Tuberculosis pleural en paciente pediátrico: reporte de un caso y revisión de la literatura / Pleural tuberculosis in a pediatric patient: case report and review

Tuberculosis (TB) is a common cause of pleural effusion in young people from endemic areas. Among the forms of extrapulmonary TB in people with immunodeficiencies, the most frequent localization is the pleura. The use of immunological and molecular biology tests for the diagnosis of TB in pleural fluid and other locations with high sensitivity and specificity is highlighted. We present a clinical case with the objective of giving an overview of the treatment of the patient with suspected pleural tuberculosis

La Tuberculosis (TB) es una causa común de derrame pleural en jóvenes en zonas endémicas. Dentro de las formas de TB extrapulmonar en personas que cursan con inmunodeficiencias, la localización más frecuente es la TB pleural. Se destaca el uso de las pruebas inmunológicas y de biología molecular para el diagnóstico de TB en líquido pleural y de otras localizaciones con una elevada sensibilidad y especificidad. Se presenta un caso clínico con el objetivo de describir una visión general del abordaje del paciente con sospecha de tuberculosis pleural

Expression Profiles of Cytokine mRNAs in the Pleural Fluid Reveal Differences Among Tuberculosis, Malignancies, and Pneumonia-Exudative Pleural Effusions.

INTRODUCTION: Tuberculosis (TB) and malignant diseases are the most common causes of lymphocytic pleural effusion in adults. Serum and pleural fluid cytokine levels have been analyzed to help in the differential diagnosis, but with limited results. PURPOSE: This study investigates transcription levels of selected cytokine genes in pleural effusion of patients under investigation for TB. METHODS: This was a prospective study that included adult patients under investigation for pleural effusion in Brazil. The expression of 19 cytokine genes was analyzed by RT-qPCR. RESULTS: The majority of cytokine-related genes expressed in pleural fluid of TB patients were similar in non-TB patients, except for RORA and RORC genes, which showed a statistically higher level in TB. All cytokines in the Th17 pattern were induced in TB patients' pleural fluid. Patients with malignant pleural effusion expressed higher levels of IFN-α1, IFN-ß1, TNF-α, IL-4 and IL-6, and suppression of TGFß-1. CONCLUSION: There is still a lot to understand about the cytokine roles in the pro- and anti-inflammatory environment of exudative pleural effusions. The data presented here showed an increased expression of Th17 pattern cytokines genes in TB patients that could be used as markers to differentiate tuberculous pleuritis from other common causes of exudative pleural effusion.

Pleuresía tuberculosa como manifestación de reconstitución inmune en un paciente con sida: Descripción de un caso y revisión de la literatura / Tuberculous pleurisy as the manifestation of immune reconstitution in an AIDS patient: Description of a case and a review of the literature

El síndrome inflamatorio de reconstitución inmune es una complicación importante y precoz en respuesta a la implementación de la terapia antirretroviral de gran actividad, especialmente en pacientes con tuberculosis. Se describe el caso de un paciente de 35 años, con serología reactiva para HIV desde mayo 2011, y bajo terapia antirretroviral de gran actividad desde julio del mismo año. Se presentó a la consulta con síntomas de derrame pleural, y se le diagnosticó pleuresía tuberculosa. El paciente presentó una mejora en los síntomas generales y respiratorios a partir del quinto día de tratamiento.(AU)

Pleuresía tuberculosa como manifestación de reconstitución inmune en un paciente con sida: Descripción de un caso y revisión de la literatura / Tuberculous pleurisy as the manifestation of immune reconstitution in an AIDS patient: Description of a case and a review of the literature

El síndrome inflamatorio de reconstitución inmune es una complicación importante y precoz en respuesta a la implementación de la terapia antirretroviral de gran actividad, especialmente en pacientes con tuberculosis. Se describe el caso de un paciente de 35 años, con serología reactiva para HIV desde mayo 2011, y bajo terapia antirretroviral de gran actividad desde julio del mismo año. Se presentó a la consulta con síntomas de derrame pleural, y se le diagnosticó pleuresía tuberculosa. El paciente presentó una mejora en los síntomas generales y respiratorios a partir del quinto día de tratamiento.

