Tuberculous Effusion Research Articles

Lenalidomide Treatment for a POEMS Syndrome Patient with Massive Pericardial Effusion as the First Manifestation

To show the successful handle of a very rare complication of POEMS syndrome. We report a case of POEMS syndrome wherein the first symptom was recurrent massive pericardial effusions. The patient was misdiagnosed as having tuberculous pericarditis and received anti-tuberculosis treatment for nearly 20 months without effect. She suffered painful pericardiocentesis every 2 to 3 months until the POEMS syndrome diagnosis was confirmed when she appeared with polyneuropathy combined with cervical lymph node biopsy, indicating Castleman disease, serum monoclonal immunoglobulin of IgG λ type, and markedly elevated serum VEGF. Lenalidomide and dexamethasone treatments were introduced, and her pericardial fluid significantly reduced. Massive pericardial effusion is a rare manifestation of POEMS syndrome. POEMS syndromes with polyserositis are easily misdiagnosed as tuberculous polyserous effusions in China. Recognition of the possible pathogenesis of POEMS syndrome with a large amount of pericardial effusion will help to identify POEMS syndrome in an early stage.

12. Dramatic improvement of chronic pleural effusion with abatacept treatment in longstanding rheumatoid arthritis, after chest sepsis during treatment with anti-TNF-α

Introduction Rheumatoid arthritis (RA) is a systemic inflammatory disorder, with various pulmonary manifestations, including parenchymal disease (interstitial lung disease), inflammation of the pleura (thickening and effusions), and inflammation of the airways and pulmonary vasculature (vasculitis and pulmonary hypertension). These changes may reflect chronic immune activation, increased susceptibility to infection, or direct toxicity from disease modifying or biological therapy. This case report describes a 69-year-old male with longstanding seropositive rheumatoid arthritis who developed severe pneumonia during adalimumab treatment, with subsequent persistent right basal pleural effusion. Treatment with abatacept has resulted in remission with significant decrease in size of the pleural effusion.

Tuberculous pleural effusion.

Tuberculous effusion is a common disease entity with a spectrum of presentations from a largely benign effusion, which resolves completely, to a complicated effusion with loculations, pleural thickening and even frank empyema, all of which may have a lasting effect on lung function. The pathogenesis is a combination of true pleural infection and an effusive hypersensitivity reaction, compartmentalized within the pleural space. Diagnostic thoracentesis with thorough pleural fluid analysis including biomarkers such as adenosine deaminase and gamma interferon achieves high accuracy in the correct clinical context. Definitive diagnosis may require invasive procedures to demonstrate histological evidence of caseating granulomas or microbiological evidence of the organism on smear or culture. Drug resistance is an emerging problem that requires vigilance and extra effort to acquire a complete drug sensitivity profile for each tuberculous effusion treated. Nucleic acid amplification tests such as Xpert MTB/RIF can be invaluable in this instance; however, the yield is low in pleural fluid. Treatment consists of standard anti-tuberculous therapy or a guideline-based individualized regimen in the case of drug resistance. There is low-quality evidence that suggests possible benefit from corticosteroids; however, they are not currently recommended due to concomitant increased risk of adverse effects. Small studies report some short- and long-term benefit from interventions such as therapeutic thoracentesis, intrapleural fibrinolytics and surgery but many questions remain to be answered.

Diagnostic value of calprotectin in differentiation between benign and malignant pleural effusion

BackgroundPleural effusion can arise as a result of more than 50 recognized causes and the differentiation between benign and malignant origin of the fluid is still a diagnostic challenge. The ability of tumor markers and other biological markers to make better diagnosis of malignant pleural effusion (MPE) remains questionable. Out of these, the calcium-related proteins S100-A8 and S100-A9 (the noncovalent heterodimer calprotectin) were demonstrated in a small amount in malignant not in benign pleural effusion.ObjectivesThis research aimed to assess the diagnostic value of calprotectin in the differentiation between infectious or benign and MPE.Patients and methodsSixty patients were divided into group I: malignant and group II: infectious pleural effusions (which were further divided into group IIA: parapneumonic effusion and group IIB: tuberculous effusion) Quantitative measurement of calprotectin was done using the enzyme-linked immunosorbent assay technique in pleural effusion.ResultsPleural calprotectin level in MPEs (229.2±168.6 ng/ ml) was significantly lower than its level of infectious pleural effusions (3202.2±1304.8 ng/ml; P<0.001). The cutoff value of calprotectin level for the diagnosis of MPE was less than or equal to 730.5 ng/ml, with 95% confidence interval and the area under the curve was 0.999, the corresponding sensitivity was 96.7 and the specificity was 100% (P<0.001).ConclusionCalprotectin is a valuable biomarker in differentiating malignant from infectious pleural effusion.

