Tuberculous Effusion Research Articles

Diagnostic utility of sonar guided biopsy in tuberculous effusion

Background/aimTuberculous pleural effusion remains the commonest cause of exudative effusions in areas with a high prevalence of tuberculosis and histological examination of pleural tissue is the gold standard for its diagnosis. This study was to assess the diagnostic utility of sonar guided biopsy in tuberculous pleural effusion. Patients and methods50 patients (34 men) of mean±SD age 38.7±16.7years with pleural effusions and a clinical suspicion of tuberculosis were enrolled in the study. Transthoracic ultrasound was performed on all patients, who were then randomly assigned to undergo ⩾4 Abrams needle biopsies followed by ⩾4 Tru-Cut needle biopsies or vice versa. ResultsPleural tuberculosis was diagnosed in 31 patients, alternative diagnoses were established in 16 patients and 3 remained undiagnosed. Pleural biopsy specimens obtained with Abrams needles contained pleural tissue in 29 patients (92.0%) and were diagnostic for tuberculosis in 26 patients (sensitivity 82%), whereas Tru-Cut needle biopsy specimens only contained pleural tissue in 21 patients (78%) and were diagnostic in 21 patients (sensitivity 64%). ConclusionsUltrasound-assisted pleural biopsies performed with an Abrams needle are more likely to contain pleural tissue and have a significantly higher diagnostic sensitivity for pleural tuberculosis.

English

CONTEXT: Pleural effusion occurs secondary to various diseases. Common causes of exudative effusion are tuberculosis, bacterial pneumonia, and malignancy. Transudative effusion is due to systemic diseases like cardiac failure, cirrhosis of liver. Conventional methods of diagnosis may not be able to establish the cause of pleural effusion. Early diagnosis and management reduces the morbidity and mortality. AIM: The objective of the study is to estimate pleural fluid Adenosine Deaminase (ADA) and C - reactive protein (CRP) levels and to evaluate their efficacy in differential diagnosis of transudative and exudative, tuberculous and non tuberculous and inflammatory and non inflammatory effusions. MATERIAL AND METHODS: Fifty two patients of pleural effusion were investigated and divided into four groups based on diagnosis. Group I, II, III and IV had 24 cases of tuberculous effusion, 13 cases of transudative effusion, 08 cases of malignant effusion and 07 cases of parapneumonic effusion respectively. Pleural fluid was analyzed for ADA (Guisti and Galanti's method) and CRP (turbidometric immunoassay). STATISTICAL ANALYSIS: The statistical analysis was done using unpaired student't' test and p value < 0.05 was considered statistically significant. RESULTS: In the present study pleural fluid ADA revealed highly significant increase in tuberculous effusion than non tuberculous effusions (p <0.001) and also when compared with non tuberculous subgroups, transudative effusion (p < 0.001), malignant effusion (p<0.001), and PPE (p<0.01). ADA levels at a cutoff value of 40U/L, showed sensitivity, specificity, positive predictive value and negative predictive value of 91.67%, 89.3%, 88% & 92.6% respectively in tuberculous effusion. Pleural fluid CRP levels in parapneumonic effusion were significantly higher compared to other types of effusions (p<0.001). Significantly higher levels of CRP were seen in exudative effusion compared to transudative effusion (p<0.001) and in inflammatory effusion compared to non inflammatory effusion (p<0.001).

Characterization Molecular Biochemical Method for Diagnostic of Tuberculosis in the Pleural Samples

