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1

Hendrawardani, Dewa Ayu Citra. "Efusi pleura pada tuberkulosis ekstra paru dengan riwayat lupus eritematosus sistemik di Puskesmas Sukasada II: sebuah laporan kasus." Intisari Sains Medis 14, no. 2 (2023): 497–503. http://dx.doi.org/10.15562/ism.v14i2.1727.

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Background: Infection is a complication that contributes to morbidity and mortality in SLE patients. Tuberculosis (TB) is an infection that is of particular concern, especially for those living in endemic areas such as Indonesia. Pleural TB is the second most common form of extrapulmonary tuberculosis after lymphatic involvement and is the most common cause of pleural effusion. This case report describes a case of pleural effusion in extrapulmonary tuberculosis with a history of systemic lupus erythematosus for the purpose of determining appropriate management. Case presentation: A 42-year-old woman complained of fever for 2 weeks, non-productive cough, lower right chest pain when coughing, and shortness of breath. The patient has a history of controlled SLE disease with medication since one year ago. On physical examination found decreased vocal fremitus right chest, dull percussion on the right chest, decreased vesicular breath sounds in the lower right lung. Complete blood count and blood chemistry showed normal results, chest X-ray showed right pleural effusion with pulmonary infiltrate on the ipsilateral pleural effusion, pleural fluid analysis showed an exudate, and adenosine deaminase levels were more than laboratory reference values. This patient was diagnosed with right pleural effusion et causa pleural TB. Management includes evacuation of pleural fluid, administering rivastar therapy at the hospital followed by 2RHZE/4RH anti-tuberculosis drugs at the Sukasada II Health Center. Significant improvement was evident by the reduced number of pleural effusions and pulmonary infiltrates on the chest X-rays of the patients in the second and final month of treatment. Conclusion: Pleural effusion in extrapulmonary TB patients with a history of SLE can be diagnosed through history, physical examination and supporting examinations such as radiography, pleural fluid analysis and histology. Treatment and monitoring of TB in SLE patients is in line with national guidelines for TB patients without SLE. Latar Belakang: Infeksi merupakan komplikasi yang berkontribusi terhadap morbiditas dan mortalitas pada pasien SLE. Tuberkulosis (TB) merupakan salah satu infeksi yang menjadi perhatian khusus terutama bagi mereka yang tinggal didaerah endemik seperti di Indonesia. TB pleura adalah bentuk paling umum kedua dari tuberkulosis ekstra paru setelah keterlibatan limfatik dan merupakan penyebab paling umum dari efusi pleura. Laporan kasus ini mendeskripsikan kasus efusi pleura pada tuberkulosis ekstra paru dengan riwayat lupus eritematosus sistemik agar tepat dalam menentukan tatalaksana yang tepat. Presentasi kasus: Perempuan 42 tahun mengeluh demam selama 2 minggu, batuk non produktif, nyeri dada kanan bawah jika batuk, dan sesak. Pasien memiliki riwayat penyakit SLE terkontrol dengan pengobatan sejak satu tahun yang lalu. Pada pemeriksaan fisik ditemukan vokal fremitus dada kanan menurun, perkusi redup pada dada kanan, suara napas vesikuler menurun pada paru kanan bawah. Pemeriksaan darah lengkap dan kimia darah menunjukkan hasil normal, foto toraks menunjukkan efusi pleura kanan dengan gambaran infiltrat paru di ipsilateral efusi pleura, analisis cairan pleura menunjukkan suatu eksudat, dan kadar adenosine deaminase lebih dari nilai rujukan laboratorium. Pasien ini didiagnosis dengan efusi pleura dekstra et causa TB pleura. Tatalaksana meliputi evakuasi cairan pleura, pemberian terapi rivastar di rumah sakit dilanjutkan obat anti tuberkulosis 2RHZE/4RH di Puskesmas Sukasada II. Perbaikan yang signifikan terbukti dengan berkurangnya jumlah efusi pleura dan infiltrate paru pada foto toraks pasien bulan kedua dan akhir pengobatan. Simpulan: Efusi pleura pada pasien TB ekstra paru dengan riwayat SLE dapat ditegakkan diagnosisnya melalui anamnesis, pemeriksaan fisik dan pemeriksaan penunjang seperti radiografi, pemeriksaan analisis cairan pleura dan histologi. Pengobatan dan monitoring TB pada pasien SLE sejalan dengan pedoman nasional pasien TB tanpa SLE.
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2

Wibowo, Imam Mukti, and Sahrun. "Pasien Pleuritis TB Terkonfirmasi ADA Test Dengan Efusi Pleura Massif Yang Mendapat Penanganan Chest Tube, WSD, dan OAT." JURNAL RISET RUMPUN ILMU KEDOKTERAN 4, no. 1 (2025): 165–73. https://doi.org/10.55606/jurrike.v4i1.4555.