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

Background: A tubercular pleural effusion can either be a sequel to a primary infection acquired 3 to 6 month previously or represent reactivation tuberculousis.&#x0D; Two different pathogenic mechanism can lead to tuberculous pleural effusion. By far the more common is the entry of only a few M. tuberculosis into the pleural space; in the presence of specific cell mediated immunity, tubercle bacilli provoke an intense hypersensitivity reaction and outpouring of fluid. Chest radiograph may or may not reveal associated parenchymal involvement. In the second variety, a subpleural caseous focus or cavity rupture into the pleural space and results in a pleural effusion. In this case chest radiograph nearly always shows parenchymal abnormalities.&#x0D; A definitive diagnosis of TBPE can be difficult to make because of the low sensitivity and / or specificity of noninvasive traditional diagnostic tools.&#x0D; In most series of patients with TBPE the result of pleural fluid staining for acid fast bacilli are virtually always negative and pleural fluid cultures are positive for mycobacteria in &lt;35% of cases. Without underlying lung parenchymal lesion sputum examination may be positive in 4% to 11% of patient with TBPE. On the other hand, pleural biopsy specimen will demonstrate granulomatous pleuritis in 50% to 80% of patients.&#x0D; This study was taken whether pleural fluid ADA and tuberculin skin test has any role in the diagnosis of tubercular pleural effusion.&#x0D; Methods and Materials: In the present study 120 cases of exudative pleural effusion in the age group of 15-40 years of varying etiology are taken who attended the pulmonary medicine department of Burdwan Medical College and Hospital.&#x0D; The study was conducted the period of March 2017 to February 2018 apart from relevant history taking a detail clinical examination, full investigation were done to reach a complete and final diagnosis.&#x0D; Result: In our study 120 patient of aged 15-40 years were taken. Different aetiological groups and there frequency as diagnosed by various mean were Tuberculous – 85%, Paraneumonic effusion – 10 %, Malignant effusion – 10%.&#x0D; There was male preponderance in all groups of pleural effusion. History of contact was present in 34 % cases of tuberculous effusion. Sputum for AFB was found 10.78% cases of tuberculous effusion. These patients also had pulmonary lesions. 80.39% cases of tuberculous effusion had pale yellow coloured effusion but 13.72 % cases had haemorrhagic fluid. 66.66% malignant effusion had haemorrhagic fluid and 33.37% of malignant effusion had pale yellow coloured fluid. Pleural fluid for malignant cell was positively 66.67% of malignant effusion. Pleural fluid for Z-N stain detect 1.96% cases tubercle bacilli in TBPE group. Plural biopsy was found positive in 68.18% cases of TBPE and 60% cases of MPE.&#x0D; Pleural fluid ADA level was significantly higher (P&lt;0.001) in patients of tuberculous effusion than non-tuberculous effusion. Taking a cut off value of 70 U/L sensitivity and specificity is 95.09% and 33.33%. But when parapneumonic effusion was excluded, the specificity increases. Lymphocytic pleural effusion below the age group of 40 years with cut off value of ADA &lt;40 U/L can be used as a screening test for malignant effusion.&#x0D; In TBPE tuberculin skin test was positive in 74.50% cases. Taking a cut off value of 10 mm or more induration of tuberculin skin test, "P" value is less than 0.001. Sensitivity and specificity of tuberculin skin test in tuberculous pleural effusion is 74.50% and 50%.&#x0D; If we compare the efficacy of ADA &gt; 70 U/L and tuberculin skin test positivity to diagnose tuberculous pleural effusion the former is superior statistically to the later (P value is less than 0.01) specificity of tuberculin skin test is low because it may be positive with infection with NTM and prior BCG vaccination.&#x0D; Conclusion: Maximum incidence of tuberculous pleural effusion occurs in the age group of 20-30 years. Malignant pleural effusion is less likely below the age group of 30 years.&#x0D; Increased ADA level &gt;70 U/L in pleural fluid is a sensitive, minimally invasive, cost effective, easy method for diagnosis of tuberculous pleural effusion.&#x0D; Lower level of pleural fluid ADA level (&lt;40 U /L) is a sensitive, specific, minimally invasive, cost effective easy method for suspecting malignant effusion. Its value is much more important when younger patients (&lt;40 years of age) present with malignant effusion, especially so when the pleural fluid is also appeared pale yellow. A low ADA level will guide us to look for malignancy in this age group.&#x0D; Tuberculin skin testing with intermediate strength PPD has a high sensitivity in patients with pleural tuberculosis. It was seen negative in 1/3rd cases of TBPE. This negative tuberculin skin test in TBPE may be due to recent tuberculous infection or may be due to sequestration of PPD reactive T-lymphocytes in the pleural space or patient may be anergic. Our study is insufficient to comment this negative result. More precise study need to comment.