Differentiating between tuberculosis-related and lymphoma-related lymphocytic pleural effusions by measuring clinical and laboratory variables: is it possible?

OBJECTIVE: To describe clinical and laboratory characteristics in patients with tuberculosis-related or lymphoma-related lymphocytic pleural effusions, in order to identify the variables that might contribute to differentiating between these diseases. METHODS: This was a retrospective study involving 159 adult HIV-negative patients with tuberculosis-related or lymphoma-related lymphocytic effusions (130 and 29 patients, respectively), treated between October of 2008 and March of 2010 at the Pleural Diseases Outpatient Clinic of the University of São Paulo School of Medicine Hospital das Clínicas Heart Institute, in the city of São Paulo, Brazil. RESULTS: Mean age and the mean duration of symptoms were lower in the tuberculosis group than in the lymphoma group. The levels of proteins, albumin, cholesterol, amylase, and adenosine deaminase (ADA) in pleural fluid, as well as the serum levels of proteins, albumin, and amylase, were higher in the tuberculosis group, whereas serum cholesterol and triglycerides were higher in the lymphoma group. Pleural fluid leukocyte and lymphocyte counts were higher in the tuberculosis group. Of the tuberculosis group patients, none showed malignant cells; however, 4 showed atypical lymphocytes. Among the lymphoma group patients, cytology for neoplastic cells was positive, suspicious, and negative in 51.8%, 24.1%, and 24.1%, respectively. Immunophenotyping of pleural fluid was conclusive in most of the lymphoma patients. CONCLUSIONS: Our results demonstrate clinical and laboratory similarities among the patients with tuberculosis or lymphoma. Although protein and ADA levels in pleural fluid tended to be higher in the tuberculosis group than in the lymphoma group, even these variables showed an overlap. However, none of the tuberculosis group patients had pleural fluid ADA levels below the 40-U/L cut-off point.

É possível diferenciar derrames pleurais linfocíticos secundários a tuberculose ou linfoma através de variáveis clínicas e laboratoriais? / Differentiating between tuberculosis-related and lymphoma-related lymphocytic pleural effusions by measuring clinical and laboratory variables: Is it possible?

OBJETIVO: Descrever características clínicas e laboratoriais em pacientes com derrames pleurais linfocíticos secundários a tuberculose ou linfoma, a fim de identificar as variáveis que possam contribuir no diagnóstico diferencial dessas doenças. MÉTODOS: Estudo retrospectivo com 159 pacientes adultos HIV negativos com derrame pleural linfocítico secundário a tuberculose ou linfoma (130 e 29 pacientes, respectivamente) tratados no Ambulatório da Pleura, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP), entre outubro de 2008 e março de 2010. RESULTADOS: A média de idade e de duração dos sintomas foi menor no grupo tuberculose que no grupo linfoma. Os níveis pleurais de proteínas, albumina, colesterol, amilase e adenosina desaminase (ADA), assim como os níveis séricos de proteínas, albumina e amilase, foram maiores no grupo tuberculose, enquanto os níveis séricos de colesterol e triglicérides foram maiores no grupo linfoma. As contagens de leucócitos e linfócitos no líquido pleural foram maiores no grupo tuberculose. Células malignas estavam ausentes no grupo tuberculose, entretanto, linfócitos atípicos foram observados em 4 desses pacientes. No grupo linfoma, a citologia para células neoplásicas foi positiva, suspeita e negativa em 51,8%, 24,1% e 24,1% dos pacientes, respectivamente. A imunofenotipagem do líquido pleural foi conclusiva na maioria dos pacientes com linfoma. CONCLUSÕES: Nossos resultados demonstram semelhanças clínicas e laboratoriais entre os pacientes com tuberculose ou linfoma. Embora os níveis de proteínas e ADA no líquido pleural tendam a ser mais elevados no grupo tuberculose que no grupo linfoma, mesmo essas variáveis mostraram uma sobreposição. Entretanto, nenhum paciente com tuberculose apresentou níveis de ADA no líquido pleural inferiores ao ponto de corte (40 U/L).