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Tuberculosis (TB) is one of the oldest infectious diseases that has existed throughout the history of human civilization and remains a major public health problem in the world today. Tuberculosis is caused by Mycobacterium Tuberculosis which can result in TB Pleuritis, which is inflammation of the pleura, both the parietal pleura and the visceral pleura, manifested by accumulation of fluid in the pleural cavity. A 20-year-old man came with complaints of coughing for the past 1 month, white phlegm, shortness of breath felt worse for the past 2 days, fever not too high for the past 1 week accompanied by cold sweats at night. The patient feels that it is difficult to gain weight and tends to lose weight this month. Chest X-ray show left massive pleural effusion. Acid fast baccili sputum was negative. USG Thorax show pleural fluids approximately 1600 cc. Tuberculosis (TB) can cause TB pleutiritis with symptoms of shortness of breath and sometimes chest pain on the side of the pleural cavity where there is fluid.3 Treatment of TB Pleuritis is the same as the treatment of pulmonary TB in general with the 2RHZE/4RH combination. Optimal fluid evacuation is carried out according to the patient's condition.
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3

Rajput, Shiv Gaurav, Shubhangi Gupta, Udaya Bhaskarini Vakamudi, and Calicut Muthukrishnan Sreedhar. "Rare Case of Pulmonary Tuberculosis Presenting as Subcutaneous Swelling and Nodular Pleural Thickening: A Case Report." Journal of Advances in Medicine and Medical Research 37, no. 1 (2025): 1–5. https://doi.org/10.9734/jammr/2025/v37i15690.

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Tuberculosis (TB) is a global health concern and can affect various organs, including the pleura1 . Pleural involvement in TB often presents as pleural effusion and smooth pleural thickening 2. We present a case of a 12-year-old male who presented with complaints of fever, weight loss and painful subcutaneous swelling below the lower left 9th rib. Ultrasound screening was done to evaluate the painful soft tissue lesion in the lower left antero-lateral chest wall, findings revealed a collection with necrotic areas within on the left side along with minimal right sided pleural effusion. HRCT Chest Imaging revealed nodular right pleural thickening with minimal right pleural effusion along with other findings as seen on the left side on USG. The patient was diagnosed with tuberculous pleural thickening based on cartridge based nucleic acid amplification test (CBNAAT) examination of the fine needle aspiration cytology (FNAC) guided pleural fluid aspiration and analysis. The case highlights the importance of considering TB as a potential etiology for nodular pleural thickening, even in a young patient, particularly in high TB burden regions.
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4

Casalini, Angelo Gianni, Pier Anselmo Mori, Maria Majori, et al. "Pleural tuberculosis: medical thoracoscopy greatly increases the diagnostic accuracy." ERJ Open Research 4, no. 1 (2018): 00046–2017. http://dx.doi.org/10.1183/23120541.00046-2017.

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Our objective was to evaluate the efficacy of a standardised work-up in the diagnosis of pleural tuberculosis (TB) that included fibreoptic bronchoscopy and medical thoracoscopy.A consecutive series of 52 pleural TB patients observed during the period 2001–2015 was evaluated retrospectively. 20 females, mean (range) age 39.7 (18–74) years, and 32 males, mean (range) age 45.75 (21–83) years, were included (28 non-EU citizens (53.8%)). The diagnosis of TB infections was established by identification (using stains, culture or molecular tests) of Mycobacterium tuberculosis in the pleura, sputum and/or bronchial specimens, or by evidence of caseous granulomas on pleural biopsies. Patients with and without lung lesions were considered separately.The diagnostic yield of the microbiological tests on pleural fluid was 17.3% (nine out of 52 patients). Among the 18 patients with lung lesions, bronchial samples (washing, lavage or biopsy) were positive in 50% of cases (nine patients). Cultures of pleural biopsies were positive in 63% of cases (29 out of 46 patients); pleural histology was relevant in all patients. Without pleural biopsy, a diagnosis would have been reached in 15 out of 52 patients (28.6%) and in four of them only following culture at 30–40 days.An integrated diagnostic work-up that includes all the diagnostic methods of interventional pulmonology is required for a diagnosis of pleural TB. In the majority of patients, a diagnosis can be reached only with pleural biopsy.
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5

Koshak, Yu F. "Video-Thoracic Surgical Treatment of TB-Empyema for Pleuro-Pulmonary Tuberculosis." Tuberculosis, Lung Diseases, HIV Infection, no. 4 (November 30, 2023): 24–30. http://dx.doi.org/10.30978/tb2023-4-24.

