Cases Of Tuberculous Pleurisy Research Articles

Trend of the Tuberculous Pleurisy Notification Rate in Eastern China During 2017-2021: Spatiotemporal Analysis.

Tuberculous pleurisy (TP) presents a serious allergic reaction in the pleura caused by Mycobacterium tuberculosis; however, few studies have described its spatial epidemiological characteristics in eastern China. This study aimed to determine the epidemiological distribution of TP and predict its further development in Zhejiang Province. Data on all notified cases of TP in Zhejiang Province, China, from 2017 to 2021 were collected from the existing tuberculosis information management system. Analyses, including spatial autocorrelation and spatial-temporal scan analysis, were performed to identify hot spots and clusters, respectively. The prediction of TP prevalence was performed using the seasonal autoregressive integrated moving average (SARIMA), Holt-Winters exponential smoothing, and Prophet models using R (The R Foundation) and Python (Python Software Foundation). The average notification rate of TP in Zhejiang Province was 7.06 cases per 100,000 population, peaking in the summer. The male-to-female ratio was 2.18:1. In terms of geographical distribution, clusters of cases were observed in the western part of Zhejiang Province, including parts of Hangzhou, Quzhou, Jinhua, Lishui, Wenzhou, and Taizhou city. Spatial-temporal analysis identified 1 most likely cluster and 4 secondary clusters. The Holt-Winters model outperformed the SARIMA and Prophet models in predicting the trend in TP prevalence. The western region of Zhejiang Province had the highest risk of TP. Comprehensive interventions, such as chest x-ray screening and symptom screening, should be reinforced to improve early identification. Additionally, a more systematic assessment of the prevalence trend of TP should include more predictors.

The incidence of tuberculous pleurisy in mainland China from 2005 to 2018.

Currently, tuberculous pleurisy (TP) remains a serious problem affecting global public health, including in China. Our purpose was to comprehensively understand and identify the incidence of TP in mainland China between 2005 and 2018. The data on registered TP cases from 2005 to 2018 were acquired from the National Tuberculosis Information Management System. We analyzed the demographics, epidemiology, and time-space distribution of TP patients. Then, the effects of potentially influential factors on TP incidences, such as medical expenses per capita, GDP per capita, and population density, were assessed using the Spearman correlation coefficient. The incidence of TP increased in mainland China from 2005 to 2018, with a mean incidence of 2.5 per 100,000 population. Interestingly, spring was the peak season for TP, with more notified cases. Tibet, Beijing, Xinjiang, and Inner Mongolia had the highest mean annual incidence. A moderate positive relationship was found between TP incidence, medical expenses per capita, and GDP per capita. The notified incidence of TP had an elevated trend from 2005 to 2018 in mainland China. The findings of this study provide insight into the knowledge of TP epidemiology in the country, which can help optimize resource allocation to reduce the TP burden.

Beware of Pleural Thickening and Calcification: An Enlightenment from a Case of Tuberculous Pleurisy

Tuberculous pleurisy, a type of extra-pulmonary tuberculosis, is the pleural inflammation caused by hypersensitive response of the pleural cavity stimulated by mycobacterium tuberculosis and its metabolites. If the patient does not receive timely and effective treatment and intervention, a large amount of fibrin will be deposited which will cause pleural thickening, adhesions, and even calcification. At present, clinical cases of typical pleural thickening and calcification have been rarely reported. In this paper, we will report a case of significant pleural thickening and calcification caused by tuberculous pleurisy; moreover, the patient earliest got tuberculous pleurisy about in 20 years ago and had received anti-tuberculous treatment at that time. The patient’s typical crescent-shaped shadow created by pleural thickening and calcification is very rare in the domestic and international literature.

Diagnostic Accuracy of Pleural Effusion Mononuclear Cells/Leukocyte Ratio in Tuberculous Pleurisy.

