Pleural Fluid Samples Research Articles

Pleural Infections: Antimicrobial Susceptibility Patterns of Bacterial Isolates and Associated Factors in Suspected Hospitalized Patients at Arba Minch General Hospital, Southern Ethiopia

Background: Pleural infection remains a clinical problem with high morbidity and mortality all over the world. Antimicrobial options are uncertain due to the lack of understanding of the bacteriology of pleural infection. Thus, the goal of this study was to determine bacteriological profiles, antimicrobial susceptibility patterns, and factors associated with pleural infection. Methods: An institution-based cross-sectional study was undertaken in Arba Minch General Hospital from 1 st January to 30 th November 2020. Socio-demographic, clinical, and behavioral data were collected using a pre-tested, structured questionnaire. Adducted amounts of pleural fluid samples were collected aseptically with sterile test tubes. Standard procedures were utilized for bacterial identification, and antimicrobial susceptibility testing was done using Kirby–Disk Bauer's diffusion method. Version 25 of the Statistical Package for the Social Sciences (SPSS) was used to analyze the data. The p-value of 0.05 was considered statistically significant. Results: A total of 152 hospitalized patients were enrolled in this study. The overall magnitude of bacterial pleural infection was 27.6%. The predominant bacteria isolated were Staphylococcus aureus with 34.9%, followed by Escherichia coli with 11.6%. Multidrug-resistant (MDR) isolates account for around 48.8% of all isolates, with Gram-positive bacterial isolates accounting for 71.4%. Methicillin-resistant was found in 26.7% and 33.3% of isolated Staphylococcus aureus (MRSA) and coagulase-negative staphylococci (CoNS), respectively. One isolate of Enterococcus spp. was found to be vancomycin-resistant. All isolated Streptococcus pneumoniae and Streptococcus pyogenes were susceptible to penicillin, erythromycin, cotrimoxazole, and vancomycin. Likewise, isolated Pseudomonas aeruginosa was susceptible to piperacillin. The pleural infection showed a statistically significant association with age group less than or equal to 25 years old (p<0.001), hospital admission for more than seven days (p<0.007), chest tube drainage (p<0.021), previous history of pneumonia (p<0.029) and habit of alcohol drinking (p<0.029). Conclusion: The overall rate of culture-confirmed pleural infection was high, and a considerable percentage of bacteria isolates showed increased resistant to routinely used antibiotics, indicating that more attention is needed to follow the spread and emergence of drug-resistant bacterial agents.

DESCRIPTION OF BACTERIAL AGENTS CAUSING INFECTION ISOLATED FROM PATIENT SAMPLES AT CAN THO UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL FROM JULY 2021 TO DECEMBER 2021

Background: Understanding the characteristics and prevalence of each bacterial agent in the survey of specimens can guide the development of research and treatment priorities for clinicians. Objectives: 1). To determine the positive culture rate from patient samples at Can Tho University of Medicine and Pharmacy Hospital from July 2021 to December 2021; 2). To determine the percentage of bacteria isolated from patient samples at Can Tho University of Medicine and Pharmacy Hospital from July 2021 to December 2021. Materials and methods: A cross-sectional descriptive study was conducted on patient samples. Bacterial agents causing infections were isolated and identified from patient samples. Results: After culturing all the samples for 6 months and defining the positive ones, we got the general positive rate was 38.35%, and the positive culture rate of pus samples was the highest (68.49%), while the positive culture rate of blood and pleural fluid samples was the lowest (with 5.24% and 3.22%, respectively). Among the isolates, S. aureus accounted for the highest rate (28.3%), S. pneumoniae (16.6%), Staphylococcus spp. (13.2%), Klebsiella spp. (12.1%), E. coli (9.4%), Pseudomonas aeruginosa (7.2%), Acinetobacter spp. (6%), Citrobacter spp. (3.8%), Stenotrophomonas maltophilia (0.8%), Enterobacter spp. (0.8%), and Burkholderia (0.4%); The gram-positive bacteria group predominated with the rate of 59%, 1.45 times higher than that of the gram-negative bacteria group (accounting for 41%); Gram-positive bacteria predominated in pus, sputum and other fluid specimens, while gram-negative bacteria predominate in urine specimens. Conclusion: The positive culture rate was 38.35%. Of all the bacteria isolated, Staphylococcus aureus accounted for the highest proportion (28.3%), in contrast, Burkholderia accounted for the lowest percentage (0.4%).

