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1.
Medicine (Baltimore) ; 98(28): e16354, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305427

RESUMO

RATIONALE: Cryptococcosis is a significant life-threatening fungal infection in worldwide, mainly reported in immunocompromised patients. Pleural effusion presentation of cryptococcal infection as the only clinical presentation is rarely seen in pulmonary cryptococcosis, which may lead to be misdiagnosed, and the study on this subject will provide further insights. PATIENT CONCERNS: A 64-year-old man was hospitalized in our department and diagnosed as hepatic B cirrhosis. A computed tomography (CT) of the thorax showed a massive right pleural effusion without pulmonary parenchymal abnormalities. He was started on empirical treatment for pleural tuberculosis (TB). However, during his hospitalization, a right pleural effusion developed and fever was not controlled. DIAGNOSES: On day 14 admission, pleural fluid cultured positive for Cryptococcus neoformans. The C neoformans isolate belonged to ST5 and molecular type VNI (var. grubii). INTERVENTIONS: The patient was diagnosed with cryptococcal pleuritis, then amphotericin B and fluconazole were administrated. OUTCOMES: Finally, the patient was improved and discharged from our hospital. LESSONS: Similar cases in cryptococcal pleuritis patients with pleural effusion as the only clinical presentation in the literature are also reviewed. Through literature review, we recommend that pleural effusion cryptococcal antigen test should be used to diagnose cryptococcal pleuritis to reduce misdiagnosis. The early administration of antifungal drug with activity to Cryptococcus seemed beneficial in preventing dissemination of cryptococcosis.


Assuntos
Criptococose/diagnóstico , Cirrose Hepática/diagnóstico , Derrame Pleural/diagnóstico , Pleurisia/diagnóstico , Criptococose/complicações , Criptococose/tratamento farmacológico , Diagnóstico Diferencial , Hepatite B/complicações , Hepatite B/diagnóstico , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Derrame Pleural/complicações , Derrame Pleural/tratamento farmacológico , Pleurisia/complicações , Pleurisia/tratamento farmacológico
2.
Intern Med ; 58(17): 2577-2579, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31118400

RESUMO

Pleuritis caused by nontuberculous mycobacteria is uncommon and difficult to diagnose. We herein report a case of Mycobacterium avium complex (MAC) pleuritis with elevated anti-glycopeptidolipid (GPL)-core IgA antibody levels in the pleural effusion. A 73-year-old woman with MAC pulmonary disease presented with massive left pleural effusion. A pleural biopsy by video-assisted thoracoscopic surgery was performed, revealing many noncaseating epithelioid cell granulomas. MAC was not identified by culture of the pleural effusion or specimens, but the anti-GPL-core IgA antibody level was markedly elevated in the pleural effusion. Measurement of anti-GPL-core IgA levels in the pleural fluid may be useful for diagnosing MAC pleuritis.


Assuntos
Anticorpos Antibacterianos/análise , Glicolipídeos/imunologia , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Derrame Pleural/microbiologia , Pleurisia/microbiologia , Idoso , Feminino , Humanos , Imunoglobulina A/análise , Imunoglobulina A/imunologia , Complexo Mycobacterium avium/imunologia , Pleurisia/diagnóstico
3.
Parasitol Res ; 118(5): 1653-1656, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30847612

RESUMO

Sparganosis is a parasitic infection caused by the metacestode stage of Spirometra mansoni and some other related diphyllobothriidean cestodes. Although various internal organs were involved in sparganum infection, pulmonary and pleural involvement is rarely reported. We herein report an uncommon form of sparganosis manifested by pleuritis and decreased peripheral blood eosinophils. Sparganum worms were found in the pleural effusion accidentally and confirmed by pathological diagnosis. After being treated with praziquantel for 10 days, the patient's symptoms, laboratory examinations, and imaging findings were improved gradually.


