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Pleural Tuberculosis

Pleural Tuberculoses


Presentation

  • BACKGROUND: The nonspecific clinical presentation and paucibacillary nature of tuberculous pleuritis remains a challenge for diagnosis.[ncbi.nlm.nih.gov]
  • CONCLUSION: Paradoxical response developed in 16% of the patients approximately 2 months after initiation of anti-tuberculosis treatment, presenting with aggravation of pre-existing pleural effusion.[ncbi.nlm.nih.gov]
  • We suggest that all patients presenting with pleural TB should be screened for anti-HIV antibodies.[ncbi.nlm.nih.gov]
  • Blood and pleural fluid were collected at presentation for IFN-gamma assays and the results evaluated for diagnostic accuracy.[ncbi.nlm.nih.gov]
  • The present study investigated MMP-1, -2 and -9 and their specific inhibitors (tissue inhibitor of metalloproteinase (TIMP)-1 and -2) in tuberculous effusions, and correlated these with clinical and histopathological features.[ncbi.nlm.nih.gov]
Fever
  • Persistent evening fever and pleural effusion led to the second diagnosis-pleural tuberculosis.[ncbi.nlm.nih.gov]
  • Abstract A 21-year-old woman was addressed to our department for progressive abdominal swelling, fatigue and fever.[ncbi.nlm.nih.gov]
  • Fever is the most common symptom (90%) and the disease is usually an acute or sub acute one. Weight loss precedes other symptoms. Exudative pleural effusion with predominant lymphocytosis is characteristic.[ncbi.nlm.nih.gov]
  • On univariate analysis, patients with PD had a shorter duration of symptoms and increased reporting of fever (p value 0.02) and were also different from those with only PTB in HIV seropositivity and sputum smear from AFB (p value 0.02 and 0.00 respectively[ncbi.nlm.nih.gov]
  • All patients of pleural tuberculosis presented in this medicine unit had fever and cough associated with chest pain (87.9%), dysnoea (42.4%), haemoptysis (9.1%), weight loss (84.4%), anorexia (90.9%).[ncbi.nlm.nih.gov]
Malaise
  • She was generally well until developing acute onset malaise, fever and chills, shortness of breath, and right-sided pleuritic chest pain over the course of a few days.[ghdonline.org]
  • Loss of appetite, weight loss, weakness, night sweats, and malaise are also common [4]. The most common haematologic manifestations are increases in the peripheral blood polymophonuclear leukocyte count and anaemia.[southsudanmedicaljournal.com]
Pleural Effusion
  • METHODS: We analyzed pleural effusion specimens obtained from 111 patients for whom the exclusion of the possibility of tuberculous pleural effusion was necessary.[ncbi.nlm.nih.gov]
  • Mycobacteria were detected exclusively in tuberculous pleural effusion samples. None of the non-tuberculous pleural effusion samples were positive for mycobacteria. Comparative analysis showed that the N-PCR assay had the highest sensitivity.[ncbi.nlm.nih.gov]
  • RESULTS: We evaluated serum and pleural fluid samples from 132 patients: 97 diagnosed with pleural tuberculosis (study group) and 35 diagnosed with pleural effusion due to other causes (control group).[ncbi.nlm.nih.gov]
  • Mycobacterium tuberculosis bacilli are seldom demonstrated in tuberculous pleural effusion (TPE) by conventional bacteriological methods.[ncbi.nlm.nih.gov]
  • Abstract Cytokines were measured in patients with pleural effusion and miliary tuberculosis (TB).[ncbi.nlm.nih.gov]
Pleuritic Pain
  • Inflammation of the lung parenchyma adjacent to a pleural surface may cause pleuritic pain. Dyspnoea is unusual unless there is extensive disease and may result in respiratory failure [11, 12].[southsudanmedicaljournal.com]
Pleural Disorder
  • How Are Pleurisy and Other Pleural Disorders Diagnosed? National Heart Lung and Blood Institute [On-line information]. Available online at . Accessed June 2012. Crawford Mechem, C. (Updated 2011 July 8). Emergent Management of Pleural Effusion.[labtestsonline.org]
Painful Cough
  • To help diagnose the cause of accumulation of fluid in the chest cavity (pleural effusion ) When a healthcare practitioner suspects that someone with chest pain, coughing, and/or difficulty breathing has a condition that is causing an accumulation of[labtestsonline.org]
Chest Pain
  • Contrast enhanced CT examination of a 22-year-old male with pleuritic chest pain showed pleural-based nodular thickening and masses without any parenchymal involvement or mediastinal lymphadenopathy.[ncbi.nlm.nih.gov]
  • A 54-year-old woman was admitted for pleural tuberculosis diagnosed by right chest pain and cough. She received combination antituberculosis therapy consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide.[ncbi.nlm.nih.gov]
  • RESULTS: In total, 17 patients presented with respiratory symptoms, including dyspnea (30%), hemoptysis (20%), cough (20%), and pleuritic chest pain (15%).[ncbi.nlm.nih.gov]
  • All patients of pleural tuberculosis presented in this medicine unit had fever and cough associated with chest pain (87.9%), dysnoea (42.4%), haemoptysis (9.1%), weight loss (84.4%), anorexia (90.9%).[ncbi.nlm.nih.gov]
  • Fever and chest pain disappeared. Repeat chest X-ray and ultrasound of the thorax revealed minimal pleural effusion.[mjdrdypu.org]