The Biological Role of Pleural Fluid PAI-1 and Sonographic Septations in Pleural Infection: Analysis of a Prospectively Collected Clinical Outcome Study.

Rationale: Sonographic septations are assumed to be important clinical predictors of outcome in pleural infection, but the evidence for this is sparse. The inflammatory and fibrinolysis-associated intrapleural pathway(s) leading to septation formation have not been studied in a large cohort of pleural fluid (PF) samples with confirmed pleural infection matched with ultrasound and clinical outcome data. Objectives: To assess the presence and severity of septations against baseline PF PAI-1 (Plasminogen-Activator Inhibitor-1) and other inflammatory and fibrinolysis-associated proteins as well as to correlate these with clinically important outcomes. Methods: We analyzed 214 pleural fluid samples from PILOT (Pleural Infection Longitudinal Outcome Study), a prospective observational pleural infection study, for inflammatory and fibrinolysis-associated proteins using the Luminex platform. Multivariate regression analyses were used to assess the association of pleural biological markers with septation presence and severity (on ultrasound) and clinical outcomes. Measurements and Main Results: PF PAI-1 was the only protein independently associated with septation presence (P < 0.001) and septation severity (P = 0.003). PF PAI-1 concentrations were associated with increased length of stay (P = 0.048) and increased 12-month mortality (P = 0.003). Sonographic septations alone had no relation to clinical outcomes. Conclusions: In a large and well-characterized cohort, this is the first study to associate pleural biological parameters with a validated sonographic septation outcome in pleural infection. PF PAI-1 is the first biomarker to demonstrate an independent association with mortality. Although PF PAI-1 plays an integral role in driving septation formation, septations themselves are not associated with clinically important outcomes. These novel findings now require prospective validation.

A RARE CASE OF ACTINOMYCES EMPYEMA

A RARE CASE OF ACTINOMYCES EMPYEMA

AFTERMATH OF AN INSIDIOUS SEVERE INFECTION: A CLINICAL CHALLENGE

AFTERMATH OF AN INSIDIOUS SEVERE INFECTION: A CLINICAL CHALLENGE

Bacteriological Profile and Resistance of Escherichia coli to Beta-lactam for Patients Consulted at Douala Laquintinie Hospital

Enterobacteriaceae are the most common causes of community-acquired and nosocomial infections. They are usually treated with beta-lactam antibiotics, i.e., penicillins, broad-spectrum cephalosporins, and carbapenems (Imipenem, meropenem, ertapenem). In order to evaluate the resistance profile of Escherichia coli (E. coli) to beta-lactam antibiotics, a 3-year retrospective study was carried out in the medical biology laboratory of the Laquintinie Hospital in Douala. The aim was to compare the behavior of Escherichia coli bacteria to penicillins, carbapenems, and cephalosporins. In order to achieve this objective, we used the results obtained from E. coli strains isolated from urine, cervico-vaginal fluid, puncture fluid, pleural fluid and pus samples. Identification was confirmed using the API 20 E Enterobacteriaceae system of biochemical testing and the VITEK 2 system. The VITEK 2 system was used to perform the antibiogram. Statistical analyses obtained from GraphPad Prim V 5.0 software allowed us to perform tests such as ANOVA, Kruskal-Wallis test, and Spearman correlations. Preliminary results show that E. coli bacteria are highly resistant to penicillins and significantly susceptible to cephalosporins of all generations if they are not ESBL (extended-spectrum beta-lactamases). Data on carbapenem behavior show less resistance and moderate susceptibility.