OBJECTIVE: To describe clinical and laboratory characteristics in patients with tuberculosis-related or lymphoma-related lymphocytic pleural effusions, in order to identify the variables that might contribute to differentiating between these diseases. METHODS: This was a retrospective study involving 159 adult HIV-negative patients with tuberculosis-related or lymphoma-related lymphocytic effusions (130 and 29 patients, respectively), treated between October of 2008 and March of 2010 at the Pleural Diseases Outpatient Clinic of the University of São Paulo School of Medicine Hospital das Clínicas Heart Institute, in the city of São Paulo, Brazil. RESULTS: Mean age and the mean duration of symptoms were lower in the tuberculosis group than in the lymphoma group. The levels of proteins, albumin, cholesterol, amylase, and adenosine deaminase (ADA) in pleural fluid, as well as the serum levels of proteins, albumin, and amylase, were higher in the tuberculosis group, whereas serum cholesterol and triglycerides were higher in the lymphoma group. Pleural fluid leukocyte and lymphocyte counts were higher in the tuberculosis group. Of the tuberculosis group patients, none showed malignant cells; however, 4 showed atypical lymphocytes. Among the lymphoma group patients, cytology for neoplastic cells was positive, suspicious, and negative in 51.8%, 24.1%, and 24.1%, respectively. Immunophenotyping of pleural fluid was conclusive in most of the lymphoma patients. CONCLUSIONS: Our results demonstrate clinical and laboratory similarities among the patients with tuberculosis or lymphoma. Although protein and ADA levels in pleural fluid tended to be higher in the tuberculosis group than in the lymphoma group, even these variables showed an overlap. However, none of the tuberculosis group patients had pleural fluid ADA levels below the 40-U/L cut-off point.

Derrame pleural / Pleural effusion

El derrame pleural es una complicación frecuente de afecciones pulmonares que involucran a la pleura, como el cáncer y la tuberculosis pulmonar, entre otros. El líquido pleural puede ser trasudado o exudado. La historia clínica es fundamental en el estudio del derrame pleural. La Rx de tórax, el ultrasonido torácico y la TC de tórax, ayudan a confirmar la sospecha clínica. Los aspectos macroscópicos más comunes del líquido pleural son el seroso y el hemorrágico. El análisis bioquímico completo y los criterios de Light clasifican el derrame pleural y orientan gran parte del diagnóstico. El cultivo bacteriológico, micológico y para micobacterias, tanto del líquido como del tejido pleural, deben practicarse de rutina. El estudio citomorfológico y la citología del mismo, así como la biopsia de pleura, siguen siendo herramientas claves. En la tuberculosis pleural, deben realizarse los estudios convencionales para el líquido, así como la Adenosina deaminasa, como método eficaz que debería ser utilizado de rutina en nuestro medio. El interferón gamma en el líquido pleural, es una prueba sensible y específica y las pruebas de amplificación de ácidos nucleicos son útiles, pero deben ser realizadas e interpretadas en el contexto de la historia clínica y los estudios convencionales

Pleural effusion is a common complication of pulmonary disorders, such as lung cancer and tuberculosis, among others. The medical history is crucial in the study of pleural effusion. The chest X-ray, ultrasound and chest CT scan of the chest will help confirm the clinical suspicion. The most common macroscopic aspects of the pleural fluid are serous and hemorrhagic. The full biochemical analysis and the Light criteria will classify pleural effusion and to lead the diagnosis. The bacteriological culture, while mycological mycobacteria and fluid as pleural tissue, must be practiced routinely. The survey of cytological cytomorphology as well as the pleural biopsy are key tools. In pleural tuberculosis, conventional studies should be practised for the pleural fluid, as well as adenosine deaminase, which is effective and should be used routinely. Gamma interferon test in the pleural fluid is sensitive and specific and nucleic acid amplification is useful but should be used and interpreted in the context of the clinical history and conventional studies

[Tuberculous serositis in patient with systemic lupus erythematosus: case report and literature review]. / Serosite tuberculosa em portadora de lúpus eritematoso sistémico - Relato de caso e revisão de literatura.