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According to WHO, the emergence of purulent diseases with superinfection is observed due to the formation of resistance of microorganisms, mixed specific and nonspecific flora to the main anti-tuberculosis drugs. The rational choice of diagnosis and surgical intervention significantly reduces the formation of suppuration resistance for pleura-pulmonary tuberculosis. Objective — to improve the surgical treatment of pleural tuberculosis empyema due to minimally invasive diagnostics and video-assisted thoracic resections. Materials and methods. A retrospective analysis was conducted on our own studies involving 685 cases of patients with stage I—III pleuro-pulmonary complications of tuberculosis empyema. This included a review of minimally invasive video-surgical diagnostics and operations conducted over the past decade. The treated patients were divided into two groups: Group 1, consisting of 351 patients (51.25 %), underwent operations using minimally invasive technologies (video-thoracoscopy (VTS), video-assisted surgical resection (VATS)); Group 2, comprising 334 patients (48.75 %), underwent open wide thoracotomy. In Group 1, 301 patients had acute pleural TB-empyema and 50 had chronic cases. Among the patients in Group 2, acute pleural TB empyema was observed in 284 cases and chronic TB empyema in 50 cases. Results and discussion. According to our data, only VTS is a highly informative method for detecting tuberculosis, pleural TB-empyema in the 1st, 2nd and 3rd stages of its development. Minimally invasive technologies have advantages over open thoracotomies and significantly reduce intraoperative bleeding, the number of posto­perative complications and mortality from surgical treatment. The analysis of our own researches proves that video­thoracoscopic interventions (VTS, VATS) in tuberculous suppurations have some disadvantages, namely: the inability to palpably assess the condition of altered structures within the pleural cavity, the technical complexity involved in performing marginal resection of a bronchial fistula. All this requires further development of high-tech surgical techniques in our country. In a comparative analysis of the frequen­cy and nature of complications during surgery, we found that, overall, in the main group, they occurred 2.1 times less frequently than in the comparison group (p < 0.05). Conclusions. To improve surgical treatment of pleural tuberculosis empyema through minimally invasive diagnostics and video-assisted thoracic resections (VATS). The greatest diagnostic difficulties were encountered in patients with localization of pleural TB empyema in the area of active tuberculous and metatuberculous changes. In 48.7 % of patients, the pleural TB empyema is diagnosed at a late stage of the purulent process.
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6

Wulandari, Selvy, Fajrinur Syahrani, Ade Rahmaini, and Putri Chairani Eyanoer. "Pleura Fluid Leukocyte Levels Test in Establish of Pleura Tuberculosis Effusion in Exudative Pleural Effusion Patients at H. Adam Malik General Hospital Medan in 2018." Jurnal Respirologi Indonesia 41, no. 3 (2021): 156–60. http://dx.doi.org/10.36497/jri.v41i3.182.

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Background: Tuberculous pleural effusion is an accumulation of fluid in the pleural cavity produced by Mycobacterium tuberculosis (MTB). The gold standard of TB pleural effusion diagnosis is to obtain TB bacilli in pleural fluid or pleural tissue. However, this is often constrained due to the low identification level of these bacilli and the slow growth of MTB cultures. This study aimed to assess the pleural fluid leukocyte level in establishing a diagnosis of pleural effusion caused by TB.
 Methods: This was a diagnostic study conducted on 111 patients with pleural effusion, caused by TB, malignancy or non-TB infections that were assigned by supporting examinations obtained from medical records, which then assessed for pleural fluid leukocytes. Statistical analysis was performed using Kruskal Wallis Test and Receiver Operating Characteristic (ROC) curve to attain the cut-off point of pleural fluid leukocyte level.
 Results: Pleural fluid leukocyte levels in TB cases were significantly different when compared to pleural effusion caused by malignancy and non-TB infections (P
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7

Amalia, Rizki Nur, and Isnu Pradjoko. "Nilai Diagnostik Adenosine Deaminase (ADA) Cairan Pleura pada Penderita Efusi Pleura Tuberkulosi." Jurnal Respirasi 2, no. 2 (2019): 35. http://dx.doi.org/10.20473/jr.v2-i.2.2016.35-40.

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Background: Tuberculosis pleural effusion is the most common extrapulmonary TB after lymphadenitis TB. Limited diagnostic methods make TB pleural effusion hard to diagnose. Adenosine deaminase ADA is an enzyme in purin catabolism process which catalyze adenosine into inosine and deoksiadenosine into deoksiinosin. This process is important in lymphoid cell differentiation. ADA is elevated in TB pleural effusion. Method: This study was a cross sectional analytic observational. Statistic analysis was using two independent samples T test. ROC curve was used to determine cut off value of ADA. Kappa test was used to determined the level of agreement of ADA cut off value. Results: Forty eight samples were included in this study, 18 samples with TB pleural effusion and 30 samples with non TB pleural effusion. There was significant difference between pleural fluid ADA in TB and non TB. Positivity of AFB sputum and MTB culture did not show any significant differences. Cut off ADA value for TB pleural effusion diagnosis was 39,19 with sensitivity 88,9% and spesificity 90%. Conclusion: Examination of ADA level in pleural fluid is a usefull tool to diagnose TB pleural effusion.
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8

Shashidhara, K. C., Rajashekar Reddy, Savitha Vijayakumar, Jerin Abraham Joseph, and B. S. Meghana. "Evaluation of polymerase chain reaction and adenosine deaminase levels for rapid diagnosis of clinically suspected tuberculous pleural effusion." Current Medicine Research and Practice 14, no. 4 (2024): 150–54. http://dx.doi.org/10.4103/cmrp.cmrp_227_23.