Metagenomic next-generation sequencing for the diagnosis of pulmonary aspergillosis in non-neutropenic patients: a retrospective study.

This study aimed to obtain further in-depth information on the value of metagenomic next-generation sequencing (mNGS) for diagnosing pulmonary aspergillosis in non-neutropenic patients. We did a retrospective study, in which 33 non-neutropenic patients were included, of which 12 were patients with pulmonary aspergillosis and 21 were diagnosed with non-pulmonary aspergillosis. Fungi and all other co-pathogens in bronchoalveolar lavage fluid (BALF) (27 cases), blood (6 cases), and/or pleural fluid (1 case) samples were analyzed using mNGS. One of the patients submitted both BALF and blood samples. We analyzed the clinical characteristics, laboratory tests, and radiologic features of pulmonary aspergillosis patients and compared the diagnostic accuracy, including sensitivity, specificity, positive predictive value, and negative predictive value of mNGS with conventional etiological methods and serum (1,3)-β-D-glucan. We also explored the efficacy of mNGS in detecting mixed infections and co-pathogens. We further reviewed modifications of antimicrobial therapy for patients with pulmonary aspergillosis according to the mNGS results. Finally, we compared the detection of Aspergillus in BALF and blood samples from three patients using mNGS. In non-neutropenic patients, immunocompromised conditions of non-pulmonary aspergillosis were far less prevalent than in patients with pulmonary aspergillosis. More patients with pulmonary aspergillosis received long-term systemic corticosteroids (50% vs. 14.3%, p < 0.05). Additionally, mNGS managed to reach a sensitivity of 91.7% for diagnosing pulmonary aspergillosis, which was significantly higher than that of conventional etiological methods (33.3%) and serum (1,3)-β-D-glucan (33.3%). In addition, mNGS showed superior performance in discovering co-pathogens (84.6%) of pulmonary aspergillosis; bacteria, bacteria-fungi, and bacteria-PJP-virus were most commonly observed in non-neutropenic patients. Moreover, mNGS results can help guide effective treatments. According to the mNGS results, antimicrobial therapy was altered in 91.7% of patients with pulmonary aspergillosis. The diagnosis of Aspergillus detected in blood samples, which can be used as a supplement to BALF samples, seemed to show a higher specificity than that in BALF samples. mNGS is a useful and effective method for the diagnosis of pulmonary aspergillosis in non-neutropenic patients, detection of co-pathogens, and adjustment of antimicrobial treatment.

DIAGNOSTIC SIGNIFICANCE OF ADENOSINE DEAMINASE AND LYMPHOCYTES IN SUSPECTED TUBERCULOUS PLEURAL EFFUSION

CONTEXT: Tuberculosis is a major public health problem in India. Tuberculous pleural effusion is a paucibacillary manifestation of the Tuberculosis, so isolation of Mycobacterium tuberculosis is difficult, biomarkers being an alternative for diagnosis. Pleural fluid Adenosine deaminase (ADA) level is being used in diagnosis of Tubercular pleural effusion. The combination of ADA and pleural fluid lymphocyte count is being recognized as a better method for increasing the specificity of ADA test. The present study was conducted to analyze the diagnostic usefulness ofAIM: ADA alone (≥ 40U/L) compared with the combination of ADA and pleural fluid lymphocyte count ( ≥ 50% ). SETTINGS AND DESIGN: METHODS AND MATERIAL:Retrospective study. Study was conducted for a period of one year from May 2017 to April 2018. A total of 110 pleural fluid samples data was analysed. SPSS 20STATISTICAL ANALYSIS USED: statistical software. ADA level in Tuberculous pleural effusion ranged from 40U/L to 112U/L with mean value ofRESULTS: 69.4U/L. Sensitivity, Specificity, Positive predictive valve (PPV) and Negative predictive values (NPV) for ADA alone were 93.2%, 76.4%, 82% and 90.6% respectively. For ADA and lymphocyte count the Specificity and PPV increased (98% and 98.1% respectively) with hardly any decrease in sensitivity or NPV (89.8% and 89.5% respectively). CONCLUSION: Combined use of ADA and pleural fluid lymphocyte count increases the specificity and PPV when compared to the specificity of ADA test alone in diagnosing Tubercular pleural effusion.

