Tubercular Effusion Research Articles

Utility of the Ratio of Adenosine Deaminase and Serum C-reactive Protein in Differentiating Parapneumonic, Tuberculous, and Malignant Pleural Effusions.

Introduction Pleural effusion is a challenging diagnosis at times, especially due to the overlap of symptoms in effusions of various etiologies. In this study, we aimed to identify if pleural fluid adenosine deaminase (ADA) or serum C-reactive protein (CRP) can be used as an additional novel biomarker for ADA in diagnosing tubercular, parapneumonic, and malignant pleural effusions. Materials and methods A prospective, observational, cross-sectional study was conducted on 79 patients diagnosed with tubercular, parapneumonic, or malignant pleural effusion from August 2022 to April 2024 at the Department of Respiratory Medicine at Dr.D. Y. Patil Medical College,Hospital&Research Centre, Pimpri, Pune. The pleural fluid ADA/serum CRP ratio was identified in each group, and analysis was done to compare the ratio in each group. The correlation with pleural fluid ADA was also identified. Results A total of 79 patients were enrolled in this study. Out of these patients, 53 (67.1%) were identified as having tubercular pleural effusion, 10 (12.7%) patients had parapneumonic effusion, and 16 (20.3%) had malignant pleural effusion. For malignant effusions, the area under the curve (AUC) using the receiver operating characteristic (ROC) for the ADA/CRP ratio was observed to be 0.862. Sensitivity was 87.50%and specificity was 82.54% at a cut-off value of ≤0.5. The positive predictive value was found to be 56%, and the negative predictive value was found to be 96.3%. For parapneumonic effusions, the AUC using the ROC for the ADA/CRP ratio was observed to be 0.880. Sensitivity was 100%and specificity was 69.57% at a cut-off value of ≤0.67. The positive predictive value was found to be 32.3%, and the negative predictive value was found to be 100%. For tubercular effusions, the AUC using the ROC for the ADA/CRP ratio was observed to be 0.955. Sensitivity was 92.45%and specificity was 88.46% at a cut-off value of >0.54. The positive predictive value was found to be 94.2%, and the negative predictive value was found to be 85.2%. The Pearson correlation coefficient (r) of 0.633 indicates a moderately strong positive linear relationship between ADA and ADA/CRP levels. Conclusion The pleural fluid ADA-to-serum CRP ratio can be used as a useful diagnostic tool for differentiating between tubercular, parapneumonic, and malignant pleural effusions. ADA/CRP ratio has added diagnostic value over ADA. In clinically puzzling scenarios, the ADA/CRP ratio can be a cost-effective tool before opting for a more expensive and invasive procedure, which is also often difficult to obtain in resource-limited healthcare settings. More research with a larger sample size is indicated to incorporate the ADA/CRP ratio as an added diagnostic tool along with ADA.

Evaluation of polymerase chain reaction and adenosine deaminase levels for rapid diagnosis of clinically suspected tuberculous pleural effusion

ABSTRACT Background: Tuberculosis (TB) often leads to pleural effusion, particularly prevalent in developing nations such as India. There has been a global rise in TB cases. Although lymphocytic predominant fluid is commonly associated with tubercular pleural effusion, it is essential to note that not all lymphocytic predominant fluids indicate TB. The diagnosis of pleural TB has benefited significantly from the use of biochemical markers. Conventional bacteriological methods are not very useful in diagnosing tubercular effusion and rarely identify Mycobacterium tuberculosis in pleural fluid. Owing to diagnostic difficulties, newer investigations, such as TB polymerase chain reaction (TB-PCR), adenosine deaminase (ADA) and culture, are amongst the most recent techniques currently used due to the challenges associated with diagnosis. Aims: This study aimed to measure the sensitivity and specificity of TB-PCR and compare them with those of ADA and TB cultures for suspected TB pleural effusion. Methods: This study included 50 patients diagnosed with pleural effusion who underwent pleural fluid analysis. Patients exhibiting exudative effusion with lymphocyte predominance also underwent a pleural biopsy. Pleural fluid ADA levels were also measured, and TB-PCR tests were conducted. Results: Eighteen patients were confirmed to have TB by biopsy. ADA was both sensitive and specific at 67% and 62.5%, respectively. However, PCR showed a sensitivity of 16.6% and a specificity of 100%. Conclusion: This study found a statistically significant association (P < 0.05) between ADA levels and distinguishing pleural effusion, which is tubercular in origin, from non-tubercular effusion. Therefore, the pleural ADA estimate appears to have the potential to be a reliable test for diagnosing TB pleural effusion. It has sufficient sensitivity and specificity while being cost-effective and easily executable compared to pleural biopsy. Our study also compared the sensitivity of PCR with pleural biopsy and discovered that PCR was more specific and less sensitive.