It is a case report of young female that had diagnostic criteria of Systemic Lupus Erithematosus in activity, according American Rheumatology Association. The patient had fever, anemia, arthritis, cellular casts, positive LE cells, positive antinuclear antibody. She has evolved to bilateral pleural effusion and pericardic effusion that both have been initially attributed to lupus. Due to she has also maintained low fever, sudoresis, loss of weight and a persistent serositis, a thoracocenthesis with pleural biopsy has been done and the result of it has revealed granulomatous chronic pleuritis, diagnosticing pleural tuberculosis. A pericardiocenthesis has also been done. After six months of anti -tuberculosis therapy, there was a regression of radiologic imaging. Some concepts referring to tuberculosis and systemic lupus erythematosus are discussed, including symptoms, diagnosis and specific situations. It is emphasized the necessity of early diagnosis and appropriate management of tuberculosis disease in lupic patients, in areas where tuberculosis is endemic.

High MMP-9 activity characterises pleural tuberculosis correlating with granuloma formation.

Tuberculosis (TB) pleural disease is complicated by extensive tissue destruction. Matrix metalloproteinase (MMP)-1 and -9 are implicated in immunopathology of pulmonary and central nervous system TB. There are few data on MMP activity in TB pleurisy. 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. Clinical data, routine blood tests, and pleural fluid/biopsy material were obtained from 89 patients presenting with pleural effusions in a TB-endemic area. MMP-1, -2 and -9 were measured by zymography or western blot, and TIMP-1 and -2 by ELISA. Pleural biopsies were examined microscopically, cultured for acid-alcohol fast bacilli and immunostained for MMP-9. Tuberculous pleural effusions contained the highest concentrations of MMP-9 compared with malignant effusions or heart failure transudates. MMP-9 concentrations were highest in effusions from patients with granulomatous biopsies: median (interquartile range) 108 (61-218) pg x mL(-1) versus 43 (12-83) pg x mL(-1) in those with nongranulomatous pleural biopsies. MMP-1 and -2 were not upregulated in tuberculous pleural fluid. The ratio of MMP-9:TIMP-1 was significantly higher in TB effusions. Tuberculous pleurisy is characterised by a specific pattern of matrix metalloproteinase-9 upregulation, correlating with the presence of granulomas and suggesting a specific role for matrix metalloproteinase-9 in inflammatory responses in tuberculous pleural disease.

Tuberculose pleural / Tuberculous pleural effusions

O derrame pleural tuberculoso pode ser devido a uma manifestação da forma primária da doença ou da reativação de uma infecção latente pelo M. tuberculosis. Os avanços nos métodos laboratoriais contribuíram sobremaneira para um melhor diagnóstico e para a compreensão da fisiopatologia desta doença. No entanto, embora o derrame pleural predominante linfocítico seja indicativo de tuberculose em nosso meio, uma rotina de abordagem diagnóstica deve ser instituída a fim de orientar o tratamento precoce e evitar seqüelas.

Tuberculous pleural effusion is a common manifestation of the primary form of the disease or consequence of the reactivation of a latent infection due to the M. tuberculosis. Advances in the laboratory methods have contributed to better diagnose and understand the pathophysiology of the effusion secondary to tuberculosis. However, although a predominant lymphocytic pleural effusion is suspicious of tuberculosis, a diagnostic routine shall be instituted to orient treatment and prevent undesirable sequels.