Radiological Semiotics of Different Types of Nontuberculous Pulmonary Mycobacterioses

Objective: to determine, evaluate, and describe different radiological patterns of microbiologically identified nontuberculous pulmonary mycobacterioses (NTPM) based on multislice computed tomography data. Material and methods. The study included 102 patients with radiological signs of lung disease and different types of NTPM. Slowly growing types of NTPM were detected in 62 (60.8 %) patients, and rapidly growing NTPM – in 40 (39.2 %). The diagnosis was established considering a patient’s complaints, a specified case history, radiological and clinical laboratory data including microscopic studies of sputum from 63 (61.8 %) patients, bronchoalveolar lavage and different types of bronchial biopsies data from 19 (18.6 %) patients, samples of lung video-assisted thoracoscopic surgery from 17 (16.7%) patients, pleural fluid samples from 2 (1.9 %) patients, and oropharyngeal wash samples from 1 (1 %) patient. We used the Somatom Emotion 16 multislice computed tomograph (Siemens) and the high-resolution algorithm (HRCT) with 0.8 mm slice thickness and 1.5 mm slice increment. Results. The HRCT data were highly polymorphic and showed interstitial focal changes, different calibre bronchiectasis, conglomerates or cavities, involvements of vessels or pleural layers. In some patients, changes in the axial interstitium were accompanied by single small focal consolidations located either discretely or in small groups. Peribronchovascular spread of dissemination foci in NTPM was detected by HRCT as irregular infiltration of the axial interstitium (vasculitis type). Changes in the bronchial tree in NTPM were characterized by bronchiolitis symptoms (extensive thickening of bronchial walls, bronchioles) with development of the tree-in-bud sign predominantly in the subpleural lung regions. In some cases, bronchiectatic changes formed conglomerate consolidations of sublobular or lobular extent. Changes of the bronchial tree were detected by HRCT predominantly as signs of deforming bronchitis, cylindrical, varicose, or cystic bronchiectasis, either restricted or spread. Changes might be accompanied by single multi-dimensional cystic bronchiectatic cavities. Conclusion. Typical HRCT signs of NTPM are endobronchial and peribronchovascular spread of foci, development of multi-dimensional conglomerates, deforming bronchitis, bronchiectasis, and presence of single multi-dimensional cystic bronchiectatic cavities.

Continued Vaccine Breakthrough Cases of Serotype 3 Complicated Pneumonia in Vaccinated Children, Portugal (2016-2019).