Background: Tuberculous pleurisy (TBP) is a common clinical type of tuberculosis (TB) in China. TBP is difficult to diagnose. Whether the mononuclear cell/leukocyte (MNC/LEU) ratio in pleural effusion can contribute to accurate TBP diagnosis remains yet unclear.Objective: To explore the diagnostic value of MNC/LEU ratio in pleural effusion for TBP in China.Methods: This study was a retrospective case-control study involving 406 patients with pleural effusion of unknown cause who were hospitalized at the Henan Provincial People's Hospital. Using histopathological examination of thoracoscopic pleural biopsy as the gold standard for TBP diagnosis, a final total of 215 subjects were included in this study including 91 cases of TBP and 124 cases of non-TBP. The receiver operating characteristic (ROC) curve of pleural effusion MNC/LEU ratio for TBP diagnosis was plotted and the area under curve (AUC) and the optimal cutoff value were determined. In addition, the sensitivity, specificity and accuracy of the MNC/LEU ratio at the optimal cutoff value for TBP diagnosis were also evaluated.Results: The MNC/LEU ratio was significantly higher in TB pleural effusion [95.9% (89.7–98.0%)] than in non-TB pleural effusion [77.8% (39.3–93.2%)] (P < 0.001). The AUC was 0.776 (95% CI, 0.714–0.830), and the sensitivity, specificity and accuracy for TBP diagnosis at the 93.7% cutoff value were 64.83%, 79.03%, and 0.730, respectively.Conclusion: The pleural effusion MNC/LEU ratio may be a new and valuable laboratory indicator for the diagnosis of tuberculous pleurisy in China.

Diagnostic efficacy of clinical decision tree and integral model in tuberculous pleurisy

Objective To explore the diagnostic efficacy of clinical decision tree and integral model in tuberculous pleurisy. Methods A prospective randomized controlled study was conducted in patients with pleural effusion admitted to Wuhan Pulmonary Hospital from January 1 to June 30, 2019. Patients with pleural effusion were randomly enrolled into the clinical decision tree group and the integral model group. Two kinds of comprehensive diagnosis models were used for diagnosis, and the diagnostic efficacy of the two methods was compared. Results The clinical decision tree group included 127 patients, 90 male, 37 female, 18–88 years old, with an average age of (49.33±19.63) years. Finally, 108 cases of tuberculous pleurisy and 19 cases of non tuberculous pleurisy were diagnosed. In the integral model group, 120 patients were included, including 89 males and 31 females, 13-84 years old, with an average age of (46.41±20.01) years. 94 cases of tuberculous pleurisy and 26 cases of non tuberculous pleurisy were finally diagnosed. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of clinical decision tree method were 57.4%, 78.9%, 93.9%, 24.6% and 60.6% respectively; and of integral model method were 75.5%, 96.2%, 98.6%, 52.1% and 80.0% respectively. Conclusion The sensitivity, specificity and accuracy of the integral model method in the diagnosis of tuberculous pleurisy were higher than that of the clinical decision tree method. The method is simple and can be widely used in the clinical diagnosis of tuberculous pleurisy. 摘要：目的 探讨临床决策树法与积分模型法对结核性胸膜炎的诊断效能。 方法 采用前瞻性随机对照研究方 法, 以2019年1月1日一2019年6月30日武汉市肺科医院收治的胸腔积液患者为研究对象。符合人组标准的胸腔积液 患者随机人组临床决策树法组和积分模型法组, 分别采用两种综合诊断模型进行诊断, 对比两组方法的诊断效能。 结果 临床决策树组共纳人127例患者, 其中男性90例, 女性37例, 年龄18~88岁, 平均(49.33±19.63)岁, 最后诊断结 核性胸膜炎108例, 非结核性胸膜炎19例；积分模型组共纳人120例患者, 其中男性89例, 女性31例, 年龄13 ~ 84岁, 平均(46.41±20.01)岁 , 最后诊断结核性胸膜炎94例 , 非结核性胸膜炎26例。临床决策树法诊断结核性胸膜炎的敏感 度57.4%, 特异度78.9%, 阳性预测值93.9%, 阴性预测值24.6%, 诊断准确率60.6%;积分模型法诊断结核性胸膜炎的敏 感度75.5%, 特异度96.2%, 阳性预测值98.6%, 阴性预测值52.1%, 诊断准确率80.0%。 结论 积分模型法诊断结核性胸 膜炎敏感度、特异度及诊断准确率均髙于临床决策树法, 方法简单, 可推广应用于结核性胸膜炎的临床诊断

Improved early diagnosis of difficult cases of tuberculous pleural effusion by combination of thoracoscopy with immunological tests