Pleural effusion in a pediatric ward: clinical feature, etiology and outcome

Background: Pleural effusion is a common respiratory complication in children. We aimed to document clinical feature, etiology, biochemical parameters and outcome of the admitted children with pleural effusion. Methods: This cross-sectional study was conducted from January 2022 to June 2023 at pediatric ward of ICMH. All children from 6 months to 14 years presented with clinical features suggestive of pleural effusion and later supported by radiology and ultrasonography of chest either at presentation or owing to other systemic illness were enrolled. Children aged below 6 months, associated chronic illness and parental denial of giving consent were excluded. In indicated cases pleural fluid was tapped and sent to laboratory for physical, biochemical examination, staining, culture, GeneXpert, LDH and ADA assay. Results: Out of 43 children, 19 underwent pleural tap and rest were managed conservatively. Most of the children were in between 2 to 6 years. There were 22 male and 21 female. Unilateral effusion was found in 25 children and 18 children developed bilateral effusion. All the children had documented fever. Other symptoms were cough, respiratory distress, chest pain, weight loss, abdominal pain, jaundice and blood mixed sputum. Physical signs correlated classical effusion features. The etiologies included DF, TB, para-pneumonic effusion, empyema, nephrotic syndrome, malignancy, acute viral hepatitis, heart failure and acute pancreatitis. There was no mortality and long-term complication in non-malignant cases. Conclusions: DF outnumbered other causes of pleural effusion in recent times owing to recent Dengue outbreak. Tubercular effusion was leading cause among cases undergoing pleural tap.

Clinical Profile of Patients with Pleural Effusion Admitted to Bharatpur Hospital

ABSTRACT
 Background: Pleural effusion occurs when there is disequilibrium between the quantity of fluid entering and leaving the pleural space. The objective of the study was to investigate the association between pleural effusion and underlying medical conditions as heart failure, pneumonia, malignancies of clinical presentations and laboratory findings of all those patients admitted to Bharatpur Hospital during the period of last 1year.
 Methods: Retrospective data from September 2022 to September 2023 from all the cases diagnosed with pleural effusion will be taken. Altogether 120 cases diagnosed with pleural effusion studied. The collected data was re-checked, reviewed, organized, entered and analyzed in statistical package for social sciences (SPSS) version 20.0.
 Results: From the findings of the study, 56.7% were male and 60.0% were from outside Chitwan District. Among the various causes of pleural effusion the most common cause was tubercular effusion (30.8%) followed by para-pneumonic effusion (19.2%). Tubercular effusion is Shortness of breath was present in 13.5%, cough in 10.8%. Tubercular pleural effusion is common in the age group 41–50 years and Patients with para-pneumonia, is 97 had lymphocyte and 23 had neutrophil. >3 gm/dl was observed in patients with tubercular effusion and Mean value of ADA for tubercular effusion was 45.8 U/L.
 Conclusions: Our study concluded that shortness of breath, cough, and Pleural fluid analysis is the diagnostic method to distinguish exudative from transudative pleural effusion. Lymphocyte rich exudative effusion occurs in case of Tubercular effusion and neutrophil rich effusion occurs in para-pneumonic effusion.
 Key words: pleural effusion, exudative, transudative.

Detection of drug-resistant Mycobacterium tuberculosis in pericardial fluid culture and its correlation with cartridge based nucleic acid amplification test and adenosine deaminase activity