Diagnostic role of interleukin -33 in the differentiation of pleural effusions especially tuberculous and malignant effusions

BackgroundTuberculous pleurisy and malignancy are two of the most common causes of pleural effusion. IL-33 is expressed in the epithelial lining and endothelial cells and is released after cell damage; it is proposed to have an essential role in sensing damage in various infectious and inflammatory diseases. This work aimed to determine the diagnostic role of IL-33 in pleural effusions.MethodsOne hundred seventeen patients with pleural effusions of different etiologies had a quantitative measurement of IL-33 in their pleural effusion and serum samples by ELISA technique.ResultsThe concentrations of IL-33 (mean ± SD) in tuberculous pleural effusion (TPE) group (22.5 ± 0.90 ng/l) were significantly higher than that of malignant pleural effusion (MPE) group (14.6 ± 2.35 ng/l; P < 0.001). There is no significant difference between the serum levels of IL-33 in (TPE) group and (MPE) group (P > 0.05). The concentrations of IL-33 in the pleural effusions were significantly correlated to that of the serum concentrations in each group (TPE: r = 0.848, P = < 0.001; MPE: r = 0.881, < 0.001) and pleural ADA in patients with tuberculous pleural effusions, (r = 0.38, P < 0.001). The cut-off value of pleural IL33 for (TPE) was 19.16 ng/l, with a sensitivity of 91.7%, a specificity of 96.4%. The cutoff point of a pleural/ serum IL-33 ratio for the diagnosis of TPE was > 1.4 with a sensitivity of 91.7% and specificity of 100% while for the determination of (MPE) was < 0.9 with a sensitivity of 83.3% and specificity of 96.4%.ConclusionIL-33 level may serve as a novel biomarker to differentiate pleural effusions, especially tuberculous from malignant effusions.

CORRELATING BIOCHEMICAL, RADIOLOGICAL AND CYTOLOGICAL OUTCOMES OF PLEURAL EFFUSION

Introduction: The research emphasises on the association bond of correlation of biochemical radiological and cytological outcomes of pleural effusion&#x0D; Material and Methods: The samples for the study were collected from the diagnostic centre, out-patient department and in-patient department of Department of Biochemistry, Internal Medicine, Respiratory Medicine at Rabindranath Tagore Medical College, Udaipur, Rajasthan The research was carried out on a total of 100 patients .The observations took about a year’s time. The research was carried out on a total of 100 patients,&#x0D; Results: 100 patients with pleural effusion were studied of which 60.00% were cases of tuberculous effusion and 40.00% were cases of non tuberculous effusion. This was reflective of the high prevalence of tuberculosis in the area being studied. The remaining 40 cases were of malignant effusion (15 cases), Transudative effusion (13 cases), synpneumonic effusion (8 cases) and 4 cases of empyema.. In patients of age more than 40 years, malignant effusion was more common; It was found more common in lower socioeconomic class such people live in crowded, unhygienic conditions. The commonest symptoms were cough (81.32%) and breathlessness (78.76%), followed by fever 69.20%, weight loss 64.64%, chest pain 45.50%, loss of appetite 63.30% and hemoptysis 15.80%.&#x0D; Conclusion: Thus it can be concluded that ADA is elevated in tubercular pleural effusion. Exudatives had decreased glucose but increased protein, LDH and cholesterol compared to transudatives Pleural fluid cytology revealed elevated Lymphocytes in tubercular and polymorphs in acute infections&#x0D; Keywords: Lactate dehydrogenase, Adenosine Deaminase biochemical, radiological and cytological outcomes of pleural effusion

Score for Differentiating Pleural Tuberculosis from Malignant Effusion.