Objectives: To compare the diagnostic efficiency of adenosine deaminase, isoenzyme adenosine deaminase-2 and concentration of interferon- $\gamma$ in patients with tuberculous pleural effusion. Materials and Methods: The prospective study was done on 114 patients who were divided into 3 groups: tuberculous, non-tuberculous infectious pleurisy, and malignant effusion. The adenosine deaminase, adenosine deaminase-2 and interferon- $\gamma$ were analyzed by receiver operating characteristic curves. Results: There was increase of all three markers in tuberculous pleural effusion but not in nontuberculous effusion. The cut-off values for adenosine deaminase, adenosine deaminase-2 and interferon- $\gamma$ were 40, 26 U/l. and 299 pg/ml respectively. Adenosine deaminase, adenosine deaminase-2 activities were significantly higher in tuberculous effusion than in malignant pleural effusion (more than 5 times) and in non-tuberculous infectious pleurisy (more than 4 times). The median of interferon- $\gamma$ concentration in pleural fluid of tuberculous patients was 1514.2 pg/ml (931.2-2187.5pg/ml) which was 10 times more than the median values of other groups of patients. There was no significant difference between patients with malignant effusion and those with non-tuberculous pleural effusion. Conclusions: All three markers had higher diagnostic yield for tuberculous effusion.

Diagnostic value of pleural fluid interferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar

ObjectiveTo investigate the diagnostic utility of interferon-gamma (IFN-γ) and adenosine deaminase (ADA) in tuberculous pleural effusions by determining the best cutoff levels of these two markers for pleural tuberculosis, in the context of the local epidemiological settings in Qatar.MethodsWe prospectively studied IFN-γ and ADA levels in the pleural fluid of patients presenting to Hamad General Hospital between June 1, 2009 and May 31, 2010.ResultsWe studied 103 patients with pleural effusions, 72 (69.9%) with pleural tuberculosis, and 31 (30.1%) with nontuberculous etiologies. The mean IFN-γ concentration for the group with tuberculous effusions was significantly higher than that in the group with nontuberculous effusions (1.98 ± 81 vs 0.26 ± 10 pg/mL [P < 0.0001]). The mean ADA activity for the tuberculous effusions group was significantly higher than that in group with nontuberculous effusions (41.30 ± 20.09 vs 14.93 ± 14.87 U/L [P < 0.0001]). By analysis of receiver operating characteristic (ROC) curves, the best cutoff values for IFN-γ and ADA were 0.5 pg/mL and 16.65 U/L, respectively. The results for IFN-γ vs ADA were: for sensitivity, 100% vs 86%, respectively; for specificity, 100% vs 74%, respectively; for positive predictive value, 100% vs 88.5%, respectively; and for negative predictive value, 100% vs 69.7%, respectively.ConclusionIFN-γ and ADA could be used as valuable parameters for the differentiation of tuberculous from nontuberculous effusion, and IFN-γ was more sensitive and specific for tuberculous effusion than ADA.

Role of Blind Closed Pleural Biopsy in the Management of Pleural Exudates

The performance of blind closed pleural biopsy (BCPB) in the study of pleural exudates is controversial. To assess the diagnostic yield of BCPB in clinical practice and its role in the study of pleural exudates. Data were retrospectively collected on all patients who underwent BCPB performed between January 1999 and December 2011. A total of 658 BCPBs were performed on 575 patients. Pleural tissue was obtained in 590 (89.7%) of the biopsies. A malignant pleural effusion was found in 35% of patients. The cytology and the BCPB were positive in 69.2% and 59.2% of the patients, respectively. Of the patients with negative cytology, 21 had a positive BCPB (diagnostic improvement, 15%), which would have avoided one pleuroscopy for every seven BCPBs that were performed. Of the 113 patients with a tuberculous effusion, granulomas were observed in 87 and the Lowenstein culture was positive in an additional 17 (sensitivity 92%). The overall sensitivity was 33.9%, with a specificity and positive predictive value of 100%, and a negative predictive value of 71%. Complications were recorded in 14.4% of patients (pneumothorax 9.4%; chest pain 5.6%; vasovagal reaction, 4.1%; biopsy of another organ 0.5%). BCPB still has a significant role in the study of a pleural exudate. If an image-guided technique is unavailable, it seems reasonable to perform BCPB before resorting to a pleuroscopy. These results support BCPB as a relatively safe technique.