BackgroundPericardial effusion is the accumulation of fluid in the pericardial cavity. In nations with high tuberculosis (TB) load, TB is the most common cause of pericardial effusion. 1–2% of patients with pulmonary TB develop Pericardial TB worldwide. Multi-drug-resistant (MDR) TB, including extrapulmonary TB (EPTB) cases, are rising in number. Adenosine Deaminase (ADA) is an enzyme in lymphocytes and myeloid cells, which has certain immune functions in the body. ADA levels are increased in inflammatory conditions, like pleural, pericardial, or joint effusions, of bacterial etiology, granulomatous conditions, neoplasms, and autoimmune pathologies. TB is the only lymphocytosis involving disease with increased ADA levels. MDR EPTB is rare, but cases are on the rise, and tuberculous pericardial effusion is one such example. Hence, it is important to know the percentage of cases detected by a culture that can be identified by cartridge-based nucleic acid amplification test (CBNAAT), their resistance patterns, and to identify potential markers like ADA, which can help in early identification of cases. The objectives of this study were to identify the Mycobacterium tuberculosis (MTB) bacilli in culture, and correlate them with cartridge-based nucleic acid amplification test (CBNAAT) results and their drug-resistance, in the Pericardial tubercular effusion, and to find if Adenosine Deaminase (ADA) levels can be used as a predictor of the presence of MTB in pericardial fluid. MethodologyWe enrolled 52 patients with moderate to large tuberculous pericardial effusion, based on pericardial fluid analysis, CBNAAT, and culture methods, between January 2021 and December 2021. ResultsThe mean age of the patients was 41.85 + 17.88 years, with a median of 38 years. Males made up 57.7% of the total patients. MTB was detected in 16 (30.8%) patients in the CBNAAT evaluations. 14 (87.5%) of the CBNAAT-positive TB patients were sensitive to Rifampicin, whereas the remaining 2 (12.5%) were resistant to Rifampicin on CBNAAT. MTB was found to be growing in 8 (15.38%) drug sensitivity test cultures. Out of these 8, 6 were sensitive to first-line drugs, whereas 2 were resistant to both Isoniazid and Rifampicin. The presence of cough was found to have a significant difference between CBNAAT-detected MTB positive and negative patients (p = 0.020), whereas an insignificant difference was found for the presence of hypertension, diabetes mellitus, obesity, dyspnea, or fever. There was also an insignificant difference between the number of patients positive for the Tuberculin skin test, between the two groups. ADA was significantly higher in the MTB-detected CBNAAT group (85.91 + 37.60U/L vs 39.78 + 24.31U/L, p = 0.005), whereas the total leukocyte count, lymphocytes, neutrophils, random blood sugar levels, and serum protein levels had no significant difference. The area under the Receiver Operator Curve (CBNAAT positive: dependent variable; ADA: test result variable) was 0.854 (null hypothesis rejected), with a standard error of 0.078. ConclusionsCulture is the gold standard method to diagnose tuberculosis. Detection of MTB on pericardial fluid culture is very uncommon, though in our study, culture came out positive in 16% of patients, and 4% were resistant to rifampicin and isoniazid. Higher ADA levels in pericardial fluid are an indicator of tuberculous pericardial effusion.

To correlate clinical and biochemical profile of pleural effusion: a retrospective study in tertiary care centre of central India

BackgroundPleural effusion indicates an imbalance between pleural fluid formation and removal. Classified into exudative and transudative, with common symptoms of dry cough, dyspnea and pleuritic chest pain. Confirmed etiology has to be established for effective treatment. ObjectiveCorrelate clinical and biochemical profile of various etiologies of pleural effusion. Materials & methodsRetrospective observational study of 2 years in the department of respiratory medicine, GMC Bhopal on 280 cases of pleural effusion. ResultsMost common etiology was tubercular 202 (72.4%) followed by malignant in 36 (12.8%). With respect to tubercular, malignant pleural effusion has relative risk (RR) of 0.138 (p value < 0.05) in the age group of 51–60 years, which is statistically significant. Patients of tuberculosis complained of fever 158 (78.2%) whereas with malignancy complained of chest pain 16 (44.4%) followed by hemoptysis 12 (33.3%). For hemoptysis, with respect to tubercular, malignant effusion has RR of 5.68 (p value < 0.05) which is significant. History of smoking was significant in malignant effusion with RR of 2.57 (p value < 0.05) as compared to tubercular. Pleural fluid ADA was >70 in 83.7% in tubercular effusion, glucose was <60 mg/dl in 79% tubercular, malignant and bacteriological cause, LDH was >1000 in 88.4% in bacteriological and 72.3% in malignant effusion. ConclusionLack of tools for confirming diagnosis leads to diagnostic dilemma and delay in treatment initiation, leading to deterioration and untoward fatality in some cases. Our goal is early diagnosis by correlating clinical symptoms with biochemical profile and help initiate rapid treatment.