IntroductionAlthough pleural effusion is a common clinical manifestation, the differential diagnosis of the cause of pleural effusion is often challenging, especially in the early differentiation of tuberculous pleurisy (TP) from other pleural effusion. The aim of this study was to evaluate the performance of commonly used laboratory tests for the early diagnosis of difficult cases of pleural effusion. MethodsPatients with undiagnosed pleural effusion were enrolled and subjected to five laboratory tests including thoracoscopy, pleural fluid adenosine deaminase assay (ADA), serum tuberculosis antibody test (TB-antibody), tuberculin skin test (TST), and T-SPOT.TB assay. The diagnosis of TP was established based on pleural histology and mycobacterial culture. The different tests were compared for diagnostic performance. ResultsA total of 106 patients were enrolled; their mean age was 53 years and 70.8% were male. Seventy-two (68%) of them were confirmed to have TP. When used individually, the five laboratory tests showed highly variable performance parameters, including sensitivity ranging from 46% to 92% and specificity ranging from 33% to 82%. When used in different combinations, thoracoscopy combined with TST or TB-antibody showed the optimal performance parameters, with a sensitivity of 80.8% and a specificity of 85.7%. ConclusionsThe results of this study suggest that the combination of thoracoscopy with TST or TB-antibody test is the best choice for the early diagnosis of difficult cases of TP in high TB burden countries.

Gene Xpert MTB / RIF – Diagnostic Role in Tuberculous Pleurisy

&lt;p&gt;&lt;strong&gt;Abstract&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tuberculous pleurisy is a common extrapulmonary manifestation and is second to tuberculous lymphadenitis. Due to its paucibacillary in origin, its diagnosis is a challenge. Furthermore, it is also complicated by the emergence of MDR. Gene Xpert MTB/RIF is a new rapid promising innovation for the detection of mycobacterium tuberculosis and its resistance to Rifampicin, giving result within two hours.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the diagnostic role of Gene Xpert MTB/RIF in suspected cases of tuberculous pleurisy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study Design: &lt;/strong&gt;Cross sectional study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study Setting: &lt;/strong&gt;Institute of Chest Medicine Mayo Hospital – a Tertiary Care Hospital affiliated with King Edward Medical University, Lahore.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methodology: &lt;/strong&gt;The study group, one hundred (M-60 and F-40) cases having exudative, predominantly lymphocytic pleural effusion with strong suspicion of tuberculous in origin were enrolled randomly for Gene Xpert MTB / RIF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among one hundred study cases, Gene Xpert detected mycobacterium tuberculosis in 12(12%) cases [M-8 (13.3%) and F-4 (10%)]. Resistance to Rifampacin was detected in 6 (6%) cases [M-2 (3.3%) and F-4 (10%)].&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Gene Xpert MTB/RIF is a useful new rapid promising technique to diagnose tuberculous pleurisy. Although at present it has limited availability and utility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key Words: &lt;/strong&gt;Gene Xpert. MTB – Mycobacterium tuberculosis. RIF – Rifampacin. TB – Tuberculosis. MDR – Multidrug resistance.&lt;/p&gt;

Clinical analysis of 113 cases of tuberculous pleurisy in children

Objective To investigate the clinical characteristics of tuberculous pleurisy(TP) in children in order to provide a good solution to the diagnosis and treatment of this disease. Methods Retrospective analysis was performed on the clinical data of 113 cases confirmed with TP who were admitted to Children's Hospital of Chongqing Me-dical University from January 2009 to December 2014. Results Among the 113 pediatric inpatients with TP, 85 cases (75.2%) were sick for less than 1 month; 92.9%(105/113 cases) age ≥5 years old by onset; and 21.2%(24/113 cases) patients demonstrated the contact with tuberculosis, among whom 70.8%(17/24 cases) attributed to linear relatives.The primary clinical manifestations included fever[96.5%(109/113 cases)], cough[76.1%(86/113 cases)] and chest pain[38.9%(44/113 cases)], with as high as 89.0%(87/109 cases) of the patients experiencing moderate or ardent fever.The positive rates of acid-fast bacilli smear and mycobacterium tuberculosis culture were 12.2%(17/139 cases) and 22.7%(15/66 cases), respectively; among the 41 patients who received pleural biopsy, 40 cases (97.6%) were identified with the typical pathological changes in tuberculosis; and all 11 patients who received acid fast stain test on pleural tissues were positive to the test.Pulmonary parenchymatous lesions were revealed on CT examination in 89.1% patients(98/113 cases), 82.4%(90/109 cases) of the patients had normal body temperature within a short period, and reduced effusion was revealed in 86 out of 98 patients who received repeated chest imaging examinations. Conclusions TP in children has acute onset typically, and the diagnosis of TP in children is more difficult than in adults, requiring considering multiple factors.Contact history with tubercular patients, etiological examination, pleural biopsy and chest CT are essential for the diagnosis of this disease. Key words: Tuberculous pleurisy; Clinical characteristics; Child