Pleural Fluid Pentraxin-3 for the Differential Diagnosis of Pleural Effusions

BackgroundConventional biomarkers cannot always establish the cause of pleural effusions; thus, alternative tests permitting rapid and accurate diagnosis are required. The primary aim of this study is to assess the ability of pentraxin-3 (PTX3) in order to diagnose the cause of pleural effusion and compare its efficacy to that of other previously identified biomarkers.MethodsWe studied 118 patients with pleural effusion, classified as transudates and exudates including malignant, tuberculous, and parapneumonic effusions (MPE, TPE, and PPE). The levels of PTX3, C-reactive protein (CRP), procalcitonin (PCT) and lactate in the pleural fluid were assessed.ResultsThe levels of pleural fluid PTX3 were significantly higher in patients with PPE than in those with MPE or TPE. PTX3 yielded the most favorable discriminating ability to predict PPE from MPE or TPE by providing the following: area under the curve, 0.74 (95% confidence interval, 0.63-0.84), sensitivity, 62.07%; and specificity, 81.08% with a cut-off point of 25.00 ng/mL.ConclusionOur data suggests that PTX3 may allow improved differentiation of PPE from MPE or TPE compared to the previously identified biomarkers CRP and PCT.

Comparative analysis of pleural fluid biochemical parameters with cholesterol to differentiate transudates from exudates

Background: Light's criteria is the gold standard to differentiate transudative pleural effusion (PE) from exudative PE, but it requires four biochemical estimations which, in developing countries such as India, may not be feasible in every patient due to economic constraints. Aims: To evaluate the comparative usefulness of pleural fluid biochemical parameters with relative usefulness of pleural cholesterol to the traditional Light' criteria. Setting and Design: Prospective institutional based study. Materials and Methods: A total of 56 cases of PE were studied consecutively, of which 34 cases were of tuberculous effusion and 22 cases of nontubercular effusion. The data obtained from the patients were collected, analyzed, and observations noted down. Statistical Analysis: Sensitivity, specificity, positive predictive value and negative predictive value of different biochemical parameters single or in combination were analyzed by SPSS 16 software. Results: According to their etiology, 7 of the effusions were transudates and 49 were exudates. Using a cutoff point of 45 mg for pleural cholesterol and values for protein and lactate dehydrogenase (LDH) of Light et al., the best diagnostic power corresponded to the combination of pleural cholesterol and LDH; cholesterol level over 45 mg/dL and/or LDH over 200 IU/L differentiate exudates from transudates with a sensitivity of 99% and a specificity of 98%. Conclusions: The measurement of pleural cholesterol and LDH permits the separation of pleural exudates from transudates with accuracy similar to the original report of Light et al., with the advantage of requiring only two laboratory determinations and no simultaneous blood sample, especially in a country like India where financial and technical constraints are immense.

The significance of the soluble Apo-1/Fas in serum and pleural effusion in differentiating tuberculous and malignant pleural effusion

Objective To investigate the significance of the soluble Apo-1/Fas(sApo-1/Fas) in differentiating tuberculous and malignant pleural effusion.Methods The level of sApo-1/Fas was detected by enzyme linked immunosorbent assay(ELISA).in serum and pleural effusion of 50 cases with malignant pleural effusion and 48 cases with tuberculous pleural effusion.Results The level of sApo-1/Fas in the serum and pleural effusion of malignant pleural effusion patients were ( 16.3 ± 2.5 ) μg/L and ( 38.6 ± 13.5) μg/L,significantly higher than those of tuberculous patients with pleural effusion( all P ＜ 0.05 ).The difference of rates of serum and pleural effusion in malignant pleural effusion and tuberculous pleural effusion patients was significant( P ＜ 0.05 ).The sensitivity,specificity and accuracy of sApo-1/Fas in serum and malignant pleural effusion were 66.0％ and 93.8％ and 79.6％.Conclusion The detecting of sApo-1/Fas may play some role in differentiating tuberculous and malignant pleural effusion. Key words: SApo-1/Fas; Malignant/tuberculosis; Pleural effusion