Differential diagnosis of lymphocytic pleural effusions between tuberculous (TBE) and malignant (ME) effusion is usually difficult in daily practice. Our aim was to develop a score to differentiate TBE from ME effusions. A cohort of 138 consecutive patients with pleural effusion was prospectively studied from May 2014 through June 2017. Glucose, lactate dehydrogenase (LDH), proteins, white cell count, lactic acid, and pH in the pleural fluid were measured. Pleural effusions other than lymphocytic, patients with a final diagnosis other than tuberculosis or malignancy, and patients who met Light’s criteria for transudate were excluded. Eighty-two samples (47 TBE and 35 ME) were included in the analysis. Using logistic regression analysis and Wald test, we developed a score including age, glucose, proteins, and lactic acid. The receiver operating characteristic curve (ROC) for the score was determined, and the area under the curve (AUC) was calculated. A cutoff of eight points was required to achieve 93.5% sensitivity, 78% specificity, and a likelihood ratio of 4.26 to distinguish tuberculosis from malignant pleural effusion. The AUC of the score was 0.915 (95% CI = 0.82–0.96).

Tuberculous pleural effusion: Modification of metabolome by the effect of common metabolic disease, diabetes mellitus

Background: Pleural effusion is an important problem in chest medicine. This problem might be seen in several conditions including tuberculosis and cancer. The differential diagnosis between tuberculous effusion and other effusions usually requires a good diagnostic test. The advance metabolomics approach is mentioned for the usefulness for differential diagnosis. The important consideration is on the effect of background metabolic alterations of the patients. Methods: The authors hereby assess the effect of background diabetes mellitus on the metabolome in tuberculous effusion. The common specific metabolome between tuberculous effusion and diabetes is searched for. The simulation to assess the confounding and overlapping effect of metabolome in diabetes to tuberculous effusion is done. Results: The only one identified common metabolome is citric acid. According to the simulation, there is a significant confounding and overlapping effect of citric acid in diabetes to tuberculous effusion. Conclusion: Diabetes might interfere with the use of citric acid as a metabolomic biomarker for tuberculous effusion.

To Assess Diagnostic value of Lymphocyte // Neutrophil ratio and Adenosine Deaminase in the Diagnosis of Exudative Tubercular Pleural Effusion

Background: Adenosine deaminase (ADA) is considered a valuable tool in the diagnosis of extra pulmonary tuberculosis. Objective: To evaluate the role of ADA and L/N ratio in the diagnosis of tuberculous pleural effusion in patients with exudative pleural effusion and to analyze the cause of non tuberculous exudative pleural effusion. Methods: This hospital based prospective study was conducted from November 2017 to November 2018 with a total number of 100 patients of exudative pleural effusion who were admitted in medical wards of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, India. Patients with transudative pleural effusion, age less than 12years and those who were hemodynamically unstable were excluded from the study. Results: A total of 100 patients with exudative pleural effusion were analyzed, of which 69 were males and 31 females. maximum number of cases were seen in age group between 21 and 40 yrs. Total ADA was found to be >40U/L in all cases of TB effusion. All cases of TB effusion were lymphocyte predominant with L/N ratio > 0.75. In case of exudative pleural effusion due to non tuberculous etiology L/N ratio was < 0.75. Conclusion: 100 cases of exudative pleural effusion were analyzed based on Total ADA and L/N ratio. 80 cases were due to tuberculosis. ADA value of >100 U/L was observed only in tuberculous effusion. L/N ratio was >0.75 in 80 cases of TB effusion and in none of the non tuberculous effusion. Combined use of ADA and L/N ratio is more efficient means for diagnosing tubercular pleural effusion than the use of ADA alone.

Right-Sided Constrictive Pericarditis: A Rare Variant of an Uncommon Disease

Constrictive pericarditis (CP) is characterized by thick pericardial fibrosis and calcification that causes progressively impaired diastolic filling of the heart with associated symptoms of heart failure. Rarely, it can also present as localized CP and depending on the CP location, clinical presentation can be variable, including compression and obstruction of right ventricular inflow tract, coronary obstruction, or pulmonary stenosis. We report a rare case of isolated constriction of the right side of the heart due to loculated tuberculous pericardial effusion.