Workup

  • Abstract We prospectively evaluated the diagnostic yield of acid-fast bacilli smear and culture for Mycobacterium tuberculosis using sputum induction (SI) in the workup of patients with suspected pleural tuberculosis (TB) who were unable to produce sputum[ncbi.nlm.nih.gov]
  • Given his typical presentation of a cavitary lung lesion and exudative lymphocytic pleural effusion, further workup with pleural biopsy was pursued and showed granulomatous changes typical of pleural TB.[shmabstracts.com]
Pleural Effusion on Chest X-Ray
  • Risk of residual pleural effusion on chest X-ray was reduced by 45% at eight weeks ( RR 0.54, 95% CI 0.37 to 0.78; 237 participants, 2 trials, low certainty evidence ), and 65% at 24 weeks ( RR 0.35, 95% CI 0.18 to 0.66; 237 participants, 2 trials, low[cochrane.org]
  • effusion Anteroposterior Chest X-ray of a pleural effusion.[en.wikipedia.org]
  • There was no case of encysted pleural effusion on chest X-ray. No other significant radiological finding (e.g. Rib erosion, diaphragmatic palsy, and space occupying lesion) was noted in any of the cases.[atmph.org]
X-Ray Abnormal
  • Radiographic features Chest X-ray abnormalities are nearly always found. However in the presence of HIV infection, a normal X-ray is more common.[southsudanmedicaljournal.com]
Chest X-Ray Abnormal
  • Radiographic features Chest X-ray abnormalities are nearly always found. However in the presence of HIV infection, a normal X-ray is more common.[southsudanmedicaljournal.com]
Pleural Effusion
  • METHODS: We analyzed pleural effusion specimens obtained from 111 patients for whom the exclusion of the possibility of tuberculous pleural effusion was necessary.[ncbi.nlm.nih.gov]
  • Mycobacteria were detected exclusively in tuberculous pleural effusion samples. None of the non-tuberculous pleural effusion samples were positive for mycobacteria. Comparative analysis showed that the N-PCR assay had the highest sensitivity.[ncbi.nlm.nih.gov]
  • RESULTS: We evaluated serum and pleural fluid samples from 132 patients: 97 diagnosed with pleural tuberculosis (study group) and 35 diagnosed with pleural effusion due to other causes (control group).[ncbi.nlm.nih.gov]
  • Mycobacterium tuberculosis bacilli are seldom demonstrated in tuberculous pleural effusion (TPE) by conventional bacteriological methods.[ncbi.nlm.nih.gov]
  • Abstract Cytokines were measured in patients with pleural effusion and miliary tuberculosis (TB).[ncbi.nlm.nih.gov]
Pleural Exudate
  • OBJECTIVES: To develop a clinical prediction rule (CPR) for the diagnosis of pleural tuberculosis (PT) in patients with pleural exudates in Peru.[ncbi.nlm.nih.gov]
  • We applied the identified CPRs to patients with pleural exudates attending two third-level hospitals in Lima, Peru, a setting with high incidence of tuberculosis.[ncbi.nlm.nih.gov]
  • "[Reappraisal of the standard method (Light's criteria) for identifying pleural exudates]". Medicina clinica. 126 (6): 211–3. doi : 10.1157/13084870. PMID 16510093.[en.wikipedia.org]
Pleural Adhesions
  • Compared with control, corticosteroids may reduce the risk of having pleural changes (such as pleural thickening or pleural adhesions), on chest X-ray at the end of follow-up by almost one third ( RR 0.72, 95% CI 0.57 to 0.92; 393 participants, 5 trials[cochrane.org]