Clinical and Etiological Profile of an Exudative Pleural Effusion in a Tertiary Care Center

Background: Pleural effusion is common clinical entity in day-to-day clinical practice. There are various etiologies for pleural effusion. Among those tubercular pleural effusion, parapneumonic effusion, malignant effusion, and congestive heart failure were the most common causes of pleural effusion. Here, we have done a retrospective study to see the etiology of pleural effusion in our tertiary care center. Patients and Methods: This retrospective study conducted in a tertiary care center over 1 year period. A total of 63 patients were included in this study after verifying in patient records of all patients who were admitted with exudative pleural effusion. The demographic data collected and complete history was obtained. Investigations such as complete hemogram, random blood sugar; renal function tests, serum proteins, chest x-ray, and pleural fluid analysis and investigations such as ultrasonogram of the chest and abdomen, echocardiogram, computed tomography scan of chest, fine-needle aspiration cytology, and pleural biopsy reports (if done) were collected. Results: Among the study participants, 40 were male and 23 were female patients with male-to-female ratio of 1.7:1. Mean age of the study population was 48.8 ± 18.7 years. The most common presenting symptom was dyspnea (84%) followed by cough (80%), fever (65%), and chest pain (43%). The most frequent cause of pleural effusion was tuberculosis in 38% of patients, followed by parapneumonic effusion (28.5%) and malignant pleural effusion (22.2%). Three patients had chylothorax, two patients had pancreatic pleural effusion and the diagnosis was unknown in two patients. Mean ± standard deviation (SD) adenosine deaminase (ADA) value of the study population was 45.3 ± 28.1. Mean ± SD of ADA values in tuberculous, parapneumonic, and malignant pleural effusion was 54.5 ± 16.8, 65.2 ± 30.7, and 18.2 ± 11.0, respectively. Conclusions: Tuberculosis is one of the common causes of exudative effusions along with parapneumonic effusions and malignancy. Pleural fluid ADA levels are highly sensitive with good specificity for the diagnosis of etiology of tubercular effusions. However in view of high levels of ADA in pleural fluid in parapneumonic effusions also, other measures such as clinical evaluation, lymphocyte to neutrophil ratio, and glucose levels are necessary to separate both these entities.

A Five-Year Study of Intrapleural Fibrinolytic Therapy in Loculated Pleural Collections

Pleural fluid loculations due to complicated parapneumonic effusion (CPE), empyema, tubercular effusion and traumatic hemothorax can be managed either by video-assisted thoracoscopic surgery (VATS) or intrapleural ibrinolytic therapy (IPFT). The former is more invasive, not easily available and is also more expensive. On the other hand, IPFT is less invasive, cheaper, easily accessible and if used early, in loculated pleural collections, break loculations and early pleural peel, thereby facilitating pleural space drainage. To study the efficacy of IPFT in facilitating pleural space drainage in loculated pleural collections of diverse aetiologies. A five-year retrospective, observational study of 200 patients, with loculated pleural collections and failed tube drainage and managed with IPFT was carried out. Responders were defined as those with significant volume of fluid drained and significant radiological resolution. There were 106 (53%) cases of CPE, 59 (29.5%) cases of tubercular effusion, 23 (11.5%) cases of empyema and 12 (6%) cases of hemothorax. Responders were 148 (74%) in number. The distribution of responders as per type of loculated pleural collection was as follows: CPE 88 (83%), tubercular 37 (62.7%), empyema 14 (60.8%) and traumatic hemothorax 11 (91.6%). The adverse effects were mild and included chest pain in six patients and low-grade transient fewer in three cases. Intrapleural fibrinolytic therapy is a safe and cost-effective option in the management of selected patients with loculated pleural effusions.

To study the diagnostic yield of pleural fluid adenosine deaminase (ADA) combined with Lymphocytic/Neutrophil (L/N) ratio in tubercular pleural effusion at a tertiary care center

Introduction: Tuberculosis is one of the leading causes of death worldwide and tubercular pleural effusion is the second most common form of extrapulmonary tuberculosis after lymph node tuberculosis. The most commonly used method to diagnose exudative pleural effusion is by the help of Light’s Criteria. The goal of our study was to search for another diagnostic tool that may have a better diagnostic yield for diagnosing pleural effusion than the present methods. Material and Methods: A prospective observational study was conducted in the pulmonary medicine department of a tertiary care center over a period of 18 months, where patients with pleural effusion were enrolled in the study after proper informed consent. These effusion cases were differentiated among tubercular and non-tubercular groups by recognized methods. Among these cases, the non-tubercular patients were taken as controls. Results: A total of 45 cases were taken after considering the inclusion and exclusion criteria, with 30 tubercular effusion cases and 15 controls. The sensitivity and specificity of combined ADA &amp; LNR were calculated to be 94.4% with a test accuracy of 89.29%. Conclusion: Our study concludes, that tubercular pleural effusion contributes substantially to the burden of disease in the world including in India.