Quantification of echodensities in tuberculous pericardial effusion using fractal geometry: a proof of concept study

BackgroundThe purpose of this study was to quantify the heterogeneous distribution of echodensities in the pericardial fluid of patients with tuberculous pericarditis using echocardiography and fractal analysis, and to determine whether there were differences in the fractal dimensions of effusive-constrictive and effusive non-constrictive disease.MethodsWe used fractal geometry to quantify the echocardiographic densities in patients who were enrolled in the Investigation of the Management of Pericarditis in Africa (IMPI Africa) Registry. Sub-costal and four chamber images were included in the analysis if a minimum of two clearly identified fibrin strands were present and the quality of the images were of a standard which allowed for accurate measurement of the fractal dimension. The fractal dimension was calculated as follows: Df = limlog N(s)/[log (l/s)], where Df is the box counting fractal dimension of the fibrin strand, s is the side length of the box and N(s) is the smallest number of boxes of side length s to cover the outline of the object being measured. We compared the fractal dimension of echocardiographic findings in patients with effusive constrictive pericarditis to effusive non-constrictive pericardial effusion using the non-parametric Mann–Whitney test.ResultsOf the 14 echocardiographs from 14 participants that were selected for the study, 42.8% (6/14) of images were subcostal views while 57.1% (8/14) were 4-chamber views. Eight of the patients had tuberculous effusive constrictive pericarditis while 6 had tuberculous effusive non-constrictive pericarditis. The mean fractal dimension Df was 1.325 with a standard deviation (SD) of 0.146. The measured fibrin strand dimension exceeded the topological dimension in all the images over the entire range of grid scales with a correlation coefficient (r2) greater than 0.8 in the majority. The fractal dimension of echodensities was 1.359 ± 0.199 in effusive constrictive pericarditis compared to 1.330 ± 0.166 in effusive non-constrictive pericarditis (p = 0.595).ConclusionsThe echocardiographic densities in tuberculous pericardial effusion have a fractal geometrical dimension which is similar in pure effusive and effusive constrictive disease.

Atrial fibrillation as a consequence of tuberculous pericardial effusion

in the current study for low-energy internal cardioversion of AF. Compared to the conventional lead configurations, the proposed electrode placement strategy achieves lower inter-electrode impedance and delivers more intense electric field thorough atrial myocardium while only having minimum amounts of myocardium subject to damage. We would like to thank Minnesota Supercomputing Institute for providing the computation resources. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [16].

Levels of YKL-40 in pleural effusions and blood from patients with pulmonary or pleural disease

BackgroundYKL-40 (a chitinase-like protein) is an inflammatory biomarker that is associated with lung injury pathogenesis. We aimed to identify the diagnostic values of YKL-40 in pleural effusions and to evaluate circulating YKL-40 levels during multiple etiological pulmonary/pleural diseases and the role of YKL-40 as a monitoring marker of inflammatory pulmonary disease. MethodsPleural YKL-40 (n=197), YKL-39 (the most homologous chitinase-like protein to human YKL-40), and conventional pleural marker levels were measured in patients with pulmonary/pleural disease. Additionally, serum YKL-40 and YKL-39 levels were analyzed in both patients and controls (n=432) and serially monitored in patients with asthma (n=27) or pneumonia (n=22). ResultsPleural YKL-40 levels were higher than those in the serum and highest in tuberculous pleural effusions (TPEs; 1181ng/mL), followed by parapneumonic, malignant, and cardiogenic effusions (560ng/mL). The diagnostic accuracy of pleural YKL-40 (0.78) for discriminating between tuberculous and malignant effusion was comparable to or greater than those of YKL-39, total protein, C-reactive protein and CYFRA 21-1, and lower than those of adenosine deaminase (p<0.05) and carcinoembriogenic antigen (p=0.05). Serum YKL-40 levels were higher in the pneumonia group than in the cancer, asthma, or control groups. Following treatment, serum YKL-40 levels were more greatly reduced in pneumonia patients than in asthma patients. Serum YKL-39 levels did not differ between patients and controls. ConclusionsPleural YKL-40 levels are elevated in TPEs and have fairly good diagnostic efficacy for detecting TPEs. However, adenosine deaminase is more efficient for detecting TPEs than pleural YKL-40. Serum YKL-40 levels are highest during pneumonia compared to common pulmonary/pleural diseases and are more useful for monitoring pneumonia than asthma.