Clinical analysis of thoracoscopy of 30 coalworker's pneumoconiosiswith pleural effusion cases

To investigate the diagnostic value of thoracoscopy on idiopathic coalworker's pneumoconiosis with pleural effusion in general medicine. Routine (general medicine) thoracoscopyof patients suffering from iIdiopathiccoalworker's pneumoconiosis with pleural effusion, pathological examination of lesions obtained (direct vision). Pathological examination revealed grayish-white miliary nodules with multiple protruding nodules, irregular focal pleura thickening, pulmonary congestion, edema, fibrous adhesion. Thorascopy produced a diagnostic rate of 93.3%. Confirmed cases includes 13 cases of tuberculous pleurisy, 11 cases of malignant pleural effusion, 4 cases of cardiac insufficiency with pleural effusion and 2 cases of idiopathic pleural effusion, with no serious complications. Thoracoscopy of idiopathic coalworker's pneumoconiosis with pleural effusion is a safe, accurate diagnostic methodin general medicine, and could benefit the establishment of a treatment method quickly, visual observation of the lesions of patients suffering from coalworker's pneumoconiosis with pleural effusion using thoracoscopy, and at the same time offer preliminary investigationof the correlation between the intensity and compactibilityof coal macule distribution and clinical stages of coalworker's Pneumoconiosis.

Clinical value of pleural biopsy in the etiological diagnosis of children with pleurisy

To investigate the clinical value of pleural biopsy in the etiological diagnosis of pleurisy in children. Totally 213 cases with pleurisy, who underwent pleural biopsy and hospitalized in Children's Hospital of Chongqing Medical University from January 2007 to April 2014 were enrolled into this study. Clinical symptoms, imaging manifestations, pleural fluid characteristics, the results of pleural biopsy and postoperative complications were retrospectively analyzed to evaluate the clinical value and security of pleural biopsy in making the etiological diagnosis of pleurisy. (1) Of the 213 cases, 144 were boys and 69 were girls, their mean age was (6. 5 ± 4. 1) years. (2) Two hundred and thirteen patients had a surgical pleural biopsy under general anesthesia, the cause of 97 cases (45. 5%) were made clear by histopathological examination, including 35 purulent pleurisy, 55 tuberculous pleurisy and 7 paragonimus infection. For the remaining 83 (41. 3%) cases a final diagnosis was made based on the full analysis of clinical data, including 63 cases of purulent pleurisy, 3 cases of tuberculous pleurisy and 17 cases of paragonimiasis pleurisy but for 33 patients no exact cause was found at the end. (3) The mean operating time of the biopsy was (1. 4 ± 0. 6) hours. Seventy one (33. 3%) patients required blood transfusion during or after the operation. Thirty one (14. 6%) cases used the ventilator after surgery, and the ventilator supporting time was (6. 6 ± 5. 8) hours on average. The wound healing reached grade A in 200 cases (93. 9%), grade B in 13 cases (14. 6%). Postoperative complications included pneumothorax in 92 cases (43. 2%), subcutaneous emphysema in 18 cases (8. 5%), bronchopleural fistula in 3 cases(1. 4%). The average days of hospitalization was (17. 7 ± 7. 1) d. Pleural biopsy is of great diagnostic value in the etiological diagnosis and differential diagnosis of pleurisy in children, and it is considered reasonable to be used in the clinical practice when appropriate.

Pediatric Tubercular Empyema Thoracis: A Diagnostic Dilemma

Empyema thoracis is defined as the collection of pus in the pleural cavity. Mycobacterium tuberculosis as an etiological agent accounts for only 2% of the tuberculous pleurisy cases. History of contact and absence of Bacillus Calmette-Guerin(BCG) vaccination scar are usually seen. We are hereby reporting, a 4 year old male child with left sided tuberculous empyema who had been adequately immunized. There was no history of tuberculosis in the family, past infection or contact with an adult case.Our case was managed conservatively with a favourable outcome.