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ABSTRACT Background: Tuberculosis (TB) often leads to pleural effusion, particularly prevalent in developing nations such as India. There has been a global rise in TB cases. Although lymphocytic predominant fluid is commonly associated with tubercular pleural effusion, it is essential to note that not all lymphocytic predominant fluids indicate TB. The diagnosis of pleural TB has benefited significantly from the use of biochemical markers. Conventional bacteriological methods are not very useful in diagnosing tubercular effusion and rarely identify Mycobacterium tuberculosis in pleural fluid. Owing to diagnostic difficulties, newer investigations, such as TB polymerase chain reaction (TB-PCR), adenosine deaminase (ADA) and culture, are amongst the most recent techniques currently used due to the challenges associated with diagnosis. Aims: This study aimed to measure the sensitivity and specificity of TB-PCR and compare them with those of ADA and TB cultures for suspected TB pleural effusion. Methods: This study included 50 patients diagnosed with pleural effusion who underwent pleural fluid analysis. Patients exhibiting exudative effusion with lymphocyte predominance also underwent a pleural biopsy. Pleural fluid ADA levels were also measured, and TB-PCR tests were conducted. Results: Eighteen patients were confirmed to have TB by biopsy. ADA was both sensitive and specific at 67% and 62.5%, respectively. However, PCR showed a sensitivity of 16.6% and a specificity of 100%. Conclusion: This study found a statistically significant association (P < 0.05) between ADA levels and distinguishing pleural effusion, which is tubercular in origin, from non-tubercular effusion. Therefore, the pleural ADA estimate appears to have the potential to be a reliable test for diagnosing TB pleural effusion. It has sufficient sensitivity and specificity while being cost-effective and easily executable compared to pleural biopsy. Our study also compared the sensitivity of PCR with pleural biopsy and discovered that PCR was more specific and less sensitive.
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McNally, Emma, Clare Ross, and Laura E. Gleeson. "The tuberculous pleural effusion." Breathe 19, no. 4 (2023): 230143. http://dx.doi.org/10.1183/20734735.0143-2023.

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Pleural tuberculosis (TB) is a common entity with similar epidemiological characteristics to pulmonary TB. It represents a spectrum of disease that can variably self-resolve or progress to TB empyema with severe sequelae such as chronic fibrothorax or empyema necessitans. Coexistence of and progression to pulmonary TB is high. Diagnosis is challenging, as pleural TB is paucibacillary in most cases, but every effort should be made to obtain microbiological diagnosis, especially where drug resistance is suspected. Much attention has been focussed on adjunctive investigations to support diagnosis, but clinicians must be aware that apparent diagnostic accuracy is affected both by the underlying TB prevalence in the population, and by the diagnostic standard against which the specified investigation is being evaluated. Pharmacological treatment of pleural TB is similar to that of pulmonary TB, but penetration of the pleural space may be suboptimal in complicated effusions. Evidence for routine drainage is limited, but evacuation of the pleural space is indicated in complicated disease.Educational aimsTo demonstrate that pleural TB incorporates a wide spectrum of disease, ranging from self-resolving lymphocytic effusions to severe TB empyema with serious sequelae.To emphasise the high coexistence of pulmonary TB with pleural TB, and the importance of obtaining sputum for culture (induced if necessary) in all cases.To explore the significant diagnostic challenges posed by pleural TB, and consequently the frequent lack of information about drug sensitivity prior to initiating treatment.To highlight the influence of underlying TB prevalence in the population on the diagnostic accuracy of adjunctive investigations for the diagnosis of pleural TB.To discuss concerns around penetration of anti-TB medications into the pleural space and how this can influence decisions around treatment duration in practice.
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Aljohaney, A., K. Amjadi, and G. G. Alvarez. "A Systematic Review of the Epidemiology, Immunopathogenesis, Diagnosis, and Treatment of Pleural TB in HIV- Infected Patients." Clinical and Developmental Immunology 2012 (2012): 1–9. http://dx.doi.org/10.1155/2012/842045.