Diagnostic utility of closed needle pleural biopsy in exudative pleural effusions

Abstract Background Exudative pleural effusions are often challenging, and on many occasions remain undiagnosed. Hence, a blind closed needle pleural biopsy (CNPB) is extremely relevant against this background. Methods We conducted a prospective study, in which a CNPB using a Cope’s needle was done in patients with exudative pleural effusion. Data were analysed using SPSS software. Results Our study included 250 patients, of which 140 (56%) were males and 110 (44%) female. 218 (87.2%) had tubercular effusion 22 (8.8%) had effusion secondary to malignancy, 8 (3.2%) had synpneumonic effusions, and 1 (0.4%) each had effusion secondary to pancreatitis and rheumatoid arthritis (RA). AFB culture was positive in 50 (22.4%) on pleural fluid, as compared to 209 (87%) on pleural biopsy. CBNAAT detected MTB in 34 (14%) on pleural fluid as compared to 72 (28.8%) on pleural biopsy. Caseous granuloma was found in 184 (73.6%). The sensitivity for AFB culture using CNPB tissue and pleural fluid was 95.8% and 22.5%, respectively (P &lt; 0.05). Drug susceptibility testing (DST) done on pleural tissue divided our patients as drug sensitive 182 (87%), MDR 13 (6.2%), preXDR 12 (5.7%), and XDR TB 2 (0.9%). For malignancy, sensitivity of pleural fluid and pleural biopsy was 9% and 63%, respectively (P &lt; 0.05). Major complications of the procedure were pain in 25 (10%), pneumothorax in 15 (6%), and haematoma in 8 (3%). Of the patients who developed pneumothorax, only one patient required intervention with an intercostal drain, and the rest resolved spontaneously. Conclusion CNPB is an easy, quick, cost-effective, and reliable method that can be used for diagnosing exudative pleural effusions of indeterminate aetiology in the out-patient setting.

Lymphocyte-Neutrophil Ratio in the Diagnosis of Tubercular Pleural Effusion in a Tertiary Care Centre: A Descriptive Cross Sectional Study

Introduction: Tuberculosis is a common infection in our community. Tubercular pleural effusion is the second most common form of extrapulmonary tuberculosis. Among the several causes of exudative pleural effusison tubercular remains the most common form in clinical practice. The aim of this study was to evaluate the significance of lymphocyte-neutrophil ratio(LN ratio) in cases of exudative effusion for diagnosis of tubercular effusion.&#x0D; Methods: This was a hospital based cross sectional studydone in Patients at tertiary care hospital from 1st September 2020 to 1st april 2021after taking ethical clearance from institutional reviw committee. Convienience samplingwas done. Statistical Analysis of data like percentages and frequencies were used for categorical variables. Mean and SD (standard deviation) were used for describing continuous variables. Inferential statistical tools like Chi-Square test and Student’s t-test were used. P-value of &lt;0.05 was considered statistically significant.&#x0D; Results: out of 200 cases 75% were tubercular pleural effusion and these cases were found have high levels of LN ratio (0.89 ± 0.11 for females and 0.97 ± 0.14 for males) and ADA (137.79 ± 44.61for females and 147.61 ± 51.64 for males) and more than 90% sensitivity and specificity of LN ratio and ADA level.&#x0D; Conclusion: Exudative pleural fluid L/N ratio &gt;0.75 is an efficient means of diagnosing tuberculous pleural effusion and its combination with ADA level gives us more accuracy and surety about the diagnosis of tubercular pleural effusion.