Assuntos
Eosinófilos/citologia , Derrame Pleural/parasitologia , Pleurisia/diagnóstico , Pleurisia/parasitologia , Praziquantel/uso terapêutico , Esparganose/diagnóstico , Esparganose/tratamento farmacológico , Plerocercoide/isolamento & purificação , Animais , China , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Esparganose/parasitologia
4.
Ann Biol Clin (Paris) ; 77(2): 187-190, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30907376

RESUMO

Primary plasma cell leukemia (PPCL) is an aggressive and rare variant of multiple myeloma (MM), with frequent extramedullary involvement, mainly liver and splenic lesions. Pleuropulmonary involvement has rarely been described in the literature. We report a case of primary plasma cell leukemia in a 46-year-old patient, whose first symptom was pleural effusion with mediastinal adenopathies simulating a pleural localization of a lymphomatous process. However, blood smear examination, electrophoresis as well as immunofixation of plasma proteins and immuno-histochemistry have helped to guide the diagnosis. Pleurisy is a rare mode of revelation of plasma cell leukemia and is a factor of poor prognosis.


Assuntos
Leucemia Plasmocitária/diagnóstico , Neoplasias Pleurais/diagnóstico , Pleurisia/diagnóstico , Evolução Fatal , Feminino , Humanos , Leucemia Plasmocitária/complicações , Leucemia Plasmocitária/patologia , Pessoa de Meia-Idade , Marrocos , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/patologia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologia , Pleurisia/etiologia , Pleurisia/patologia , Radiografia Torácica
5.
Rev Mal Respir ; 36(3): 359-363, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30704806
6.
Intern Med ; 58(11): 1617-1620, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30713311

RESUMO

We documented four cases of systemic lupus erythematosus (SLE) presenting with pleuritis as the initial disease manifestation. The diagnosis was challenging because, atypically, all patients were elderly and 3 of the 4 patients were men. Furthermore, SLE pleuritis, characterized by lymphocytic pleural effusion and high ADA activity, is difficult to differentiate from tuberculous pleurisy. A detailed physical examination, blood tests, and urinalysis are therefore indispensable to ensure an accurate diagnosis. We also reviewed the previously published case reports on SLE patients presenting with pleuritis and discussed the relevant findings.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Pleurisia/etiologia , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Exame Físico/métodos , Derrame Pleural/etiologia , Pleurisia/diagnóstico , Tuberculose Pleural/diagnóstico
7.
Acta Gastroenterol Belg ; 81(3): 427-429, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30350533

RESUMO

Cytomegalovirus (CMV) reactivation is a common complication after liver transplantation. In patients with CMV infection, indicated by a positive CMV DNA titer, the presence of any clinical symptom is termed CMV disease. The most common organ affected in CMV disease is the gastrointestinal tract, causing esophagitis, gastritis, enteritis or colitis. CMV infection of the pleura and pericard has been reported in immunocompromised patients, but is rarely seen following liver transplantation.We report a case of a 59-year-old male who developed CMV pleuropericarditis after liver transplantation. Initial ganciclovir treatment did not improve the patient's symptoms and therapy was switched to Foscarnet which ultimately resulted in resolution of infection. However, a few weeks after Foscarnet cessation, the patient again developed bilateral pleural effusion. Ultimate biochemical and clinical response was achieved with IV ganciclovir treatment. The patient was discharged from the hospital with oral Valganciclovir for 3 weeks and has since remained relapse free for >1 year.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Transplante de Fígado , Pericardite/diagnóstico , Pleurisia/diagnóstico , Antivirais/uso terapêutico , Infecções por Citomegalovirus/etiologia , Infecções por Citomegalovirus/terapia , Drenagem , Ganciclovir/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/efeitos adversos , Cirrose Hepática Alcoólica/cirurgia , Masculino , Pessoa de Meia-Idade , Pericardiocentese , Pericardite/etiologia , Pericardite/terapia , Pleurisia/tratamento farmacológico , Pleurisia/etiologia , Toracentese , Tomografia Computadorizada por Raios X
8.
Am J Med Sci ; 356(5): 487-491, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30055756

RESUMO

A 65-year-old man was admitted for productive cough and dyspnea. Bilateral pleural effusions were observed on chest X-ray. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, bacterial culture and polymerase chain reaction analysis for Mycobacterium tuberculosis were negative. Immunological examinations showed high levels of immunoglobulin G4 (IgG4) in both serum and pleural effusion fluid. Pathologic evaluation of a left pleural biopsy specimen using hematoxylin and eosin staining and immunohistochemical staining showed fibrosis-associated lymphoplasmacytic infiltration, 50 IgG4-positive plasma cells per high-power field, and an IgG4/IgG ratio of 40%. Thus, a diagnosis of IgG4-related pleuritis without other systemic manifestations was established. The bilateral pleural effusion improved following corticosteroid therapy. This is a rare case of IgG4-related pleuritis with no other organ involvement.


