN and effusion/serum OPN ratio were not significantly different in patients with malignant from those with tuberculous effusions. The lack of difference in serum OPN and effusion/serum OPN ratio between patients with malignant and those with tuberculous effusion may be attributed to the heterogeneity of the malignant effusion group. Receiver-operating characteristic (ROC) curve analysis has shown that effusion/serum CRP ratio outperformed effusion/serum OPN ratio as a diagnostic marker for tuberculous pleural effusion.