Perfil funcional de pacientes portadores de seqüela de tuberculose de um hospital universitário / Functional profile of patients with tuberculosis sequelae in a university hospital

OBJETIVO: Descrever os dados de função pulmonar de pacientes com seqüela de tuberculose pulmonar, pleural e pleuropulmonar. MÉTODOS: Em um ambulatório de tuberculose de um hospital universitário, de 218 pacientes atendidos, 56 tinham seqüela de tuberculose pulmonar, pleural e pleuropulmonar, e 162 tiveram outros tipos de tuberculose. No laboratório de função pulmonar, 43 foram elegíveis para o estudo, de fevereiro de 2000 a julho de 2004. Foram excluídos os pacientes com doenças prévias, como: asma; doença pulmonar obstrutiva crônica; insuficiência cardíaca; doenças do colágeno; silicose; cirurgia torácica prévia; e espirometria inaceitável ou não realizada. Os campos pulmonares foram divididos em seis zonas e os radiogramas classificados em: grau I, com mínimo envolvimento em somente uma zona sem cavitação; grau II, com envolvimento de duas ou três zonas ou uma zona com cavitação; grau III, com envolvimento grave em mais de três zonas com ou sem cavitação. RESULTADOS: Cinqüenta pacientes foram incluídos no estudo e 44 deles tiveram tuberculose pulmonar (88 por cento). O distúrbio ventilatório combinado foi o mais prevalente, 17/50 (34 por cento). Os distúrbios acentuados foram mais significativos no grau III (p = 0,0002). A função pulmonar normal predominou nos graus I e II (p = 0,002). CONCLUSÃO: A descoberta e o tratamento precoce dos casos de tuberculose pulmonar contribuem para a diminuição dos casos da doença e de suas seqüelas, melhorando a qualidade de vida desses pacientes. Os autores sugerem uma análise logitudinal e seqüencial (protocolo), com maior número de pacientes com seqüelas de tuberculose nos serviços de referência no Brasil.

Functional profile of patients with tuberculosis sequelae in a university hospital.

OBJECTIVE: To describe data related to the pulmonary function of patients with sequelae of pulmonary tuberculosis, pleural tuberculosis or both. METHODS: In the outpatient clinic of a university hospital, 218 patients were evaluated. Of those 218, 56 had sequelae of tuberculosis (pulmonary, pleural or both), and 162 had other types of tuberculosis. All patients were evaluated in the pulmonary function laboratory between February 2000 and July 2004, and 43 were found to be eligible for inclusion in the study. Patients with a history of asthma, chronic pulmonary obstructive disease, cardiac insufficiency, collagen diseases, silicosis or thoracic surgery, as well as those for whom spirometry yielded unacceptable results or was not performed, were excluded. The lung fields were divided into six zones, and radiographic results were classified by degree: I (involvement of only one zone with no cavitation); II (involvement of two or three zones or of one zone with cavitation); or III (extensive involvement of three or more zones with or without cavitation). RESULTS: The final study sample comprised 50 patients, 44 (88%) of whom had pulmonary tuberculosis. The most prevalent form (17/50; 34%) was mixed ventilatory disturbance. Severe disturbances were more significant in degree III radiographs (p = 0.0002) and normal pulmonary function was predominant among patients presenting degree I and II radiographs (p = 0.002). CONCLUSION: The early discovery and treatment of tuberculosis contribute to reduce the number of cases, as well as the incidence of tuberculosis sequelae, thereby improving the quality of life of tuberculosis patients. Further studies, involving longitudinal, sequential analysis and larger samples of patients with tuberculosis sequelae, should be conducted in referral centers in Brazil.

[Tuberculous pleural effusions]. / Tuberculose pleural.

Tuberculous pleural effusion is a common manifestation of the primary form of the disease or consequence of the reactivation of a latent infection due to the M. tuberculosis. Advances in the laboratory methods have contributed to better diagnose and understand the pathophysiology of the effusion secondary to tuberculosis. However, although a predominant lymphocytic pleural effusion is suspicious of tuberculosis, a diagnostic routine shall be instituted to orient treatment and prevent undesirable sequels.