Treatment

  • We therefore recommend careful documentation of a previous history of liver disease and baseline investigation of liver function tests before initiation of treatment.[ncbi.nlm.nih.gov]
  • CONCLUSION: Paradoxical response developed in 16% of the patients approximately 2 months after initiation of anti-tuberculosis treatment, presenting with aggravation of pre-existing pleural effusion.[ncbi.nlm.nih.gov]
  • In addition, we provide an update on the changing epidemiology, clinical features and current treatment options. SUMMARY: Newer immunological tests and scoring systems will revolutionize the way tuberculous pleurisy is diagnosed in the years ahead.[ncbi.nlm.nih.gov]
  • The RPT was measured on chest X-ray at the completion of treatment and the final follow-up. The average periods of anti-tuberculosis medication and the follow-up after completion of treatment were 6.7 and 7.6 months, respectively.[ncbi.nlm.nih.gov]
  • The diagnosis of Rhodotorula mucilaginosa infection was established by the isolation of the yeast in two blood cultures followed by a good response to amphotericin B treatment.[ncbi.nlm.nih.gov]

Prognosis

  • PTE has a good prognosis in children and no long term sequelae are expected. 2010 Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • Hepatitis is a frequent side effect and entails poor prognosis. We therefore recommend careful documentation of a previous history of liver disease and baseline investigation of liver function tests before initiation of treatment.[ncbi.nlm.nih.gov]
  • Atelectasis classically affects the anterior segments of the upper lobes or the medial segment of the RML · Pleura § Pleural effusion as a manifestation of primary TB occurs more often in adults than children § With appropriate treatment, it carries the best prognosis[learningradiology.com]
  • Expectations (prognosis) The outlook is excellent if tuberculous pleural effusion is diagnosed early and treatment is begun quickly. Complications Tuberculous pleural effusion can cause permanent lung damage if not treated early.[ufhealth.org]
  • What is the prognosis for patients managed in the recommended ways? The prognosis for patients with pleural effusions depends on the underlying cause.[clinicaladvisor.com]

Etiology

  • RESULTS: In total, 37 pleural effusion patients took part in the study, of whom 19 (51.3%) had tubercular etiologies and 18 (48.7%) had etiologies from other causes.[ncbi.nlm.nih.gov]
  • Thus, in a patient with recurrent pleural effusion, rheumatoid etiology should also be kept in mind as a differential diagnosis.[mjdrdypu.org]
  • PATIENTS: ADA activity, IFN-gamma levels, and PCR were evaluated in 140 cases of pleural effusion, 42 with confirmed pleural TB, 19 with probable pleural TB, 70 with a nontuberculous etiology, and 9 having an undetermined etiology.[ncbi.nlm.nih.gov]
  • The differential included both infectious and malignant etiology with infection being higher on the differential due to the relative rapid onset of the patient’s symptoms.[shmabstracts.com]

Epidemiology

  • OBJECTIVE: To analyze the epidemiological characteristics of and trends regarding the incidence of pleural TB.[ncbi.nlm.nih.gov]
  • Knowledge of pleural TB epidemiology would be beneficial. To help clarify pleural TB epidemiology, we analyzed US national TB surveillance data for 1993 to 2003.[ncbi.nlm.nih.gov]
  • Author information 1 Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America ; McGill International TB Centre & Department of Epidemiology, Biostatistics, and Occupational Health, McGill University[ncbi.nlm.nih.gov]
  • However, the epidemiology and demographics of tuberculous pleurisy are changing due to the impact of HIV co-infection and the increasing number of pleural effusions seen as part of re-activation disease.[ncbi.nlm.nih.gov]
  • Further studies, involving larger patient samples and different epidemiological scenarios, are warranted.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Pleural involvement is elevated in patient with HIV, specifically in those with higher CD4, which may point to the pathophysiology of this condition. Pleural involvement can occur in the setting of primary or reactivation TB.[morningreporttwh.blogspot.com]
  • Pathophysiology [ edit ] Pleural fluid is secreted by the parietal layer of the pleura and reabsorbed by the lymphatics in the most dependent parts of the parietal pleura, primarily the diaphragmatic and mediastinal regions.[en.wikipedia.org]
  • Case Discussion Pathophysiology Mycobacterium tuberculosis affects the pleura at different stages of pulmonary and systemic disease as the pleura can be involved in either primary or post-primary (reactivation) TB disease.[heartlandntbc.org]
  • Tuberculous pleural effusion: Pathogenesis and pathophysiological features. Pleural Dis 2001;4:182-6. 6. Stead WW, Eichenholz A, Strauss HK.[atmph.org]

Prevention

  • Author information 1 Tuberculosis and Mycobacteriology Branch, Division of AIDS, STD, and TB Laboratory Research, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. stevelawn@yahoo.co.uk Abstract This study examined the impact of the host[ncbi.nlm.nih.gov]
  • الصفحة 223 - American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603-662. ‏[books.google.com]
  • Patients were classified by reported site of disease; site designations were defined using the Centers for Disease Control and Prevention tuberculosis surveillance reporting system [ 19 ].[academic.oup.com]
  • TB is a preventable disease, even in those who have been exposed to an infected person.[ufhealth.org]

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