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Background. High HIV burden countries have experienced a high burden of pleural TB in HIV-infected patients.Objective. To review the epidemiology, immunopathogenesis, diagnosis, and treatment of pleural TB in HIV-infected patients.Methods. A literature search from 1950 to June 2011 in MEDLINE was conducted.Results. Two-hundred and ninety-nine studies were identified, of which 30 met the inclusion criteria. The immunopathogenesis as denoted by cells and cytokine profiles is distinctly different between HIV and HIV-uninfected pleural TB disease. Adenosine deaminase and interferon gamma are good markers of pleural TB disease even in HIV-infected patients. HIV-uninfected TB suspects with pleural effusions commonly have a low yield of TB organisms however the evidence suggests that in dually infected patients smear and cultures have a higher yield. The Gene Xpert MTB/RIF assay has significant potential to improve the diagnosis of pleural TB in HIV-positive patients.Conclusions. Pleural TB in HIV-infected patients has a different immunopathogenesis than HIV-uninfected pleural TB and these findings in part support the differences noted in this systematic review. Research should focus on developing an interferon gamma-based point of care diagnostic test and expansion of the role of Gene Xpert in the diagnosis of pleural TB.
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11

Ampow, Angelina T., Joan F. J. Timban, and Alfa G. E. Y. Rondo. "Gambaran Foto Toraks Pasien Tuberkulosis Paru dengan Efusi Pleura di RSUP Prof. Dr. R. D. Kandou Periode Januari – Juni 2022." Medical Scope Journal 5, no. 1 (2023): 57–63. http://dx.doi.org/10.35790/msj.v5i1.45128.

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Abstract: Although tuberculosis is a long-known infectious disease, it is still one of the leading causes of death worldwide. Chest X-ray could be used to detect tuberculous lesion. This study aimed to obtain the imaging of chest X-ray in pulmonary tuberculosis patients with pleural effusion at Prof. Dr. R. D. Kandou Hospital from January to June 2022. This was a retrospective and descriptive study with a cross-sectional design. The results showed that of 440 pulmonary tuberculosis patients at Prof. Dr. R. D. Kandou Hospital, 291 patients (66.1%) had pleural effusion dominated by age of 56-65 years (25.1%) and male (64.9%). Comorbidities in pulmonary tuberculosis with pleural effusion was mostly chronic kidney disease (CKD) (51.02%). The most common chest X-ray characteristics were infiltrates (93.5%) and cavities (91.4%), and the most common lesion was far advanced (97.6%). In conclusion, the majority of pulmonary tuberculosis patients with pleural effusion were males in the age group of 56-65 years with CKD comorbidity, and chest X-ray features of infiltrate and cavities with far advanced lesions. Keywords: chest X-ray; pulmonary tuberculosis; pleural effusion Abstrak: Tuberkulosis (TB) merupakan penyakit infeksi yang sudah lama dikenal tapi masih menjadi salah satu penyebab utama kematian di dunia. Untuk menemukan lesi TB dapat dilakukan pemeriksaan foto toraks Penelitian ini bertujuan untuk mengetahui gambaran foto toraks pasien TB paru dengan efusi pleura di RSUP Prof. Dr. R. D. Kandou periode Januari – Juni 2022. Jenis penelitian ialah deskriptif retrospektif dengan desain potong lintang. Hasil penelitian menunjukkan dari 440 pasien TB paru di RSUP Prof. Dr. R. D. Kandou didapatkan 291 pasien (66,1%) dengan efusi pleura, didominasi oleh usia 56-65 tahun (25,1%), jenis kelamin laki-laki (64,9%). Penyakit penyerta pada TB paru dengan efusi pleura paling banyak yaitu penyakit ginjal kronik (PGK) (51,02%). Gambaran foto toraks yang ditemukan paling sering ialah infiltrat (93,5%) dan kavitas (91,4%). Luas lesi yang ditemukan paling sering yaitu far advanced (97,6%). Simpulan penelitian ini ialah pasien tuberkulosis paru dengan efusi pleura paling banyak ditemukan pada laki-laki kelompok usia 56-65 tahun dengan penyakit penyerta PGK, serta gambaran foto infiltrat dan kavitas dengan lesi luas (far advanced). Kata kunci: foto toraks; tuberkulosis paru; efusi pleura
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Rai, Santosh P. V., Livingstone Yvette K., Kale Alok, and Goel Akshita. "Imaging of Pleural Tuberculosis: A Narrative Review." Indographics 03, no. 02 (2024): 157–62. https://doi.org/10.1055/s-0044-1792163.