Role of fine‐needle aspiration cytology and fluid cytology in extra‐pulmonary tuberculosis

Extra-pulmonary tuberculosis is the presence of disease in an organ without obvious involvement of the lungs (World Health Organization, Tuberculosis Fact sheet, 2006). The present article focuses on the incidence of extra-pulmonary tuberculosis as an emerging and clinically significant disease to be reckoned with in the present era. It also highlights fine-needle aspiration cytology (FNAC) as an inexpensive, less invasive procedure for early diagnosis of such tuberculosis and timely initiation of specific therapy. All cases of proved tuberculosis presenting to the M.V.J. Medical College and Research Hospital were recorded over a period of two years (2008-2010); and categorized as pulmonary and extra-pulmonary cases. A total of 96 cases of tuberculosis were observed; extra-pulmonary tuberculosis was seen in 64 cases. Of these 56 cases were from lymphnodes and 8 from extra-nodal sites which included tuberculous dactylitis (two cases), tuberculous mastitis (two cases), tuberculous synovial effusion (one case), pericardial effusion (one case), epididymo-orchitis (one case), and cold abscess (one case). The cytology patterns observed included granulomatous inflammation and necrosis with or without acid fast bacilli.

CXCL12 as a biological marker for the diagnosis of tuberculous pleurisy

Although a chemokine CXCL12 is implicated in some infectious diseases, especially those in which T cell-mediated immunity plays critical roles, the relevance of CXCL12 to tuberculosis has never been elucidated. To determine the clinical efficacy of CXCL12 as a diagnostic marker for tuberculous (TB) pleurisy, we measured CXCL12 concentration in pleural fluid and serum from patients with various etiologies. Of 60 patients with pleural fluid, the median age of TB patients was 52 which was significantly lower than 71 of non-TB patients (P<0.01). CXCL12 level in TB effusion (4456±1013pg/mL, n=15) was significantly higher than non-TB effusion (2851±1229pg/mL, n=45) (P<0.01). On the other hand, serum CXCL12 level showed no significant differences among TB pleurisy, non-TB pleurisy, and normal healthy subjects. The sensitivity and specificity of CXCL12 in pleural fluid for the diagnosis of TB pleurisy was 60.0% and 93.2% (cut-off value=4600pg/mL), respectively. Area under the receiver operating characteristic (ROC) curve (AUC) for CXCL12 was 0.84. As the source of CXCL12, pleural mesothelium, endothelium of pulmonary vessels, bronchial epithelium, multinucleated giant epithelioid cells, and macrophages were positive for CXCL12 staining. Increased CXCL12 level in pleural fluid could be an informative diagnostic marker for differentiating TB pleurisy from other etiologies.

Diagnostic value of soluble B7-H4 in malignant pleural effusion

To explore the diagnostic value of soluble B7-H4 (sB7-H4) in tuberculous pleural effusion and malignant pleural effusion. A total of 98 patients of pleural effusion treated in Nanjing Chest Hospital from January 2007 to December 2009 were enrolled. The etiologies were tuberculous (n = 48) and malignant (n = 50). The levels of sB7-H4 in pleural effusion were detected by sandwich enzyme linked immunosorbent assay. The rational clinical diagnostic value was established by receiver operating characteristic (ROC) curves. The level of sB7-H4 in malignant pleural effusion was significant higher than that in tuberculous effusion ((65.7 ± 5.8) vs (28.6 ± 8.7) µg/L, P < 0.05). The cut-off value of sB7-H4 was 36.5 µg/L for malignant pleural effusion. And the rates of sensitivity, specificity and accuracy were 92.0%, 83.3% and 87.8% respectively. The level of sB7-H4 may be used as a valuable parameter in the differentiation of tuberculous from malignant effusion.