Assuntos
Imunoglobulina G/efeitos adversos , Derrame Pleural/diagnóstico , Pleurisia/diagnóstico , Corticosteroides/administração & dosagem , Idoso , Azatioprina/administração & dosagem , Humanos , Masculino , Derrame Pleural/tratamento farmacológico , Derrame Pleural/etiologia , Pleurisia/tratamento farmacológico , Pleurisia/etiologia , Prednisolona/administração & dosagem , Resultado do Tratamento
9.
Clin Respir J ; 12(9): 2407-2410, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30004629

RESUMO

Non-specific pleuritis (NSP) is defined as fibrinous or inflammatory pleuritis which cannot be attributed to a specific benign or malignant etiology. It can be diagnosed in biopsies in up to 30% of cases of exudative pleuritis after thoracoscopy, with a mean of 19.2%. In 66 out of 469 (14.2%) patients in combined series, a malignant pleural disease (mostly mesothelioma) was found during a follow-up of at least 21 months. Most likely, a follow-up time of 12 months is sufficient, although the current routine is a follow-up of 2 years. Because of a benign course in 85% of patients with NSP, a repeated invasive procedure after thoracoscopy is only indicated in a limited group of patients. The most important indications for a repeated pleural biopsy are persistent chest pain, recurrent pleural effusion, radiologic findings suggestive for malignant pleural disease.


Assuntos
Biópsia/métodos , Pleurisia/diagnóstico , Pleurisia/etiologia , Toracoscopia/instrumentação , Assistência ao Convalescente , Biópsia/estatística & dados numéricos , Diagnóstico Diferencial , Reações Falso-Negativas , Feminino , Humanos , Incidência , Neoplasias Pulmonares/complicações , Masculino , Mesotelioma/complicações , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Pleurisia/epidemiologia , Pleurisia/terapia , Valor Preditivo dos Testes , Fatores de Risco , Toracoscopia/métodos
10.
J Int Med Res ; 46(7): 2976-2982, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29756504

RESUMO

Although the infectious diseases tuberculosis (TB) and cryptococcosis both cause formation of single or multiple nodules in immunodeficient hosts, cases of co-infection of these diseases are rarely seen. We report a patient who was co-infected with TB and cryptococcosis. A male patient with no clinical evidence of immunodeficiency presented with a 3-week history of abdominal distension accompanied by oedema of recurring lower extremities. The patient was diagnosed with tuberculous peritonitis and tuberculous pleurisy by an abdominal puncture biopsy. Several months after being treated for TB, the patient was diagnosed with Cryptococcus infection and received antifungal treatment. Computed tomographic and magnetic resonance imaging findings suggested that treatment was effective. This case illustrates the challenges encountered during assessment of neoplasms associated with TB and cryptococcosis. Differential diagnosis requires an abdominal puncture biopsy. Diagnosis of Cryptococcus infection also requires a positive cryptococcal culture and positive India ink staining analysis. Notably, our patient also showed no obvious symptoms of cryptococcosis after receiving anti-TB treatment. Accordingly, in this report, we discuss the possible pathogenic mechanisms that underlie the coincidence of both types of inflammatory lesions. We emphasize the need for a greater awareness of atypical presentations of TB accompanied by Cryptococcus infection.


Assuntos
Coinfecção/diagnóstico , Criptococose/diagnóstico , Pneumopatias/diagnóstico , Peritonite Tuberculosa/diagnóstico , Pleurisia/diagnóstico , Tuberculose Pleural/diagnóstico , Antifúngicos/uso terapêutico , Antituberculosos/uso terapêutico , Coinfecção/tratamento farmacológico , Criptococose/tratamento farmacológico , Humanos , Pneumopatias/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Peritonite Tuberculosa/tratamento farmacológico , Pleurisia/tratamento farmacológico , Tuberculose Pleural/tratamento farmacológico
11.
Intern Med ; 57(15): 2251-2257, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-29526951

RESUMO

An 81-year-old man was admitted with bilateral pleural effusion. A clinical examination showed lymphocytic pleura effusion and elevated serum IgG4 levels, so that IgG4-related disease was suggested, whereas tuberculous pleurisy was suspected because of high adenosine deaminase (ADA) levels in the pleural effusion. A surgical pleural biopsy revealed that there were large numbers of IgG4-positive cells and IgG4/IgG positive cell ratio exceeded 40% in several sites. Accordingly, we diagnosed IgG4-related pleuritis and treated with the patient with glucocorticoid therapy. The ADA levels in pleural effusion can increase in IgG4-related pleuritis, and it is therefore important to perform a pleural biopsy.