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AbstractPleural tuberculosis is the second most common type of extrapulmonary tuberculosis (TB) after TB lymphadenitis and presents secondary to pulmonary TB in most cases. TB pleuritis develops due to a delayed hypersensitivity response precipitated by the discharge of tubercular bacilli in the pleural space typically within 6 to 9 months of the initial TB infection. TB empyema on the other hand is multibacillary and purulent, often seen in cases of pulmonary TB. Longstanding pleural TB can also present as fibrothorax, chylothorax, or empyema necessitans. It shows features similar to pleural mesothelioma in later stages and is important to be considered as a differential, especially in endemic regions. This review article aims to provide an in-depth knowledge into the basic anatomy of pleural space, pathophysiology of pleural TB, and imaging features helpful in making a diagnosis.
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Tarigan, Lupita Yessica, and Deddy Iskandar. "Pemeriksaan Adenosine Deaminase (ADA) sebagai Alternatif Diagnosis TB pada Anak." Cermin Dunia Kedokteran 49, no. 7 (2022): 382–85. http://dx.doi.org/10.55175/cdk.v49i7.253.

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Pendahuluan. Diagnosis tuberkulosis (TB) pada anak merupakan masalah tersendiri karena manifestasi klinis yang beragam dan tidak tersedianya standar baku penegakan diagnosis. Kasus. Anak perempuan usia 6 tahun, dengan klinis demam, batuk, dan sesak napas. Pada pemeriksaan fisik didapatkan penurunan suara napas di rongga dada kanan. Hasil pemeriksaan radiologi didukung ultrasonografi tampak gambaran efusi pleura kanan yang sebagian sudah terorganisasi. Hasil uji laboratorium didapatkan leukositosis dan hasil tes IGRA negatif. Analisis cairan pleura menunjukkan peningkatan kadar adenosine deaminase. Pengobatan TB menghasilkan perbaikan klinis dan radiologi bermakna. Simpulan. Pemeriksaan adenosine deaminase dapat dipertimbangkan untuk alternatif diagnosis TB pada anak.
 Diagnosis of tuberculosis (TB) in children is still problematic because of various clinical manifestations and the unavailability of diagnostic standard. Case. A 6-year old girl with fever, cough, and shortness of breath. On physical examination, there was a decreased breath sounds in the right chest. Radiology examination showed a partially organized right pleural effusion, supported with ultrasound finding. Lab test found leucocytosis and IGRA test was negative. Pleural fluid analysis showed increased adenosine deaminase level. TB treatment resulted in significant clinical and radiological improvement. Conclusion. Adenosine deaminase test can be considered as an alternative to TB diagnosis in children.
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Lee, Chung-Shu, Li-Chung Chiu, Chih-Hao Chang, et al. "The Clinical Experience of Mycobacterial Culture Yield of Pleural Tissue by Pleuroscopic Pleural Biopsy among Tuberculous Pleurisy Patients." Medicina 58, no. 9 (2022): 1280. http://dx.doi.org/10.3390/medicina58091280.

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Background and Objectives: Tuberculous pleurisy is a common extrapulmonary TB that poses a health threat. However, diagnosis of TB pleurisy is challenging because of the low positivity rate of pleural effusion mycobacterial culture and difficulty in retrieval of optimal pleural tissue. This study aimed to investigate the efficacy of mycobacterial culture from pleural tissue, obtained by forceps biopsy through medical pleuroscopy, in the diagnosis of TB pleurisy. Materials and Methods: This study retrospectively enrolled 68 TB pleurisy patients. Among them, 46 patients received semi-rigid pleuroscopy from April 2016 to March 2021 in a tertiary hospital. We analyzed the mycobacterial culture from pleural tissue obtained by forceps biopsy. Results: The average age of the study participants was 62.8 years, and 64.7% of them were men. In the pleuroscopic group, the sensitivity of positive Mycobacterium tuberculosis (M. TB) cultures for sputum, pleural effusion, and pleural tissue were 35.7% (15/42), 34.8% (16/46), and 78.3% (18/23), respectively. High sensitivities of M. TB culture from pleural tissue were up to 94.4% and 91.7% when pleural characteristic patterns showed adhesion lesions and both adhesion lesions and presence of micronodules, respectively. Conclusions: M. TB culture from pleural tissue should be considered a routine test when facing unknown pleural effusion during pleuroscopic examination.
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Alsayed Abouahmed, Eman. "Novel biomarkers for Diagnosis of Pulmonary Tuberculosis and Tuberculous Pleural Effusion." Annals of International Medical and Dental Research 8, no. 2 (2022): 43–51. http://dx.doi.org/10.53339/aimdr.2022.8.2.8.