Role of medical thoracoscopy in the diagnosis of pleural effusions

BackgroundMedical thoracoscopy (semi-rigid and rigid thoracoscopy) have revolutionized the management of undiagnosed pleural effusions. Though semi-rigid thoracoscopy has a good diagnostic yield in malignant and tubercular effusions, its role in the management of a complicated pleural effusions is debatable. Hence, rigid thoracoscopy becomes handy in these cases. The present study looked into the role of medical thoracoscopy in the diagnosis of pleural effusions in different conditions. MethodsThis study included all patients who underwent medical thoracoscopy at our center between May-2010 and March-2020. Basic demographics data, type of medical thoracoscopy used, and histopathology details were collected and analyzed. ResultsA total of 373 patients were subjected to medical thoracoscopy (202 semi-rigid thoracoscopy and 171 rigid thoracoscopy). Out of whom 246 (66%) were males, the mean age was 51.9 ± 13.2 years. Diagnosis was achieved in 370 patients with a yield of 99.2%. The diagnostic yield in semi-rigid thoracoscopy was 99.5% with lung malignancy being the most common diagnosis (41%; n = 81), followed by tuberculosis (31%; n = 61). The diagnostic yield in rigid thoracoscopy was 100% in our study. Along with high diagnostic yield, complete drainage and lung expansion was seen in 93.5% (160 out of 171 patients) without requiring a second procedure. ConclusionsSemi-rigid thoracoscopy and rigid thoracoscopy should complement each other in the diagnosis of pleural effusions. Rigid thoracoscopy should be considered as the procedure of choice in a complicated pleural effusion.

Outcome of Significant Pericardial Effusion of Infectious Etiology in Children: an Observational Retrospective Cohort Study

Information on outcome of pediatric pericardial diseases from India is limited. The aim of this study is to study the outcome of significant pericardial effusion of infectious etiology in children. This study is a retrospective analysis of significant pericardial effusion of infectious etiology in children admitted to a tertiary care hospital of northern India during the last 10 years. Of the 74 patients, 71.6% (53/74) had tuberculosis, most being “probable” tubercular effusion. Pyogenic cases (17/74) usually had a pleura-pulmonary focus. Pericardial fluid adenosine deaminase (ADA) and contrast enhanced computer tomography (CECT) chest were useful diagnostic aids in tubercular effusions. Pericardiocentesis and surgery were done in 72.9% (54/74) and 12.1% (9/74), respectively. On median follow-up of 18 months, death or chronic constrictive pericarditis was seen in 2 patients each, both had tubercular effusions. Tuberculosis is still the commonest infectious cause of pericardial effusion in children from this part of the world. Introduction of early intervention with pericaridiocentesis or surgery may improve the outcome of this once deadly disease.

English

BACKGROUND The pleura is involved in pulmonary or systemic tuberculosis by various mechanisms like delayed hypersensitivity. Tuberculous empyema usually results from failure of a primary tubercular effusion to resolve and further progresses to chronic suppurative form. In tuberculous empyema, the pleural fluid is purulent, and is loaded with tuberculous organisms on direct acid-fast bacillus (AFB) smear examination and / or culture of pus. We need to assess the role of cartridge based nucleic acid amplification test (CBNAAT) in the diagnosis of tuberculous empyema. METHODS This study was a prospective observational study of all adult patients of empyema above 15 years of age, admitted in the Department of Pulmonology, over a period of 1 year, 6 months after obtaining clearance from ethical committee and proper consent from the study subjects. RESULTS A total of sixty-three (63) empyema cases were recruited and analysed further. On evaluation, we diagnosed 26 cases with tubercular aetiology (41.27 %) and remaining thirty-seven (58.73 %) cases with non-tubercular aetiology. CONCLUSIONS Pleural fluid (pus) cartridge based nucleic acid amplification test (CBNAAT) is very sensitive and provides a rapid confirmed diagnosis within 2 hrs. including drug susceptibility. In this study, sensitivity of CBNAAT in suspected tuberculous empyema patients was 88.5 % and specificity was 100 %. Pleural fluid CBNAAT is more sensitive in both pleural fluid AFB smear positive (100 %) and pleural fluid AFB smear negative (72.7 %) cases. So, pleural fluid and sputum direct AFB smear and CBNAAT should be sent in all suspected tuberculous empyema cases for early diagnosis of tuberculosis and early detection of rifampicin resistance. KEY WORDS Mycobacterium Tuberculosis, Tubercular Empyema, Pleural Fluid, CBNAAT, AFB, Anti-Tubercular Drugs

A Cross-Sectional Study Comparing Adenosine Deaminase Levels in Pleural Effusion of Tuberculous versus Non-Tuberculous Aetiology