Assuntos
Imunoglobulina G/imunologia , Pleurisia/imunologia , Adenosina Desaminase/análise , Idoso de 80 Anos ou mais , Biópsia , Glucocorticoides/uso terapêutico , Humanos , Linfócitos/patologia , Masculino , Pleurisia/diagnóstico , Pleurisia/tratamento farmacológico
12.
BMJ Case Rep ; 20182018 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-29437801

RESUMO

We report two cases of pleurisy caused by non-tuberculous mycobacteria followed by pneumothorax. The onset of pleurisy was accompanied by acute fever. Cultured samples of the pleural effusions from the two patients, an 80-year-old man and an 87-year-old woman, were ultimately found to contain Mycobacterium intracellulare and Mycobacterium kansasii, respectively. Both patients were initially administered antibiotics, but their fevers persisted. Therefore, different combinations of antimycobacterial drugs were used, which reduced the fever in a few days. In these patients, pleurisy caused by non-tuberculous mycobacteria followed by pneumothorax was characterised by acute fever and improvement in the fever after administration of antimycobacterial drugs; however, the aetiology remains to be clarified.


Assuntos
Antibacterianos/uso terapêutico , Antituberculosos/uso terapêutico , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Pleurisia/tratamento farmacológico , Idoso de 80 Anos ou mais , Quimioterapia Combinada , Feminino , Febre/etiologia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/microbiologia , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/microbiologia , Mycobacterium kansasii/isolamento & purificação , Pleurisia/diagnóstico , Pleurisia/microbiologia , Radiografia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Scand J Surg ; 107(2): 145-151, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29121816

RESUMO

BACKGROUND AND AIMS: The development of pleural infection may imply a worse state of health and prognosis. The objective of this study was to ascertain the long-term survival and causes of death after pleural infections and to compare them to those of matched controls. MATERIAL AND METHODS: Altogether 191 patients treated for pleural infections at a single University Hospital between January 2000 and December 2008 and 1910 age- and gender-matched controls were included. Survival data and the causes of death for non-survivors were obtained from national databases and compared between the groups. RESULTS: The etiology of pleural infection was pulmonary infection in 70%, procedural complication in 9%, trauma in 5%, malignancy in 4%, other in 7%, and unknown in 5% of patients. The course of treatment was surgical in 82%, drainage only in 12%, and conservative in 5% of included patients. The median follow-up time was 11 years. Mortality rates were 8.4% versus 0.8% during the first 90 days, p < 0.001, and 46.6% versus 24.5% overall, p < 0.001, in patients and controls, respectively. Mortality was significantly higher in patients with pulmonary infection, procedural complication, or malignancy as the etiology of pleural infection. In multivariable analysis, advanced age, previous malignancies, institutional care, alcoholism, and malignant etiology for the infection were associated with inferior survival. Deaths caused by malignancies, respiratory diseases, and digestive diseases were significantly more common in patients than in controls. CONCLUSION: Long-term survival in patients with pleural infections is significantly inferior to that of age and gender-matched controls.


Assuntos
Empiema Pleural/diagnóstico , Empiema Pleural/mortalidade , Pleurisia/diagnóstico , Pleurisia/mortalidade , Adulto , Idoso , Estudos de Casos e Controles , Causas de Morte , Empiema Pleural/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pleurisia/etiologia , Prognóstico , Taxa de Sobrevida
15.
Pediatr Emerg Care ; 34(11): e201-e203, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28350720