P31 Routine analysis of pleural aspirates for AFB in patients with pleural effusion of unknown cause is of limited use

The investigation of pleural effusion of unknown cause may include analysis of pleural aspirate for presence of acid-fast bacilli (AFB) by smear and culture. We reviewed data on all pleural...

Clinical significance of cytokine measurement in pleural effusion

We measured the activity of adenosine deaminase (ADA) and the concentration of interleukin-1 beta (IL-1 beta), interleukin-2 (IL-2), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) in the pleural effusions from 28 patients with tuberculosis, 30 with neoplastic diseases, 25 with bacterial infections and 18 with congestive heart failure or liver cirrhosis. The levels of ADA (83.0 +/- 32.1 IU/L) and IFN-gamma (795.0 +/- 666.4 pg/ml) in tuberculous effusions were significantly higher than those in other groups (p < 0.0001). IL-1 beta level in the effusions of bacterial infections (265.2 +/- 379.2 pg/ml) was higher than that in other groups (p < 0.0001). TNF-alpha level in the effusions of tuberculosis (31.7 +/- 36.7 pg/ml) and bacterial infections (69.5 +/- 232.9 pg/ml) was higher than that in other groups. IL-8 level of exudative effusions was higher than that of transudates. IL-2 was only present in 4 effusions from tuberculosis and 1 effusion from bacterial infections. Diagnostic utilities of cytokines and ADA for tuberculous effusion were evaluated using receiver operating characteristics (ROC) curve analysis. The cut-off points of ADA, IL-1 beta, IL-8, TNF-alpha and IFN-gamma determined in this analysis were 54 IU/L, 5.5 pg/ml, 405 pg/ml, 4.5 pg/ml and 28 pg/ml, respectively and the sensitivity and the specificity of them were 88.0% and 95.9%, 19.1% and 74.1%, 57.1% and 63.2%, 81.0% and 77.2%, and 96.2% and 98.5%, respectively. In ADA, TNF-alpha and IFN-gamma, the areas under the curve (AUC) that represent the diagnostic accuracy were 0.968, 0.719 and 0.993, respectively. AUC of IFN-gamma was significantly higher than that of ADA or TNF-alpha. In tuberculous pleural effusion, IFN-gamma was significantly correlated with TNF-alpha, IL-1 beta and ADA. The correlation was also present between TNF-alpha and ADA.

Rapid diagnosis of tuberculosis in aspirate, effusions, and cerebrospinal fluid by immunocytochemical detection of Mycobacterium tuberculosis complex specific antigen MPT64

The aim of the study was to evaluate the diagnostic potential of immunocytochemical staining for the detection of Mycobacterium tuberculosis complex-specific antigen MPT64, in tuberculous lymph node aspirates, cerebrospinal fluid, and effusions from pleura and abdomen. One hundred ninety patients with a diagnosis of tuberculosis (cases) and 80 patients with nontuberculous lesions (controls) were enrolled and differentiated on the basis of clinical features, histology, cytology, clinical biochemistry, Ziehl-Neelsen staining, Lowenstein-Jensen culture, and response to antituberculous therapy. Cervical lymph nodes fine-needle aspirate (n = 150), cerebrospinal fluid (n = 27), pleural fluid (n = 41), and peritoneal fluid (n = 52) were collected and stained with anti-MPT64 and anti-BCG antibodies using immunocytochemistry. Nested-PCR for IS6110 was done for comparison and to calculate the diagnostic indices of the ICC staining. ICC staining with anti-MPT64 was positive in 128/190 (67.4%) tuberculous smears and in 4/80 (5%) control smears thus giving sensitivity of 67.4% and the specificity of 95%, while anti-BCG was positive in 112 (58.9%) tuberculous smears and in 16/80 (20%) control smears with sensitivity of 58.9% and specificity of 80%. When diagnostic validation of ICC was done using PCR as the gold standard, the overall sensitivity, specificity, positive- and negative-predictive values for ICC staining in smears with anti-MPT64 was 96, 96, 95, and 97%, respectively, while the corresponding values for anti-BCG were 87, 88, 86, and 88%. ICC staining using anti-MPT64 represents a robust and simple method for establishing an early etiological diagnosis of M. tuberculosis complex infection in extrapulmonary tuberculosis.