Relación entre los niveles de adenosina deaminasa y desarrollo de engrosamiento pleural residual en tuberculosis pleural

Introducción: el engrosamiento pleural residual (EPR) es frecuente en tuberculosis pleural (TBCP) y no es claro si puede pronosticarse con la toracentesis inicial. Objetivo: evaluar la relación entre los índices de inflación y la activación linfocitaria pleural especialmente la adenosina deaminasa (ADA) y el desarrollo de EPR en TBCP. Tipo de estudio: observacional analítico de cohorte prospectiva. Lugar de estudio: programa de tuberculosis en el hospital de referencia. Material y métodos: pacientes con diagnóstico de TBCP a quienes se les realizó toracentesis incluyendo determinación de ADA y fueron tratados y controlados sin recibir glucocorticoides. Se definió EPR con métodos radiológicos. Los datos se recolectaron en forma prospectiva. La relación entre predictores y EPR se evaluó con prueba no paranétrica con una p<0,01 de significativa. Resultados: durante 48 meses, 57 pacientes cumplieron los criterios de inclusión; el diagnóstico se realizó en 84 por ciento con biopsia pleural. Se desarrolló EPR en 33 pacientes (58 por ciento) y no hubo EPR en 24 (42 por ciento). Los valores de LDH, proteínas, porcentaje de linfocitos y concentración de glucosa fueron similares en ambos grupos. La concentración de ADA fue similar (grupo con EPR:97 más menos 48; grupo sin EPR: 106 más menos 45; p=0,48, Mann-Whitney) en los dos grupos y no se encontró un punto de corte con apropiada discriminación para pronosticar EPR. Conclusión: en este grupo de pacientes ningún hallazgo de la toracentesis inicial se relacionó con el desarrollo de EPR. Los resultados son similares a los informados por otros investigadores, pero es la primera vez que se describen para el nivel de ADA pleural

Compartimentalização da imunidade celular em pacientes com pleurite crônica tuberculosa / Compartmentalization of cellular immunity in patients with chronic tuberculous pleuritis

A tuberculose pleural (tbp) é uma das formas extra-pulmonares da tuberculose humana de melhor prognóstico. A presença de derrame pleural rico em células de origem imune que se forma na cavidade pleural pode estar relacionada com a cura espontânea observada em pacientes com tbp. A partir dessas observações, o presente estudo teve por objetivo investigar a imunidade celular de pacientes com pleurite crônica tuberculosa através da análise comparativa do perfil das células mononucleares do sangue e do derrame pleural por FACS e comparar a proliferação celular, resposta citotóxica e produção de citocinas induzidas pelo antígeno do M. tuberculosís e antígenos recombinantes de micobactérias. Avaliamos também o papel de citocinas sobre a resposta citotóxica das células mononucleares do derrame pleural contra células alvos K562. Doze pacientes incluídos neste estudo tiveram diagnóstico de pleurite tuberculosa confirmado pela presença de granulomas nas biópsias pleurais. Pacientes HIV e HTLV positivos ou com outras doenças associadas foram excluídos desta avaliação. O perfil das células mononucleares foi analisado por citometria de fluxo para identificar os subtipos de linfócitos presentes no sangue e no derrame pleural. A proliferação das células mononucleares foi obtida pela incorporação de [3H] timidina. Os níveis de IFN-y, TNF-a e IL-10 foram analisados nos sobrenadantes das células mononucleares estimuladas com antígeno do M. tuberculosís e antígenos recombinantes de micobactérias. O papel da IL-12, IFN-y, TNF-a, IL-10 e TGF-~ na resposta citotóxica induzida pelo antígeno do M. tuberculosís nas células mononucleares foi avaliado através de ensaios de liberação de [51Cr]. A análise do perfil de células por FACS demonstrou um enriquecimento de linfócitos CD4+ que co-expressam CD45RO+ entre as células do derrame comparado ao perfil das células mononucleares do sangue. Linfócitos B, CD8+ e células NK são menos frequentes no compartimento pleural. Mononucleares...

Levels of interleukin-8 in tuberculous pleurisy and the profile of immunocompetent cells in pleural and peripheral compartments.