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Background: The present study aimed to evaluate the importance of serum, pleural adenosine deaminase (ADA), and Gene Xpert in Diagnosis of TB and TB Pleural Effusion (TB-PLE.).Material & Methods:The study was done with 75 TB cases, 50 cases of them were diagnosed as Pulmonary TB and 25 cases as TB pleural effusion, collecting also 50 non-TB pleural effusion, Malignant and acute bacterial infection comprise 21 and 29 cases respectively. Cases with transudative pleural effusion were excluded from the study. Finally, 75 were healthy control group.Results:There was a highly significant difference between the mean age of TB-PE Patients and Patients non-TB-PLE (P-value <0.001), while there was a non-significant difference with patients with P-TB (P-value >0.05). Mean of Serum ADA level were highest 53.16 U/L in TB-PE cases, shown to be statistically significant when compared to 43.2 U/L in P-TB and 25.4 U/L in non TBpleural effusion. With p-value of 0.02 and 0.001respectively.Conclusions:We concluded that GeneXpert can be a useful diagnostic method in patients with suspected pulmonary tuberculosis. Serum and pleural fluid ADA level is a very helpful test to rule out a TB and can help differentiate tubercular etiology from non-tubercular.
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Tarigan, Lupita Yessica, and Deddy Iskandar. "Pemeriksaan Adenosine Deaminase (ADA) sebagai Alternatif Diagnosis TB pada Anak." Cermin Dunia Kedokteran 49, no. 7 (2022): 382. http://dx.doi.org/10.55175/cdk.v49i7.1935.

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<p>Pendahuluan. Diagnostik tuberkulosis (TB) pada anak merupakan masalah tersendiri karena manifestasi klinis yang beragam dan tidak tersedianya standar baku penegakan diagnosis. Kasus. Anak perempuan usia 6 tahun, dengan klinis demam, batuk, dan sesak nafas. Pada pemeriksaan fisik didapatkan penurunan suara napas di rongga dada kanan. Hasil pemeriksaan radiologis didukung ultrasonografi tampak gambaran efusi pleura kanan yang sebagian sudah terorganisasi. Hasil uji laboratorium didapatkan leukositosis dan hasil tes IGRA negatif. Analisis cairan pleura menunjukkan peningkatan kadar adenosin deaminase. Pengobatan TB menghasilkan perbaikan klinis dan radiologis bermakna. Simpulan. Pemeriksaan adenosin deaminase dapat dipertimbangkan untuk alternatif diagnosis TB pada anak.</p><p>Diagnosis of tuberculosis (TB) in children is still problematic because of various clinical manifestations and the unavailability of diagnostic standard. Case. A 6-year old girl with fever, cough and shortness of breath. On physical examination, there was a decrease breath sounds in the right chest. Radiology examination showed a partially organized right pleural effusion, supported with ultrasound finding. Lab test found leucocytosis and IGRA test was negative. Pleural fluid analysis showed increased adenosine deaminase level. TB treatment resulted in significant clinical and radiological improvement. Conclusion. Adenosine deaminase test can be considered as an alternative for TB diagnosis in children.</p><p> </p>
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Anthony Tjajaindra, Veronica Winda Soesanto, and Anak Agung Made Sucipta. "Massive Pleural Effusion in Tuberculosis Due to Systemic Lupus Erythematosus: A Case Report." International Journal of Medical Science and Health Research 13, no. 1 (2025): 40–50. https://doi.org/10.70070/wy3xjh07.

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Introduction : Tuberculosis (TB) posed a significant risk for mortality and morbidity in autoimmune disorders like systemic lupus erythematosus (SLE). TB in SLE patients often manifests as extrapulmonary disease, affecting areas like the pleura, leading to pleuritis and effusion. This case report aims to assess a case of massive pleural effusion in tuberculosis patient due to co-existing SLE. Case Description : We present the case of a 17 y.o. girl who experienced progressive shortness of breath, worsening one day prior to her admission to the Emergency Department of Wangaya Regional General Hospital. Examination indicated a massive pleural effusion. Pleural drainage was performed the following day, yielding a total of 2,800 mL of pleural fluid. Further examination revealed symptoms of SLE, strengthen by family history. A positive antinuclear antibody (ANA) test confirmed the diagnosis of SLE. Patient then given pulse intravenous methylprednisolone at dose of 600 mg once a day for three days and antituberculosis Fixed-Dose Combination therapy. After the effusion resolved, patient had outpatient treatment and control periodically. Conclusion : The increased risk of tuberculosis in SLE individual linked to immunological abnormalities in SLE, which hampers the body’s ability to control TB infection. Suspecting of SLE in patients with massive pleural effusion can lead to prompt treatment.
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Muhammad Zainul A, Fajrinur Syahrani, Parluhutan Siagian, and Putri Chairani Eyanoer. "Diagnostic Accuracy of Gene X-pert MTB/RIF for Tuberculous Pleural Effusion Compared to Adenosine Deaminase (ADA) at Haji Adam Malik General Hospital Medan." Sumatera Medical Journal 2, no. 2 (2019): 79–84. http://dx.doi.org/10.32734/sumej.v2i2.1067.