ABSTRACTWe previously reported that despite the use of pneumococcal conjugate vaccines (PCVs), vaccine serotypes remained important causes of pneumonia with pleural effusion and empyema (pediatric complicated pneumococcal pneumonia [PCPP]). We cultured and performed PCR on 174 pleural fluid samples recovered from pediatric patients in Portugal from 2016 to 2019 to identify and serotype Streptococcus pneumoniae. Most PCPP cases (n = 87/98) were identified by PCR only. Serotypes 3 (67%), 14, and 8 (5% each) were the most frequent. Vaccine breakthrough cases were seen among age-appropriately, 13-valent, PCV vaccinated children (median: 3 years, range: 17 months to 7 years), mostly with serotype 3 (n = 27) but also with serotypes 14 and 19A (n = 2 each). One breakthrough was seen with serotype 14 in an age-appropriately, 10-valent, PCV-vaccinated child and another with serotype 3 in a child to whom the 23-valent polysaccharide vaccine was administered. While the relative risk of serotype 1 PCPP decreased almost 10-fold from the period of 2010 to 2015 to the period of 2016 to 2019 (relative risk [RR] = 0.106), that of serotype 3 PCPP almost doubled (RR = 1.835). Our data highlight the importance of molecular diagnostics in identifying PCPP and document the continued importance of serotype 3 PCPP, even when PCV13 use with almost universal coverage could be expected to reduce exposure to this serotype.IMPORTANCE The use of conjugate vaccines against Streptococcus pneumoniae in children has led to substantial reductions in pneumococcal invasive disease. However, the reductions seen in each of the 13 serotypes currently included in the highest-valency vaccine approved for use in children (PCV13), were not the same. It is becoming clear that most vaccine breakthroughs worldwide involve serotype 3 and are frequently associated with complicated pneumonia cases, often with empyema or pleural effusion. Here, we show that despite almost universal PCV13 use, which would be expected to reduce vaccine serotype circulation and further reinforce vaccine direct protection, pneumococci and serotype 3 remain the major causes of pediatric complicated pneumonia. Molecular methods are essential to identify and serotype pneumococci in these cases, which frequently reflect vaccine breakthroughs. A broader use of molecular diagnostics will be essential to determine the role of this important serotype in the context of PCV13 use in different geographic regions.

Safe Insertion, Maintenance and Removal of Chest Tube

Chest tube insertion is a vital, often life-saving procedure which may be required for any patient. A comprehensive knowledge about safe insertion, maintenance and removal of the chest tube is vital for every health-care professional. This article describes essential components of chest tube management such as type of chest tubes, drainage systems, how to perform safe insertion, connecting to the drainage system, fixation of chest tube, precautions during initial drainage, monitoring of patient, daily measurement and emptying of bottle, pain relief, chest physiotherapy, patient transport, method of collecting pleural fluid sample and steps of safe removal.

Diagnostic Utility Of Fluid Cytology By Conventional Smear And Cell Block Method In Pleural Effusion

The cytological examinations of serous effusions have been well-accepted, and a positive diagnosis is often considered a definitive diagnosis. The study was planned to determine the diagnostic utility of fluid cytology by conventional smear and cell block method in pleural effusion. This was a hospital-based open cohort observational study conducted on patients diagnosed with pleural effusion. The study period was one year, and patients were recruited using a nonprobability sampling method. The fluid samples were subjected to the conventional smear examination, followed by cell block preparation. The overall morphologic details, cellularity, architecture, and nuclear and cytoplasmic details were studied and compared in conventional smear and cell block techniques. The samples were categorized as unsatisfactory, benign, suspicious for malignancy, or malignancy. The study was conducted on 113 pleural fluid samples. The study demonstrated that the cell block technique improved the cellular yield and established diagnosis in malignant effusions.

Malignant pleural disease: a pragmatic guide to diagnosis.

The diagnosis of malignant pleural disease is important in the care of patients with cancer. However, a one-size-fits-all approach to diagnosis may lead to delays in care as the sensitivity of each biopsy modality varies and can be dependent on the tumor type. We review current literature on pleural biopsy techniques and propose a diagnostic algorithm for suspected malignant pleural disease. Recent literature has shown that the sensitivity of pleural fluid cytology varies based on tumor type resulting in a limited value of repeated thoracenteses in many cases. Furthermore, the ability to test for molecular biomarkers on pleural fluid samples has contributed to the recommendations to send large volumes of pleural fluid for analysis. Studies have also supported the consideration of medical thoracoscopy earlier in the diagnostic work-up of malignant pleural disease. The decision to repeat a diagnostic thoracentesis when suspecting malignant pleural effusions should take into account the primary tumor type. Open pleural biopsy with medical thoracoscopy has been shown to be a relatively safe diagnostic modality with high sensitivity and should be considered in patients with a nondiagnostic thoracentesis.