Subxiphoid Tube Pericardiostomy in the Management of Pericardial Effusion: Our Experience

Introduction – There is minimal amount of fluid within the two layers of the pericardium. This serves to lubricate the layers preventing friction. Various disease processes can lead to increase in the amount of this fluid which cause haemodynamic compromise these patients. Various methods have been used to drain this fluid. We report our experience with subxiphoid tube pericardiotomy in the drainage of pericardial effusion. Material and Method – we reviewed case files of 30 patients that presented to us with pericardial effusion over a six-year period. Results - There were 19 males (63.3%) and 11 females (36.7%). Age range is between 2 yrs and 65 years with a mean of 27.3 yrs. Adult age group accounted for 25 (83.3%) while paediatric age group was 5 (16.7%). Predominant symptom was dyspnea and all patients had subxiphoid tube pericardiostomy for drainage. Majority of our patients (80%) had tuberculosis as the cause of their effusion. Mortality was 3 (10%) following the drainage but cause of death was progression of their disease. The was recurrence in one patient who had malignant effusion and was subsequently treated with pericardial window but later lost to follow up. Conclusion - Subxiphoid tube pericardiostomy still remains the main stay in the management of massive tuberculous pericardial effusion in our environment as it provides the opportunity to drain the fluid and take adequate fluid samples and tissue for diagnosis. Recurrence rate is also low.

The usefulness of pleural fluid presepsin, C-reactive protein, and procalcitonin in distinguishing different causes of pleural effusions

BackgroundWe aimed to determine the presepsin concentration in pleural fluid from patients with pleural effusions of different aetiologies and to compare its diagnostic value with that of pleural fluid C-reactive protein (CRP) and procalcitonin (PCT).MethodsWe enrolled 132 patients with pleural effusion who underwent diagnostic evaluation, and we classified them into six categories: empyema, parapneumonic effusion, tuberculous effusion, malignant effusion, paramalignant effusion, and transudate effusion. Additionally, all pleural effusions were categorised as infectious or non-infectious effusions.ResultsReceiver operating characteristic analysis was used to evaluate diagnostic performance. When diagnosing empyema, the marker with the highest sensitivity was pleural fluid presepsin (cut-off: 754 pg/mL; sensitivity: 90.9%, specificity: 74.4%) and that with the highest specificity was pleural fluid CRP (cut-off: 4.91 mg/dL; sensitivity: 63.6%, specificity: 89.3%). Pleural fluid PCT tended to be lower in patients with empyema than in those with parapneumonic effusion, but this was not useful for the diagnosis of empyema. When diagnosing infectious pleural effusion, a combination of pleural fluid CRP (cut-off: 2.59 mg/dL) and presepsin (cut-off: 680 pg/mL) produced the highest diagnostic accuracy (83.3%).ConclusionsPleural fluid presepsin was found at high levels in patients with empyema and parapneumonic effusion. This pattern closely resembles the previously reported pattern of pleural fluid CRP. Some combinations of pleural fluid inflammatory markers may be more clinically useful than these markers in isolation.

Diagnostic utility of QuantiFERON-TB Gold and Xpert MTB/RIF combined with adenosine deaminase in tuberculous pleural effusion: a prospective study