Tuberculous pleural effusion (TPE) is a common condition in developing countries compared to developed countries. It is one of the most prominent characteristics of extrapulmonary tuberculosis. The enzyme Adenosine deaminase (A.D.A.) is highly active in diseases that induce cellular immunity. Therefore, the present study was designed to evaluate the accuracy of A.D.A. levels in diagnosing pleural effusion caused by tubercular etiology. The study was a cross-sectional type and was conducted at the tertiary care institute from July 2019 to March 2020. A total of one hundred thirty-five patients with pleural effusion were recruited for the study. Among which eighty-nine pleural effusion patients were suffering from tuberculosis, and forty-six pleural effusion patients were without tuberculosis. A p-value &lt; 0.05 was taken as statistically significant. For calculations, IBM SPSS Statistics 21 manufactured by I.B.M., U.S.A was used. Findings of the present study have shown a significant difference between A.D.A. levels of tubercular effusion patients (69.3±27.22) compared to non-tubercular pleural effusion patients (20.46±7.34). Further, there was a significant difference between Lactate dehydrogenase (L.D.H.) levels of the tubercular effusion patients (172.72±25.7) in comparison to non-tubercular pleural effusion patients (81.91±6356). However, there was no significant difference between total protein (p&gt;0.05), glucose level (p&gt;0.05) and total cells (p&gt;0.05) level of both the groups. From this study, it was inferred that the A.D.A. level was considerably high in pleural effusion patients with tubercular aetiology in comparison to non-tubercular pleural effusion.

Clinico-Etiological Profile of Children with Pericardial Effusion in a Tertiary Care Hospital in Eastern India.

Pericardial effusion may be due to various causes. With the changing scenario of newer generation antibiotics and robust immunization program our aim is to identify the change, if any, in etiology and disease menifestations. This is a hospital-based uni-center prospective study with a population of 30 children for a period of 1½ year. Clinico-epidemiological features, investigations, complications and short-term outcome were assessed. We found 13 (43.33%) patients having mild, 11 (36.67%) had moderate and 6 (20%) had severe pericardial effusion. Cardiac tamponade was present in six cases. Among the study population 9 (30%) patients were diagnosed as having pyogenic pericardial effusion and 8 (26.67%) had tubercular effusion. The predominant symptoms of pericardial effusion in our children were fever and tachycardia (83.33%).Other symptoms at presentation were tachycardia (76.67%), cough (63.33%), chest pain (50%), orthopnea (43.33%) and skin rash (16.67%). Pericardiocentesis was done in 14 cases (46.67%) of which 4 patients (13.33%) required pig tail catheterization. Infectious etiology still remains the primary cause of pericardial effusion in our country. The presenting clinical signs are very much nonspecific and also not so prominent unless hemodynamic compromisation occurs. This study showed that bacterial and tubercular pericardial effusions are still two most prevalent etiological diagnosis in this part of country. Early diagnosis and treatment has good outcome.

A study on adenosine deaminase activity in pleural effusion of tuberculous and non tuberculous origin

Introduction: Accumulation of fluid in the pleural space that exceeds the physiological amount is defined as pleural effusion. Pleural effusion can be either transudative or exudative. The exudative pleural effusion is predominantly observed in tuberculosis. Adenosine deaminase (ADA) level remains high in disorders where cellular immunity is stimulated. Tuberculosis is one such disease. Materials and Methods: The cases were classified as two groups. 30 patients of tubercular pleural effusion were enrolled in Group I and 30 patients of non-tubercular pleural effusion were Group II. In non-tubercular pleural effusion, 6 cases were malignant effusions, 12 cases were parapneumonic effusions and 12 cases were transudative effusions, which include 4 cases of congestive cardiac failure, 4 cases of nephrotic syndrome and 4cases of hepatic cirrhosis. The following biochemical parameters in pleural fluid were estimated. They are Glucose, Protein and Adenosine deaminase. Results: In this study mean pleural fluid glucose level was significantly higher in transudative when compared to exudative pleural effusions. In exudative pleural effusions, mean pleural fluid protein level was increased significantly as compared to transudative pleural effusions. The activity of ADA in tubercular effusion was significantly higher when compared to non tubercular pleural effusions of different etiology such as malignant parapneumonic and transudative. Conclusion: The assessment of ADA act as better marker for identifying tuberculosis than the traditional markers. Keywords: Pleural effusion, Exudative, Transudative, Tuberculosis, Adenosine deaminase.