Abstract 5766: Pan-cancer analysis revealed characteristics of reversion mutations in homologous recombination repair genes

Abstract Background: Reversion mutations of BRCA1/2 are associated with decreased response to platinum-based chemotherapies and PARP inhibitors. While patient with homologous recombination repair (HRR) genes have proven efficacy to PARP inhibitors, reversion mutations in these genes have not been widely studied. Here, we performed pan-cancer analysis to reveal the characteristics of HRR reversion mutations. Methods: We assessed 1,992 patients with at least one loss of function mutation in BRCA1, BRCA2, ATM, BARD1, BRIP1, CDK12, CHEK1, CHEK2, FANCL, PALB2, RAD51B, RAD51C, RAD51D, RAD54L, ERCC3, RAD51, WRN, FANCI, MRE11A, ATR, FANCD2, FANCA, FANCC, BLM and NBN. Somatic reversion mutations were indel or missense mutations that restore the open reading frame and potentially protein function fully or partially. Definitive reversion mutations are confirmed secondary mutations in patients with known pathogenic germline HRR gene mutations, or in a subsequent sample of previously detected somatic pathogenic mutants. Other reversion mutations are putative due to lack of matched samples. Results: Overall, we found 31/1,992 (1.6%) tumors with definitive or putative HRR reversion mutations, including 17 with germline and 14 with somatic predisposed pathogenic HRR mutations. Of these, we identified 9 BRCA1 (29%, 2 sBRCA1 and 7 gBRCA1) and 12 BRCA2 (39%, 4 sBRCA2 and 8 gBRCA2). We also found pathogenic germline PALB2 (1, 3%) and RAD41D (1, 3%), and somatic mutations in CDK12 (3, 9%), ATM (2, 6%), WRN (1, 3%), FANCD2 (1, 3%), and ATR (1, 3%). Overall, 43 reversion mutations were detected (37 definitive and 6 putative), with eight patients carrying multiple reversion mutations. Importantly, 40/43 reversion mutations were found within 2bp upstream to the start site of original deleterious variants, and all were unique to currently known database. Missense-induced reversions were found in 74% primary stop-gain mutations, while indel-induced reversions were associated with 59% primary frameshift mutations. These HRR reversion mutations were primarily found in breast cancer (9%, 10/107) and ovarian cancer (6%, 3/54), and also in cases of prostate (1/25, 4%), pancreatic (1/29, 3%), colorectal (2%, 9/418), and non-small cell lung cancer (1%, 6/703). Of note, the incidence of multiple HRR reversion mutations was higher in breast cancer (75%, 6/8). Lastly, reversion mutations were detectable in plasma, pleural and ascites fluid samples, suggesting great clinical utility of ctDNA to monitor reversion mutations. Conclusions: This study analyzed clinical and mutational characteristics of reversion mutations in HRR genes, which could occur as single or multiple variants to restore the function of predisposed pathogenic HRR mutations, resulting in resistance to platinum-based chemotherapies or PARP inhibitors. Monitoring these mutations with tissue or liquid biopsy samples are crucial for treatment guidance. Citation Format: Jing Li, Xiaoying Wu, Yan Shi, Di Wang, Yedan Chen, Yang Shao. Pan-cancer analysis revealed characteristics of reversion mutations in homologous recombination repair genes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5766.