RESUMO

The diagnosis of pulmonary thromboembolism (PE) is often delayed because it is usually misdiagnosed as pneumonia or deep vein thrombosis. We report an unusual case of PE misdiagnosed as viral pleuritis on the first arrival at the emergency department (ED) in our hospital. A 14-year-old girl with no previous significant medical history was referred to the ED with pleuritic and chest pain with low-grade fever 4 days before admission. Echography showed a small amount of left pleural effusion. A 12-lead electrocardiogram was normal. She received a diagnosis of viral pleuritis. Two days before admission, she revisited ED with dyspnea and exacerbated pain. Echography showed slight increase in left pleural effusion. She had the same diagnosis. The chest pain remained at the same level. On the day of admission, she presented to ED with vomiting, watery diarrhea, abdominal pain, chest pain, and respiratory distress. Laboratory findings showed hypoalbuminemia and proteinuria. Echography showed a moderate amount of pleural effusion on both sides and no dilatation of the right cardiac ventricle. Contrast-enhanced chest computed tomography was performed to search the cause of the respiratory distress, which showed filling defects with contrast material in pulmonary arteries. A 12-lead electrocardiogram showed an S1Q3T3 pattern. She received a diagnosis of PE caused by nephrotic syndrome. Pulmonary thromboembolism can mimic infectious pleuritis and lead to misdiagnosis and/or delayed diagnosis. Thus, risk factors of PE should be considered in pediatric patients presenting with symptoms suggesting infectious pleuritis.


Assuntos
Pleurisia/diagnóstico , Embolia Pulmonar/diagnóstico , Adolescente , Dor no Peito/etiologia , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Humanos , Derrame Pleural , Tomografia Computadorizada por Raios X/métodos
16.
Acta Clin Croat ; 57(4): 789-791, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31168220

RESUMO

- Infections are well-known complications of radical prostatectomy. In the United States and Europe, the rates of surgical site infections are generally less than 1% and of other infections up to 3%. We report a case of a 62-year-old man who developed severe sepsis with renal insufficiency, paralytic ileus and polyserositis after radical prostatectomy, as a consequence of probable quinolone-resistant bacterial infection. Computed tomography of the abdomen and chest showed polyserositis with bilateral pleural and peritoneal effusions. Treatment with meropenem and other supportive measures resulted in good clinical outcome. This case suggested that severe sepsis with exudative polyserositis was probably caused by mobilization of an infective agent (bacterium) during bladder neck dissection as part of open radical prostatectomy.


Assuntos
Adenocarcinoma , Pseudo-Obstrução Intestinal , Peritonite , Pleurisia , Complicações Pós-Operatórias , Prostatectomia , Neoplasias da Próstata , Insuficiência Renal , Sepse , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Antibioticoprofilaxia/métodos , Humanos , Pseudo-Obstrução Intestinal/diagnóstico , Pseudo-Obstrução Intestinal/etiologia , Pseudo-Obstrução Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/métodos , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/terapia , Pleurisia/diagnóstico , Pleurisia/etiologia , Pleurisia/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Insuficiência Renal/diagnóstico , Insuficiência Renal/etiologia , Insuficiência Renal/terapia , Sepse/diagnóstico , Sepse/etiologia , Sepse/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
17.
Colomb Med (Cali) ; 48(2): 47-52, 2017 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-29021638

RESUMO

INTRODUCTION: The diagnosis of pleural tuberculosis requires an invasive and time-consuming reference method. Polymerase chain reaction (PCR) is rapid, but validation in pleural tuberculosis is still weak. OBJECTIVE: To establish the operating characteristics of real-time polymerase chain reaction (RT-PCR) hybridization probes for the diagnosis of pleural tuberculosis. METHODS: The validity of the RT-PCR hybridization probes was evaluated compared to a composite reference method by a cross-sectional study at the Hospital Universitario de la Samaritana. 40 adults with lymphocytic pleural effusion were included. Pleural tuberculosis was confirmed (in 9 patients) if the patient had at least one of three tests using the positive reference method: Ziehl-Neelsen or Mycobacterium tuberculosis culture in fluid or pleural tissue, or pleural biopsy with granulomas. Pleural tuberculosis was ruled out (in 31 patients) if all three tests were negative. The operating characteristics of the RT-PCR, using the Mid-P Exact Test, were determined using the OpenEpi 2.3 Software (2009). RESULTS: The RT-PCR hybridization probes showed a sensitivity of 66.7% (95% CI: 33.2%-90.7%) and a specificity of 93.5% (95% CI: 80.3%-98.9%). The PPV was 75.0% (95% CI: 38.8%-95.6%) and a NPV of 90.6% (95% CI: 76.6%-97.6%). Two false positives were found for the test, one with pleural mesothelioma and the other with chronic pleuritis with mesothelial hyperplasia. CONCLUSIONS: The RT-PCR hybridization probes had good specificity and acceptable sensitivity, but a negative value cannot rule out pleural tuberculosis.