Role of ADA and CBNAAT(Cartridge Based Nucleic Acid Amplification Test) in diagnosis of Tuberculosis in straw coloured exudative pleural effusion in patients attending Government General Hospital, KAKINADA

India is presently one of the high burden countries for tuberculosis and accounts for 23% of global TB burden with 2.2 million patients. Of these reported cases in India around 20% are of Extra Pulmonary Tuberculosis(EPTB).Pleural effusion due to TB is currently the second common location for EPTB next to TB lymphadenitis . The bacteriological confirmation to diagnose EPTB is more difficult due to its paucibacillary nature. The present study was done to determine the role of ADA and CBNAAT both being rapid and non-invasive diagnostic methods for early detection of tuberculous pleuritis, which is essential for treatment initiation, improved patient outcome and for more effective public health intervention.An observational study was done on 100 patients presenting with clinico- radiological picture suggestive of pleural effusion, either admitted or attending OPD of Department of Pulmonary Medicine from Nov 2017 to Nov 2019 at GGH, Kakinada.Out of 100 exudative pleural effusions in study, male predominance with 80% of males and 20% females. Lymphocyte predominance is 74%, sputum AFB was positive in 6 cases. With ADA cut off as 40IU/L, 70 cases had an ADA &amp;#62; 40IU/L out of which 64 were tubercular, and 6 were malignant effusions .ADA has a sensitivity of 94% and specificity of 60%.Pleural fluid CBNAAT was positive in 30 cases, out of which 2 cases had an ADA &amp;#60; 40 IU/L .All are rifampicin sensitive. The sensitivity of CBNAAT is 40% and specificity 82%.There is a positive correlation between the lymphocyte predominance with ADA and CBNAAT with P&amp;#60;0.05%. : Estimation of ADA in pleural fluid is a simple, rapid, and less expensive laboratory investigation where the diagnosis is uncertain. The sensitivity of ADA, when combined with lymphocyte-predominant exudates, helps to diagnose tubercular effusions. The role of CBNAAT in diagnosing pleural TB is limited due to its poor sensitivity.

Yield of pleural biopsy in different types of tubercular effusions

IntroductionThe yield of mycobacteria is shown to be very low in pleural effusions as it is a pauci-bacillary disease. The present study looked at the yield of mycobacterium tuberculosis (MTB) in terms of GeneXpert for acid fast bacilli (AFB) and culture using a medical thoracoscopy guided biopsy and analysed whether the yield increases in more complicated effusions. Materials and methodsThis is a retrospective analysis of patients who underwent medical thoracoscopy for tubercular pleural effusions at our institute over the last 5-years. Patients who had no or minimal thin septations were considered as simple effusions and were subjected to semi-rigid thoracoscopy (n = 61). While patients who had multiple loculations and thick septations were considered as complicated effusions and were subjected to rigid thoracoscopy (n = 64). We considered granuloma on a biopsy as the standard for diagnosis of Tuberculosis (TB). Xpert MTB/RIF and The BACTEC MGIT was used for culture. ResultsOut 125 patients with granulomatous inflammation on biopsy, 56 (44.8%) were positive for either GeneXpert or culture for MTB. Only GeneXpert was positive in 43 and only culture was positive in 13. Amongst 61 patients with simple effusion, 14 had either GeneXpert for AFB or AFB culture being positive and 9 out of these patients had GeneXpert for MTB detected on biopsy sample. Only culture was positive in 5 patients. In complicated pleural effusion group either GeneXpert or culture for mycobacterium was positive in 42 (65.6%) out of 64 patients. Only GeneXpert was positive in 34 and culture alone was positive in 8 patients. ConclusionThe yield of MTB increases as the pleural effusion becomes more complicated. GeneXpert in a biopsy sample is a useful marker for MTB yield especially in a complicated effusion.

Evaluation of efficacy of assay of lactate dehydrogenase in serum and pleural fluid in the diagnosis of tubercular pleural effusions

Tuberculosis is a communicable disease with differing manifestations. It is a disease which is one of the leading causes of morbidity and mortality worldwide and a disease which is affecting economy directly and indirectly. Extra pulmonary manifestations are an area of interest to laboratory as diagnosis is often difficult and not definitive. Pleural effusion is one of the commonest extra pulmonary manifestations. Differential diagnosis is a big palindrome for pleural fluids. To test the reliability of lactate dehydrogenase of serum and pleural fluid in diagnosing tubercular effusions. Serum and Pleural fluids of tubercular and non tubercular origin were assayed for lactate dehydrogenase and studied. The serum levels were sensitive and not specific and pleural fluid levels were neither sensitive nor specific. The lactate dehydrogena se activity may be used a tool to distinguish exudates and transudates and also the ratio of lactate dehydrogenase and adenosine deaminase may be used if any other method are not available.