Differentiating tuberculous pleuritis from other exudative lymphocytic pleural effusions.

BACKGROUND: Recently, the combination of clinical and pleural fluid data can be used to calculate a score which helps facilitate differential diagnosis between tuberculous pleuritis (TBP) and No-TBP effusions. However, a reliable determination of adenosine deaminase (ADA) remains difficult to obtain in Thailand. Therefore, the aim of our study was set out to develop a scoring which makes use of clinical and pleural fluid data. METHODS: A retrospective study involved 15 patients with TBP and 41 patients with no-TBP. The clinical and pleural fluid data of all patients from January 1, 2011, 32 to December 31, 2014, were collected. The diagnostic sensitivity, specificity, positive and negative predictive value were calculated. RESULTS: The parameters were superior in detecting TBP, including the ADA ≥17.5 U/L, In scoring I [ADA ≥40 U/L, age The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.35 years, temperature ≥37.8 ℃, and RBC The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.5×109 /L] as ≥1.5 points, and scoring II [no previous history of cancer, age The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.35 years, temperature ≥37.8 ℃ RBC The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.5×109 /L, pleural protein ≥50 g/L, and LDH ratio ≥2.2] as ≥4.5 points, since the area under curve (AUC) 74.0%, 74.0%, and 81.0%, sensitivity 73.3%, 73.3%, and 71.4%, and specificity 68.7%, 62.5%, and 71.1%, respectively). Moreover, no previous history of cancer and lower RBC The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.5×109 /L indicated sensitivity (90.6% and 65.5%), and specificity (70.0% and 44.4%), respectively. Summated scores of ≥5 points in model 1 and ≥6 points in model 2 yielded measures of sensitivity (46.7% and 57.1%), and specificity (84.4% and 80.5%), respectively. CONCLUSIONS: The high pleural fluid ADA, high scores model 1, high scores model 2, lower RBC, and no previous history of cancer may help to categorize patients into probable TBP for further clinical decisionmaking.

Coinfection of Pulmonary Paragonimiasis and Pulmonary Tuberculosis in Thailand.

The authors report a case of coinfection of pulmonary paragonimiasis and pulmonary tuberculosis which is an uncommon coinfection. The patient presented with a one-week history of nonmassive hemoptysis about 1 month after completion of treatment for smear-negative pulmonary tuberculosis (sputum polymerase chain reaction positive for Mycobacterium tuberculosis). She lived in Nakhon Nayok province and reported taking raw crabs from time to time. The complete blood count revealed eosinophilia and her chest radiograph showed patchy infiltration at right lower lung field. Computed tomography scan of the chest revealed consolidation with internal air bubbles at anterobasal segment of right lower lobe. The diagnosis of pulmonary paragonimiasis was confirmed by detecting eggs of the genus Paragonimus in her wet-mount sputum. She was treated with oral praziquantel for 3 consecutive days with improvement. To our knowledge, although coinfection of pulmonary paragonimiasis and pulmonary tuberculosis is rare, it should be considered as the differential diagnosis in patients who live in the endemic area presenting with hemoptysis and eosinophilia.

Unexpected causes of pulmonary hypertension in a previously healthy Thai rural man with right-sided heart failure.

UNLABELLED: Male, 52 FINAL DIAGNOSIS: Pulmonary hypertension Symptoms: Diarrhea • dyspnea • jaundice MEDICATION: - Clinical Procedure: - Specialty: Endocrinology and Metabolic. OBJECTIVE: Unusual clinical course. BACKGROUND: Hyperthyroidism is one of the important causes of high-output failure and reversible pulmonary artery hypertension. Severe pulmonary artery hypertension is rarely found in associated with hyperthyroidism due to the small number of cases reported. We present an interesting case with multiple unexpected findings of the possible causes of severe pulmonary artery hypertension: hyperthyroidism, pulmonary embolism, and ostium secundum atrial septal defect. CASE REPORT: We present the case of a previously healthy rural Thai man who progressively developed dyspnea on exertion, chronic diarrhea, and jaundice for the previous 3 months. Physical examination revealed right-sided predominate chronic heart failure with signs of pulmonary hypertension. The investigation demonstrated autoimmune hyperthyroidism, cholestatic jaundice, moderate tricuspid regurgitation, ostium secundum atrial septal defect, and severe pulmonary artery hypertension. After treatment with an anti-thyroid drug and closure of the ostium secundum atrial septal defect, his symptoms of jaundice and pulmonary artery pressure were completely resolved. CONCLUSIONS: Severe pulmonary artery hypertension may not solely be a result of hyperthyroidism. Further investigation for other causes is recommended.

Are two sputum samples enough for diagnosing pulmonary tuberculosis.

OBJECTIVE: To determine the optimum number of sputum specimens for smear and culture in the diagnosis of pulmonary tuberculosis. MATERIAL AND METHOD: A retrospective study was conducted in culture-positive pulmonary tuberculosis patients at Siriraj Hospital during April 2009 to October 2010. Number of sputum specimens and microbiological results were retrieved from the microbiologic laboratory. Positive yield and incremental yield of each sputum specimen were calculated. RESULTS: There were 401 patients during the study period, 153 (38.2%) had positive smear for acid-fast bacilli. Overall diagnostic yields of solid culture media and liquid culture media, were 72.1% and 95.3% respectively. Incremental of overall diagnostic yield from 1 to 2 and 2 to 3 sputum specimens were 8% and 6% respectively. CONCLUSION: In place where a routinely combined smear and culture for every sputum sample submitted to the microbiologic laboratory, two specimens are sufficient for the diagnosis in nearly all pulmonary tuberculosis patients.