A RETROSPECTIVE COHORT STUDY INVESTIGATING CYTOLOGICAL SENSITIVITY IN MALIGNANT PLEURAL EFFUSION

TYPE: Abstract TOPIC: Disorders of the Pleura PURPOSE: Cytological analysis of pleural fluid is a first line investigation for evaluating a unilateral pleural effusion. Despite long-standing use, diagnostic sensitivity of pleural fluid sampling for malignant pleural effusions (MPEs) is highly variable, between 46-91%. Our objective was to analyse cytological sensitivity in patients with confirmed malignancy using a large retrospective cohort, comparing to previous studies including Arnold et al [1]. METHODS: Consecutive patients with unilateral pleural effusions who underwent thoracocentesis at a district general hospital between 2015-2020 were recruited. Cytology was reported by consultant histopathologists. Sensitivity was calculated based on final diagnosis, confirmed by medical consultants. All data was collected retrospectively using an electronic records system. RESULTS: Of 419 patients recruited, 162 had confirmed malignancy and 146 had cytology reported. Overall sensitivity for pleural cytology to diagnose MPEs was 48.8%. Sensitivity varied according to cancer primary with gynaecological malignancy most sensitive (78%), then lung adenocarcinoma (72%) and breast cancer (68%). Mesothelioma (26%) and Haematological malignancy (20%) had comparatively lower sensitivity which reflects results in previous studies. CONCLUSIONS: Cytological sensitivity for MPEs varies according to cancer primary. CLINICAL IMPLICATIONS: Our results are comparative to previous studies and further highlight the importance of pleural analysis and further diagnostic testing in the diagnosis of MPEs. DISCLOSURE: Nothing to declare. KEYWORD: pleural effusion

Comparison of Ziehl Neelsen Stain, Auramine Rhodamine Stain and Culture Sensitivity of AFB in Routine and Concentrated Pleural Fluid

Background: Nearly one third of the global population is infected with mycobacterial tuberculosis. Pleural tuberculosis accounts for 20% of extrapulmonary tuberculosis. The diagnosis of tuberculous pleural effusion is difficult because of the low detection rate of different diagnostic tests like microscopy and culture. Current study aimed to compare the detection rate of different tests in non-concentrated and concentrated pleural fluid.&#x0D; Methods: A hospital based prospective cross sectional study was carried out over one year duration in the Medicine Department of Bir Hospital. A total of 52 cases were enrolled. Detailed history taking and physical examination; radiological, hematological and serum biochemical investigations were performed. Thoracocentesis was performed in all the patients; 20 ml pleural fluid was sent for microscopy with ZN and AR staining as well as for AFB culture. Up to 500ml of pleural fluid was heparinized and kept on cylindrical jar for two hours and 50 ml of sediment was also sent for microscopy and culture within one hour. The results obtained were documented and analysis was done.&#x0D; Results: A total of 52 patients, 31 (59.6%) males and 21 (40.4%) females were included. Their mean age of study participants was 38.67 ± 17.71 (range 16-82 years). Common presentations were fever (94.2%), cough (92.3%), breathlessness (84.6%), chest pain (65.4%) and significant weight loss (59.6%). Haemoptysis was present in 13.5%, anemia in 48.1%, enlarged cervical lymph nodes in 5.8% of the patients. The detection rates of ZN stain, AR stain and AFB culture in non-concentrated pleural fluid were 3.8%, 9.6% and 11.5% respectively. The detection rates for the same tests using concentrated pleural fluid of the same patients were 7.7%, 25% and 17.3% respectively. Differences in detection rate with AR stain and AFB culture for non- concentrated and concentrated pleural fluid were statistically significant (p value &lt;0.01).&#x0D; Conclusion: The detection of AFB using microscopy with ZN and AR staining as well as culture in solid media is low. The detection rate was significantly increased by using concentrated pleural fluid sample for microscopy and culture.

Influence of Malignant Pleural Fluid from Lung Adenocarcinoma Patients on Neutrophil Response.