The clinical investigation of so-called "pleural tuberculoma" in the last 3 years

We have investigated on the clinical features of pleural nodular lesions which have appeared during chemotherapy of tuberculous pleurisy. Such lesions were observed in more than 10% of the cases of tuberculous pleurisy. This type of lesion occurred more frequently in the pleurisy patients whose chest X-ray did not show any tuberculous lesion in lung field and whose sputum was negative of tubercle bacilli. Most of the patients with such lesion were young. From these results, it was suggested that such lesion might develop during the course of primary tuberculosis. Single nodular lesion was more common but multiple nodular lesions were not rare. They had occurred in 2-4 months after the start of anti-tuberculous chemotherapy including RFP, usually accompanied with chest pain. They had disappeared within 6-12 months without any additional therapy. In summary, pleural nodular lesions, which occurred during chemotherapy of tuberculous pleurisy, were not rare, but the clinical course and prognosis of such lesion were favourable and improved without any additional therapy. The etiology of such lesion has remained to be clarified.

Trace Elements Analysis of Urine and Hair in Tuberculous Pleurisy

In this study, copper, zinc, magnesium, manganese, selenium, and iron of urine and hair were measured in the patients with tuberculous (TB) pleurisy (n = 24) and in the control group (n = 20). Selenium, magnesium, and zinc of hair were found to be significantly lower in TB pleurisy cases than those in the control group (p < 0.05, p < 0.001, and p < 0.01, respectively). On the contrary, selenium and magnesium of urine were found to be significantly elevated in TB pleurisy cases than those in the control group (p < 0.05 and p < 0.001, respectively). There was no significant difference in the value of manganese and iron between TB pleurisy and the control group (p > 0.05). Copper level were significantly increased in hair and decreased in urine of the patients (p < 0.01). The occurrence of these abnormalities constitutes new information regarding trace elements in TB pleurisy patients. These results may provide an additional disease correlate for assessing TB pleurisy risk.

Tuberculous pleurisy: High adenosine deaminase level in cold abscess content

Introduction: Tuberculous pleurisy is one of the most common form of extrapulmonary tuberculosis (TB). Measurement of adenosine deaminase (ADA) level in the effusions is advocated to have a high diagnostic yield in the diagnosis of tuberculous pleurisy as well as pericardial and peritoneal effusions due to TB. The diagnostic yield of ADA measurement in other materials such as abscess content has never been published before. Case report: In this report we present a case of tuberculous pleurisy in whom ADA level in the pleural fluid was not higher than expected while it was very high in the drained material of cold abscess due to TB. Conclusion: To the best of our knowledge this is the first case study reporting the measurement of ADA in the content of a cold abscess due to TB. In conclusion, we suggest that ADA measurement in all kinds of liquid or caseous material other than effusions may have a diagnostic role in TB.

Serum Trace Element Levels in Tuberculous Pleurisy

In this study, copper, zinc, magnesium, manganese, selenium, and iron were measured by inductively coupled plasma atomic emission spectrophotometry in patients with tuberculous (TB) pleurisy (n = 24) and in the control group (n = 20). Selenium, magnesium, and zinc were found to be significantly lower in TB pleurisy cases than those in the control group (p < 0.01, p < 0.001, and p < 0.001, respectively). There was no significant difference in the value of manganese and iron between TB pleurisy and the control group (p > 0.05). Copper levels were significantly increased in the serum of the patients (p < 0.0001). These results may provide an additional disease correlate for assessing TB pleurisy risk.

Differential Diagnosis of Tuberculous and Malignant Pleural Effusions: What is the Role of Adenosine Deaminase?