Our study investigated the presence of IL-8 in pleural exudates from tuberculosis patients (TBP) (n = 13), and evaluated whether it was related with the profile of major immunocompetent cells present in their pleural and peripheral compartments. To allow comparisons, an additional group of patients with parapneumonic pleural effusions (PNE) (n = 7) was included. Blood peripheral immunophenotypic studies were also carried out in 12 age-matched healthy controls (Co), and 39 tuberculosis patients classified, according to the extent of pulmonary involvement, into mild (n = 9), and advanced (n = 30) cases. Patients were recruited before starting therapy, had HIV negative serology, and showed no age differences among groups (mean +/- SD., 40.7 +/- 14.7 years). IL-8 concentrations were measured by an ELISA method while immunophenotypic analysis was performed by using FITC-conjugated monoclonal antibodies reacting against the following cell surface molecules: CD3, CD4, CD8, CD25 (IL-2R+ cells), CD19, and CD68. IL-8 was detected in all pleural exudates though levels in the TB patients, 384 +/- 110 pg/ml, appeared significantly higher than the PNE group, 185 +/- 110 pg/mg, (P < 0.015, mean +/- S.D.). In turn, the former group presented values of pleural CD3+, CD4+, and CD25, which were found increased in comparison with PNE patients (P < 0.01). Unlike the pleural compartment, patients with TBP showed a marked and significant decrease in their circulating levels of cells bearing the CD3, CD4, CD19, CD25, and CD68 phenotypes not only when comparing with Co but also with PNE and mild patients. Differences between the levels of pleural and peripheral T-cells from TBP patients may be the reflection of an important influx of T-lymphocytes from the circulatory system to the pleural cavity, probably linked to the presence of chemotactic factors within the pleural fluid like IL-8.

Pleural tuberculosis and human immunodeficiency virus co-infection.

SETTING: Department of internal medicine in a general hospital in Rio de Janeiro, Brazil, which provides secondary care to the poor population. OBJECTIVE: The aim of this study was to evaluate the prevalence of human immunodeficiency virus (HIV) infection in patients with pleural tuberculosis (TB) and to compare its manifestations in HIV-negative and HIV-infected patients. DESIGN: Cross-sectional study. METHODS: Forty-three patients with a final diagnosis of pleural TB were submitted to HIV testing (ELISA), chest X-ray, and thoracentesis for biochemical, cytological and bacteriological analysis. Pleural tissue was obtained in 36 patients for histopathological examination. PPD testing was performed in 29 patients. Whenever productive cough was present, sputum acid-fast smears and culture for Mycobacterium tuberculosis were performed. RESULTS: The HIV prevalence was high (30%). TB symptoms were similar in both groups. Atypical radiological aspects were observed in HIV-infected patients with concurrent pulmonary TB (P = 0.03). Pleural fluid, tissue aspects and PPD testing were comparable in both groups. CONCLUSION: Only atypical radiographic patterns in patients with concurrent pulmonary TB were indicative of HIV infection. Therefore, a high index of suspicion is necessary for the early recognition of HIV/TB co-infection. We suggest that all patients presenting with pleural TB should be screened for anti-HIV antibodies.

Valor diagnóstico de la adenosín deaminasa en pacientes con pleuritis tuberculosa en la ciudad de Medellín 1991-1993

Se realizó un estudio observacional, descriptivo y prospectivo en 145 pacientes: 88 con diagnóstico de tuberculosis pleural confirmado por medio de cultivo o biopsia y 57 con derrame pleural no tuberculoso. Fue practicado en varias instituciones de salud de la ciudad de medellín durante el período de 1991-1993, con el fin de valorar la utilidad de la adenosín deaminasa en el diagnóstico de tuberculosis pleural. Se obtuvo para dicha prueba una sensibilidad de 92.04 por ciento y una especificidad de 89.47 por ciento, mostrando que la adenosín deaminasa es una importante herramienta diagnóstica de bajo costo en nuestro medio