Assuntos
Derrame Pleural/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Tuberculose Pleural/diagnóstico , Adulto , Colômbia , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Masculino , Mesotelioma/diagnóstico , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Pleurisia/diagnóstico , Valor Preditivo dos Testes , Sensibilidade e Especificidade
19.
Rev. clín. esp. (Ed. impr.) ; 217(7): 420-422, oct. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-166687

RESUMO

La biopsia pleural está especialmente indicada en las siguientes circunstancias: a) análisis del líquido pleural no concluyente y estudio de esputos negativo, si no se dispone de adenosina-desaminasa (ADA); b) sospecha de tuberculosis multirresistente; c) necesidad de distinguir entre pleuritis tuberculosa (si cursa con neutrofilia) y derrame paraneumónico complicado; d) derrame pleural maligno coexistiendo con ADA muy elevada; e) derrame coexistiendo con cáncer de pulmón y con citología pleural negativa; f) sospecha de mesotelioma, y g) necesidad de aplicar retratamiento en pacientes con recaída tras quimioterapia. Es recomendable hacer biopsia con aguja guiada por técnicas de imagen en a) y b), y sería preferible hacer toracoscopia en el resto de las situaciones (AU)


Pleural biopsies are especially indicated in the following circumstances: a) inconclusive pleural fluid analysis and negative sputum study, if adenosine deaminase (ADA) levels are unavailable; b) suspected multi-resistant tuberculosis; c) a need for differentiating tuberculous pleurisy (if it progresses with neutrophilia) and complicated parapneumonic effusion; d) malignant pleural effusion coexisting with very high ADA levels; e) effusion coexisting with lung cancer and negative pleural cytology; f) suspected mesothelioma; and g) need for implementing re-treatment for patients with relapse after chemotherapy. Image-guided needle biopsy is recommended for cases a and b, while thoracoscopy is preferable for the other cases (AU)


Assuntos
Humanos , Exsudatos e Transudatos , Pleurisia/complicações , Pleurisia/diagnóstico , Toracoscopia/métodos , Tuberculose/complicações , Biópsia/métodos , Biópsia , Pleura/cirurgia , Mesotelioma/diagnóstico
20.
Saudi Med J ; 38(7): 699-705, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28674714

RESUMO

OBJECTIVES: To evaluate the diagnostic validity of GeneXpert for the detection of Mycobacterium tuberculosis (MTB) in pericardial and pleural effusions samples. METHODS: A cross sectional study was conducted at the Mycobacteriology Laboratory, Allama Iqbal Medical College, Lahore, Pakistan. A total of 286 (158 pleural and 128 pericardial fluids) samples were received from tuberculosis (TB) suspects between January 2014 and August 2016. Every sample was processed for Ziehl-Neelsen (Zn) smear, Lowenstein Jensen (LJ) culture, GeneXpert MTB/RIF assay according to standard protocols. Validity of GeneXpert assay for the detection of MTB was evaluated using LJ culture as gold standard. RESULTS: Out of 286 effusions samples, MTB was isolated by LJ culture in 51 (17.8%) samples followed by GeneXpert in 43 (15%), and acid- fast bacilli (AFB)  was detected by Zn smear microscopy in 11 (3.8%) samples. GeneXpert showed high sensitivity (84.3%), specificity (100%), with positive predictive value (100%), and  negative predictive value (96.7%), while Zn smear showed sensitivity 18.3%, specificity 99.1%, positive predictive value 81.8%, and negative predictive value  85.4%. A strikingly high sensitivity of 72.2% was observed for pericardial fluid by GeneXpert. CONCLUSION: GeneXpert assay is an innovative tool, for prompt detection of MTB and drug resistance. It is definitely an attractive point of care test, with high sensitivity and specificity along with turn around time of 2 hours, which facilitates timely diagnosis and appropriate management of TB pleuritis and pericarditis.


Assuntos
Pericardite Tuberculosa/diagnóstico , Pleurisia/diagnóstico , Tuberculose/diagnóstico , Estudos Transversais , Genes Bacterianos , Humanos , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Sensibilidade e Especificidade
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