ObjectiveTuberculous pleural effusion remains difficult to diagnose despite numerous diagnostic tools. The aim of this study was to evaluate and compare the diagnostic efficiency of adenosine deaminase (ADA) analysis in the diagnosis of tuberculous pleural effusion when used alone or in combination with QuantiFERON-TB Gold (QFT-G) or Xpert MTB/RIF.Patients and methodsSeventy-one patients with unknown bilateral or unilateral pleural effusion were subjected to pleural tapping, and pleural fluid samples were subjected to total ADA, QFT-G, and Xpert MTB/RIF. Pleural biopsies (thoracoscopic or closed) were performed for 41 patients, sent for histopathology of tuberculosis culture and Xpert MTB/ RIF, and they were differentiated into tuberculous (TB) and non-TB effusions by culture for Myobacterium tuberculosis and/or histopathology of pleural biopsy.ADA results were further analyzed using receiver operating characteristic curve to determine the cutoff values to achieve the optimum sensitivity and specificity.ResultsForty-six patients had definite TB pleural effusion and 25 patients had non-TB pleural effusion. For ADA at a cutoff point of >40 IU/l, the sensitivity was 97.83% (n=45) [95% confidence interval (CI): 88.47–99.94%) and specificity was 76.00% (95% CI: 54.87–90.64%), but at a cutoff point of 70 U/l, the specificity was 96.00% (95% CI: 79.65–99.90%) and sensitivity was 84.78% (n=39) (95% CI: 71.13–93.66%). The sensitivity of QFT-G was 23.91% (95% CI: 12.59–38.77%) and specificity was 96.00% (95% CI: 79.65–99.90%). The sensitivity of Xpert MTB/RIF was 47.83% (95% CI: of 32.89–63.05%) and specificity was 100.00% (95% CI: 86.28–100.00%). Combined analysis of ADA at a cutoff value greater than 70 U/l with Xpert MTB/RIF showed a sensitivity of 85.64% (95% CI: 71.13–96.23%) and specificity of 98.50% (95% CI: 78.64–99.93%). ADA at a lower cutoff value greater than 40 U/l showed a sensitivity of 96.78% (95% CI: 77.13–99.66%) and specificity of 97.00% (95% CI: 79.65–99.90%).ConclusionADA is a useful marker in the diagnosis of TB pleural effusion. ADA specificity with low cutoff value can be improved by combining with Xpert MTB/RIF, resulting in an accurate test to identify patients with suspected TB pleural effusion.

Tuberculous Pericardial Effusions in Children.

Current data on tuberculous pericardial effusion in children are limited. In this study, the cases of 30 children with tuberculous pericardial effusion were reviewed retrospectively. The prevalence of human immunodeficiency virus and of culture-confirmed tuberculosis was high. Chest radiography provided lower diagnostic sensitivity than sonography but detected all large and complicated effusions. Outcomes were generally good, and residual complications were mainly due to comorbidity.

Dynamic variation of matrix metalloproteinase-1 and matrix metalloproteinase-9 concentrations in tuberculous pleurisy pleural effusion of rats

Dynamic variation of matrix metalloproteinase-1 and matrix metalloproteinase-9 concentrations in tuberculous pleurisy pleural effusion of rats