The objective of this study was to evaluate the utility of invasive and noninvasive diagnostic procedures in tuberculous pleurisy (TPE) in an area with intermediate incidence of tuberculosis. The aim was to determine the cutoff value for adenosine deaminase (ADA) and the sensitivity and specificity of ADA and evaluate pleural fluid cytology and pleural biopsy in the differential diagnosis of malignant and tuberculous pleurisy. The study included 121 patients. TPE was confirmed in 54 patients and malignant effusion in 67 patients. Criteria used for TPE diagnosis were positive cultures of effusion or biopsy specimen, tuberculous granulomas, or positive sputum cultures without other explanation for pleural effusion. Malignancy was diagnosed by either cytology or biopsy. The cutoff value of ADA in TPE was 49 U/L, sensitivity was 89.2%, specificity was 70.4%, positive predictive value (PPV) was 84.4%, and negative predictive value (NPV) was 78.4%. ADA activity below 16 U/L suggests that TPE is highly unlikely with sensitivity=38.5%, specificity=100%, PPV=100%, and NPV=57.4%. ADA effusion/serum ratio reached a cutoff in TPE of 1.7 (sensitivity=84.6%, specificity=72.2%, PPV=81.4%, NPV=71.4%). Sensitivity, specificity, PPV, and NPV of cytology evaluation for TPE are 72.2%, 70.1%, 66.1%, and 75.8%, respectively. Pleuroscopy-guided pleural biopsy had sensitivity=66.7%, specificity=100%, PPV=100%, and NPV=78.8%. In 27.8% of TPE cases, pleural fluid cultures were positive. There is no doubt that pleuroscopy-guided biopsy is of great value for TPE diagnosis; however, sensitivity and specificity of noninvasive tests, especially ADA, can help to distinguish between TB and malignancy.

High risk of tuberculosis in systemic lupus erythematosus?

The incidence and severity of tuberculosis (TB) in patients with systemic lupus erythematosus (SLE) varies greatly among different series. In addition, prospective data are scarce. The aim of this study is to analyse the frequency and severity of TB in our cohort of lupus patients. We analysed data from a prospective database of a single center cohort of 232 patients with SLE (ACR criteria). Prophylaxis with isoniazid was not regularly administered. We identified all cases of TB diagnosed during 10 years (January 1994 to December 2003). The following variables were analysed: annual incidence of TB, location of infection and response to therapy. Data from published series reporting on the incidence of TB among SLE patients were extracted. Three patients (1.3%) suffered clinically manifest TB in 1603 patient-years of follow-up, resulting in an incidence of 187 cases/100,000 patient-years (95% CI 39-547). The pooled annual incidence of TB infection in our area during this period was 30/100,000 individuals. We recorded two cases of pulmonary TB and one case of tuberculous pleurisy. All patients had good response to therapy. The annual incidence of TB among SLE patients in other series, most of them from developing countries, varied between 150/100,000 patients in Turkey and 2450/100,000 patients in India. Of note, high prevalence of extrapulmonary forms as well as elevated TB-associated mortality was reported in most series. TB was more frequent in SLE patients than expected in the general population. We did not see any cases of disseminated infection and all patients had good response to treatment. Our data compare favourably in terms of incidence, severity and outcome with those from highly endemic areas.

Diagnostic Utility of MAGE Expression in Exudative Pleural Effusion

Background : In recent years, numerous human tumor specific antigens such as melanoma antigen gene(MAGE) that is recognized by autologous cytotoxic T lymphocytes have been identified. MAGE is expressed in many human malignancies in various organs, such as lung, breast, stomach, esophagus and leukemia. Therefore MAGE has been studied widely for tumor diagnosis and immunotherapy. But, so far there were no clinical studies evaluating the role of MAGE in pleural effusion. We investigated the expression of MAGE in the patients with exudative pleural effusion for it's diagnostic utility and the results were compared with those of cytologic examinations. Methods : Diagnostic thoracentesis was performed in 44 consecutive patients with exudative pleural effusion during 6 months. We examined the expression of MAGE and cytology with the obtained pleural effusion. Expression of MAGE was interpreted by means of a commercial kit using RT-PCR method. Enrolled patients were divided into two groups such as malignant and benign and we analyzed its' sensitivity and specificity. Results : There were no significant differences between two groups in age, sex, white blood cell counts in pleural fluid, pleural fluid/serum protein ratio and pleural fluid/serum LDH ratio. The sensitivity and specificity of MAGE were 72.2% and 96.2% respectively and the positive predictive value and negative predictive value of MAGE were also 92.9% and 83.3% respectively. The sensitivity and negative predictive value of cytologic examinations were 66.7% and 81.3% respectively. There were no significant differences between sensitivities of MAGE and cytologic examinations but false positive result of MAGE was found in 1 case of tuberculous pleurisy. Conclusion : MAGE is a sensitive and specific marker for the differential diagnosis between benign and malignant effusion in patients with exudative pleural effusion. And MAGE would provide the equal sensitivity compared with that of cytologic examination in patients with malignant pleural effusion if 5mL of the pleural fluid is examined.