Simple SummaryThis study provides novel information about the role of neutrophils in malignant pleural effusion (MPE) and hallmarks their clinical relevance. Since these cells have emerged as important regulators of cancer, we characterized their phenotype and functions in MPE microenvironment. We found that neutrophil-derived products (degranulation molecules and neutrophil extracellular traps (NETs)) were increased in MPE. In addition, NETs were associated with a worse outcome in lung adenocarcinoma patients with MPE.Malignant pleural effusion (MPE) is a common severe complication of advanced lung adenocarcinoma (LAC). Neutrophils, an essential component of tumor infiltrates, contribute to tumor progression and their counts in MPE have been associated with worse outcome in LAC. This study aimed to evaluate phenotypical and functional changes of neutrophils induced by MPE to determine the influence of MPE immunomodulatory factors in neutrophil response and to find a possible association between neutrophil functions and clinical outcomes. Pleural fluid samples were collected from 47 LAC and 25 heart failure (HF) patients. We measured neutrophil degranulation products by ELISA, oxidative burst capacity and apoptosis by flow cytometry, and NETosis by fluorescence. The concentration of degranulation products was higher in MPE-LAC than in PE-HF. Functionally, neutrophils cultured with MPE-LAC had enhanced survival and neutrophil extracellular trap (NET) formation but had reduced oxidative burst capacity. In MPE, NETosis was positively associated with MMP-9, P-selectin, and sPD-L1 and clinically related to a worse outcome. This is the first study associating NETs with a worse outcome in MPE. Neutrophils likely contribute to tumor progression through the release of NETs, suggesting that they are a potential therapeutic target in LAC.

Pleural tuberculosis: experiences from two centers in Brazil

ObjectiveThis study aimed to describe the clinical and laboratory findings of patients diagnosed with pleural tuberculosis at two hospitals in southern Brazil. MethodsPatients aged < 18 years were evaluated retrospectively. The patients’ medical and epidemiological history, tuberculin skin test results, radiological and pathological findings, and pleural fluid analysis results were retrieved. ResultsNinety-two patients with pleural tuberculosis were identified. The mean age was 10.9 years old. Twenty-one percent were children aged six years or less. The most common symptoms were fever (88%), cough (72%), and chest pain (70%). Unilateral pleural effusion was observed in 96% of the cases. Lymphocyte predominance was found in 90% of the pleural fluid samples. The adenosine deaminase activity of the pleural fluid was greater than 40 U/L in 85% of patients. A diagnosis of community-acquired pneumonia with antibiotic prescriptions was observed in 76% of the study population. ConclusionsTuberculosis etiology must be considered in unilateral pleural effusion in a child with contact with a case of tuberculosis. Pleural fluid biomarkers contribute to the diagnosis of pleural tuberculosis in children and adolescents.

Deconvolution of malignant pleural effusions immune landscape unravels a novel macrophage signature associated with worse clinical outcome in lung adenocarcinoma patients

BackgroundImmune checkpoint inhibitors are still unable to provide clinical benefit to the large majority of non-small cell lung cancer (NSCLC) patients. A deeper characterization of the tumor immune microenvironment (TIME)...

Reassessing the optimal volume for malignancy detection in serous fluid cytology.

The international system for reporting serous fluid cytopathology (TIS) recommends submitting at least 50-75 mL of serous fluid to decrease false-negative results. However, prior studies did not agree on specific volume requirements or consensus adequacy criteria. Our study aims to assess whether fluid volume affects the adequacy rate and to assess the minimum volume necessary for optimal adequacy in pleural and peritoneal fluids. A total of 8530 serous fluid cytology cases were identified in the laboratory information system. Differences in mean fluid volume received in the laboratory were compared using an ANOVA Games-Howell test based on TIS category. The percentage of malignant diagnoses across the volume ranges of 0 to 5 mL, 5 to 10 mL, 10 to 25 mL, 25 to 50 mL, 50 to 75 mL, 75 to 100 mL, 100 to 150 mL, 150 to 250 mL, 250 to 500 mL, 500 to 2000 mL was compared in pleural and peritoneal fluids using a chi-square test, and a SiZer analysis was performed. Mean fluid volume in inadequate, atypical, and negative cases was significantly lower compared to positive cases. A SiZer analysis showed a positive relationship between the malignancy fraction of pleural and peritoneal fluids and fluid volume. The percentage of malignant diagnoses in pleural and peritoneal fluid samples increased significantly up to a volume range of 75-100 mL. There is a significant relationship between fluid volume, adequacy and detection of malignancy in serous effusion cytopathology. The malignancy fraction increases with larger fluid volumes but at least 75-100 mL of fluid should be submitted for optimal diagnosis of malignancy in pleural and peritoneal fluids.