English

INTRODUCTION : Pleural effusion is a collection of fluid in the Pleural space. It is not a disease but rather a complication of an underlying illness. Effusion can occur for a variety of reasons. Common classification systems divide pleural effusions into two categories of (1) Transudative pleural effusions and (2) Exudative pleural effusions. Determining the cause of a pleural effusion is greatly facilitated by analysis of the pleural fluid. Thoracentesis is a simple bedside procedure that permits fluid to be rapidly sampled, visualized, examined microscopically, and quantified. A systematic approach to analysis of the fluid in conjunction with the clinical presentation should allow the clinician to diagnose the cause of an effusion. • A definitive diagnosis is provided by the finding of malignant cells or specific organisms in the pleural fluid, can be established in approximately 25 percent of patients. • Pleural effusion remains undiagnosed after routine tests in pleural fluid in many patients. so, we need a simple and safe investigative tool to evaluate undiagnosed effusion. This study is designed to diagnose the cases of undiagnosed effusions by a simple and safe investigative tool. Pleural fluid accumulates when pleural fluid formation exceeds pleural fluid absorption. Normally fluid enters the pleural space from the capillaries in the parietal pleura and is removed via the lymphatics situated in the parietal pleura. Fluid can also enter the pleural space from the interstitial spaces of the lung via the visceral pleura or from the peritoneal cavity via small holes in the diaphragm. The lymphatics have the capacity to absorb 20 times more fluid than is normally formed. Accordingly, a pleural effusion may develop when there is excess pleural fluid formation (from the interstitial spaces of the lung, the parietal pleura, or the peritoneal cavity) or when there is decreased fluid removal by the lymphatics. AIMS AND OBJECTIVES : 1. To evaluate the role of closed Pleural biopsy in diagnosing exudative effusions not diagnosed by Pleural fluid analysis. 2. To compare the yield of each test (Histopathological examination, Reverse Transcriptase Polymerase Chain Reaction and culture for Tuberculosis by BACTEC) in Pleural biopsy specimens of undiagnosed exudative Effusions. MATERIALS AND METHODS : STUDY DESIGN : This is a Prospective (Observational) study designed to evaluate the role of closed pleural biopsy in undiagnosed exudative Pleural effusion. STUDY CENTER : The study was done at the Department of Thoracic Medicine – Government General Hospital, Chennai. STUDY DURATION : January 2010 to June 2010. STUDY POPULATION : Patients with exudative pleural effusion remain undiagnosed after pleural fluid analysis. Proforma was designed and ethical clearance was obtained. A written informed consent was obtained from all the patients included in the study after explaining in detail the nature and purpose of the study. INCLUSION CRITERIA : Exudative effusion which is negative for Malignant cells, Acid Fast Bacillus, Gram stain and Non Tuberculous culture in Pleural fluid. EXCLUSION CRITERIA : • Exudative effusion positive for Malignant cells, • Exudative effusion positive for Tuberculosis in Pleural fluid Smear, • Exudative effusion positive for Gram stain or Non-Tuberculous Culture, • Parenchymal lesion in the X-ray suggestive of Tuberculosis or Malignancy or parapneumonic effusion, • Uncooperative patients, • Coagulation disorders, • Dry pleural tapping, • Empyema, • Uremia. CONCLUSION : Combination of Histopathological examination, BACTEC culture and Reverse Transcriptase Polymerase Chain Reaction in closed Pleural biopsy has a greater diagnostic yield in diagnosing exudative effusions not diagnosed by Pleural fluid analysis. • Histopathological examination diagnosed 67% of Tuberculous effusion. • Reverse Transcriptase Polymerase Chain Reaction diagnosed 26.1% of Tuberculous effusion. • BACTEC diagnosed 11.8% of Tuberculous effusion. • Histopathological examination diagnosed 70% of Malignant effusion. • 82.3% of Tuberculous cases were diagnosed by combining all three tests. • 82.3% of Tuberculous cases were diagnosed by combining Histopathological examination and Reverse Transcriptase Polymerase Chain Reaction. • Pleural biopsy diagnosed 79% of undiagnosed effusion. • Closed Pleural Biopsy can be used as a easy, quick, cost effective and relatively safe method to diagnose an exudative effusion not diagnosed by pleural fluid analysis.

Diagnostic value of soluble triggering receptor expressed on myeloid cells-1 in pleural effusion

Objectives The aim of this study was to assess the value of the pleural fluid soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in the diagnosis of the etiology of pleural effusion. Background The accurate diagnosis of pleural effusion remains a challenging problem even after thoracocentesis and closed pleural biopsy. TREM-1 is a recently described molecule that plays an important role in myeloid cell-activated inflammatory responses. Patients and methods We measured sTREM-1 levels from 20 patients with transudative effusion, 20 patients with malignant effusion, 20 patients with tuberculous effusion, and 20 patients with parapneumonic effusion using a specific enzyme-linked immunosorbent assay technique. Result sTREM-1 levels were significantly higher in parapneumonic effusion (45.50 ± 13.21 ng/l) than tuberculous effusion (34.90 ± 10.51 ng/l) and in malignant effusion (15.37 ± 5.01 ng/l) than transudative effusion (6.75 ± 3.35 ng/l). Conclusion Our study suggests that sTREM-1 can differentiate between infectious effusions (parapneumonic and tuberculous) and noninfectious effusions (malignant and transudative effusions).

Echocardiographic Findings of Tuberculous Pericardial Effusion in Early Stage of Chronic Kidney Disease

Echocardiographic Findings of Tuberculous Pericardial Effusion in Early Stage of Chronic Kidney Disease

Anasarca as the Initial Manifestation of Tuberculous Pericarditis in a Child

AbstractPericarditis is a rare manifestation of tuberculosis in children. The usual clinical features include fever, cough, tachypnea, chest pain, and pedal edema. Very rarely, generalized edema may occur as a presenting feature. We describe a 10-year-old boy, who presented with anasarca and had received treatment with corticosteroids for a mistaken diagnosis of nephrotic syndrome and was subsequently diagnosed with tuberculous pericardial effusion. The rarity of manifestations and the difficulties encountered to diagnose tuberculous pericarditis prompted us to report this case. The report may serve to sensitize pediatricians to consider systematic investigations to reach the diagnosis in children presenting with anasarca and avoid the empiric use of steroids in anasarca.