The value of pleural fluid anti-A60 IgM in BCG-vaccinated tuberculous pleurisy patients

Objectives To determine if detection of IgM and IgG antibodies against mycobacterial antigen A60, together with the Mantoux tuberculin skin test (TST), could be used in the diagnosis of tuberculous pleurisy (TP) in BCG-vaccinated cases.Methods We investigated 125 BCG-vaccinated patients with pleural effusion. Of these, 88 had TP and 37 had non-tuberculous pleurisy (NTP). TST and anti-A60 IgM and IgG measurements by ELISA were performed in the sera and pleural effusions of both groups.Results Cut-off values, in optical density, for serum anti-A60 IgM, pleural fluid anti-A60 IgM, serum anti-A60 IgG and pleural fluid anti-A60 IgG were defined as 0.624, 0.614, 0.464, and 0.613, respectively. TP patients had higher IgG and IgM levels in the serum (P < 0.001 and P < 0.05, respectively) and pleural effusion (P < 0.001 and P < 0.001, respectively). Regardless of the diagnosis, IgG and IgM levels were higher in the sera (P < 0.001 and P < 0.05, respectively) and pleural effusions (P < 0.001 and P < 0.001, respectively) of TST-positive cases, and serum and pleural fluid IgM levels were higher (P < 0.001 and P < 0.001, respectively) in the TST-positive TP cases. Sensitivity and specificity of TST were 65% and 68%, respectively. As a single parameter, pleural fluid anti-A60 IgM had the highest sensitivity (77%) and specificity (94%) in patients with negative TST.Conclusion We suggest that in populations where tuberculosis prevalence is high and BCG vaccination is common, pleural fluid anti-A60 IgM can facilitate the diagnosis of TP.

Diagnosis of Tuberculous Pleurisy Using the Biologic Parameters Adenosine Deaminase, Lysozyme, and Interferon Gamma

We compared the parameters pleural adenosine deaminase (PADA, determined in 405 patients), the PADA/serum ADA ratio (P/SADA; 276 cases), pleural lysozyme (PLYS, 276 cases), the PLYS/serum LYS ratio (P/SLYS; 276 cases), and pleural interferon gamma (IFN, 145 cases) regarding their ability to differentiate tuberculous pleural effusions from others. The 405 pleural effusions were classified by previously established criteria as tuberculous (91), neoplastic (110), parapneumonic (58), empyemas (10), transudates (88), or miscellaneous (48). The intermean differences between the tuberculous group and each of the others were statistically significant for all five parameters (p < 0.01 for PLYS and P/SLYS with respect to the empyema group; p < 0.001 otherwise), except for PADA and P/SADA with respect to the empyema group. All the tuberculous pleurisy cases had PADA values of 47 U/L or more, as compared to only 5 percent of the other cases (sensitivity, 100 percent; specificity, 95 percent). P/SADA was above 1.5 in 85.7 percent of tuberculous effusions and 11 percent of the others (sensitivity, 85.7 percent; specificity, 89 percent). PLYS, with a diagnostic threshold of 15 g/ml, had a sensitivity of 85.7 percent and a specificity of 61.6 percent; P/SLYS, with a threshold of 1.1, had a sensitivity of 67.3 percent and a specificity of 90.3 percent; and IFN, with a threshold of 140 pg/ml, had a sensitivity of 94.2 percent and a specificity of 91.8 percent. The lowest misclassification rate was achieved by PADA, with statistically significant differences (p < 0.001) with respect to P/SADA, PLYS, and P/SLYS, but not with respect to IFN. The only significant pairwise correlations among these parameters were between P/SLYS and PADA and between P/SLYS and P/SADA. We conclude that PADA and IFN are useful parameters for early diagnosis of tuberculous pleurisy, and that the other parameters considered have no advantages over PADA and IFN for this purpose (though the high specificity of P/SLYS may be noted).