Pneumopericardium as a Complication of Pericardiocentesis

Pneumopericardium is a rare complication of pericardiocentesis, occurring either as a result of direct pleuro-pericardial communication or a leaky drainage system. Air-fluid level surrounding the heart shadow within the pericardium on a chest X-ray is an early observation at diagnosis. This clinical measurement and process is variable, depending on the hemodynamic status of the patient. The development of a cardiac tamponade is a serious complication, necessitating prompt recognition and treatment. We recently observed a case of pneumopericardium after a therapeutic pericardiocentesis in a 20-year-old man with tuberculous pericardial effusion.

Diagnostic accuracy of biomarkers of oxidative stress in parapneumonic pleural effusions

The imbalance between oxidants and antioxidants is referred to as oxidative stress and has been associated with various respiratory disorders. The aim of this study was the assessment of 8-isoprostane (8-iso-PGF(2α)) and Cu/Zn superoxide dismutase (Cu/Zn SOD) in exudative pleural effusions in order to examine the diagnostic accuracy of these markers in the differentiation between complicated and uncomplicated parapneumonic effusions. The study included 214 consecutive patients with pleural effusions [68 parapneumonic (31 uncomplicated parapneumonic, 20 complicated parapneumonic, 17 empyemas), 24 tuberculous, 88 malignant and 34 transudates]. 8-Isoprostane and Cu/Zn SOD were determined by ELISA in pleural fluid and serum. Parapneumonic effusions were characterized by higher pleural fluid 8-isoprostane levels compared to transudative, malignant and tuberculous effusions. Pleural fluid Cu/Zn SOD levels were lower in transudates, while serum levels were higher in transudative compared to all exudative pleural effusions. Both pleural fluid 8-isoprostane and Cu/Zn SOD were higher in complicated parapneumonic effusions and empyemas compared to uncomplicated parapneumonic effusions. Pleural fluid 8-isoprostane was the most accurate test to differentiate between complicated and uncomplicated parapneumonic pleural effusions with a sensitivity of 100% and a specificity of 58·1% at a cut-off point of 35·1 (AUC = 0·848). Pleural fluid 8-isoprostane and Cu/Zn SOD may provide useful information for the differentiation between uncomplicated and complicated parapneumonic effusions and empyemas.

Differential Levels of Cytokines and Soluble Fas Ligand between Tuberculous and Malignant Effusions

Tuberculous pleurisy, which is characterized by an extensive inflammatory exudate in the pleural space, is a common manifestation of extrapulmonary tuberculosis caused by Mycobacterium tuberculosis infection but is difficult to diagnose. This study compared concentrations of three cytokines (interferon-γ and interleukin [IL]-2 and -4) and soluble Fas ligand in serum and pleural effusions from 36 patients with tuberculous pleurisy, 30 with malignant pleurisy and 30 healthy volunteers. Interferon-γ concentration was significantly higher in serum and pleural effusions, and the concentration of soluble Fas ligand was significantly higher in pleural effusion, from patients with tuberculous pleurisy than in those with malignant pleurisy. Levels of IL-2 and IL-4 were also raised in serum, but failed to reach statistical significance. Interferon-γ and soluble Fas ligand levels were significantly higher in pleural effusion than in serum. Pleural soluble Fas ligand concentrations correlated linearly with those of interferon-γ in patients with tuberculous pleurisy. These findings suggest a predominant T-helper-1 response to M. tuberculosis infection.