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Indonesia is one of the few countries in the world with very high burden of tuberculosis (TB). Tubercular pleural effusion (Pleural TB) is the most common form of extra-pulmonary TB, however the remains a common clinical challenge. This research from May 2017 through September 2017 a total of 42 patients with exudative lymphocytic pleural effusions suspected to pleural tuberculosis were enrolled in this study. Adenosine deaminase (ADA) and Gene X-pert were examined from pleural fluid. Diagnosis was made clinically or based from sputum/pleural fluid culture. The result of this research showed out of all participants, 64,3% (27/42) had ADA in positive level (>40 IU/L) and 31% (13/24) had Gene X-pert positive Mycobacterium Tb. The Gene X-pert sensitivity was 40.7% with specificity 86.6%, PPV and NPV were 44.8% and 57.1% respectively. Kappa Compatibility study show that Gene X-pert point was 0.227 (p 0.066). The usefulness of Gene X-pert to diagnose pleural TB is limited by its poor sensitivity. Gene X-pert cannot be used as single diagnostic tool for tuberculous pleural effusion
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Rodríguez, Rubén. "TUBERCULOSIS PLEURAL EN PACIENTE PEDIÁTRICO: REPORTE DE UN CASO Y REVISIÓN DE LA LITERATURA PLEURAL." Neumología Pediátrica 13, no. 1 (2018): 29–31. http://dx.doi.org/10.51451/np.v13i1.201.

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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.
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Limalvin, Nicholas P., Novita Maulidiyah, Ferry Limantara, and Fajar Kurniawan. "Massive pleural effusion, what should we do in emergency department? a case report." International Journal of Advances in Medicine 10, no. 6 (2023): 467–70. http://dx.doi.org/10.18203/2349-3933.ijam20231454.

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Indonesia has been known as an endemic country of tuberculosis (TB). Most of the cases are pulmonary TB, and pleural effusion is one of the common cases. Untreated pleural effusion can become massive pleural effusion, a true emergency case in the emergency room. In this report we present a 21-years-old female patient with new onset massive pleural effusion due to TB infection. A 21-year-old female patient with no previous medical illness came to ER with shortness of breaths since a week ago. Cough and unmeasured fever have been reported since a month ago. Tachypnea, extreme tachycardia, asymmetric chest movement, decreased vocal fremitus, dullness of percussion, and decreased left pulmonary sound were found. Chest x-ray showed a massive left pleural effusion with tracheal deviation. High flow nasal cannula was given due to blood gas analysis interpreting moderate respiratory distress. Thoracentesis was immediately performed with estimated 1200 CC yellow coloured fluid production. Other laboratory findings include hyponatremia and hypoalbuminemia. This patient was diagnosed with pleural effusion type pulmonary TB, treated with anti-TB drugs, mucolytic, corticosteroid, and analgesics. Serial chest x-rays showed improvement of pleural effusion. In developing countries like Indonesia, the most common causes of pleural effusion was TB infection besides malignancy. A massive pleural effusion diagnosis can be established with history taking, physical examination, chest sonography, chest x-ray, and/or CT-scan. Thoracentesis must be performed within minutes after massive pleural effusion was established.
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Teke, Turgut. "New Biomarkers Used in the Diagnosis of Tuberculosis-Related Pleural Effusions." Journal of Pediatric Infectious Diseases 15, no. 03 (2020): 113–17. http://dx.doi.org/10.1055/s-0040-1702216.

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AbstractTuberculosis-related pleural effusion (TPE) is reported in 12 to 38% of thoracic tuberculosis (TB) cases in the pediatric population. In TPE, the pleural fluid bacilli load is very low, generally resulting in negative acid-fast bacill (AFB) staining and Mycobacterium culture. In the pleural fluid, AFB stain positivity is reported in <20%, and Mycobacterium tuberculosis positive culture in 18 to 38%. In childhood, this ratio is even lower. Also, pleural effusion (PE) mycobacterial culture gives late results (2–8 weeks). Therefore, TPE is diagnosed with pleura biopsy and pleural liquid examination. However, pleura biopsy is a more invasive operation and the diagnosis rates vary. The clinical and laboratory findings are not typical; it is very hard to distinguish between TPE and another cause of exudative PE. This situation makes it essential for research on reliable new biomarkers that can provide fast and accurate diagnosis of TPE. Adenosine deaminase (ADA) activity being above 40 to 50 U/L (despite varying depending on age) strongly suggests TPE. Other new biomarkers featured in TPE diagnosis are interferon-γ, cytokines, and nucleic acid multiplication tests. However, the results of ADA and other potential biomarkers shown to be beneficial in TPE diagnosis should always be interpreted with clinical and microbiological findings because no biomarker can provide information about M. tuberculosis culture and drug resistance. Especially in countries with high resistance against TB drugs, performing pleura biopsy, culture and drug resistance tests are important with regard to diagnosis and therapy planning.
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Seiscento, Márcia, Francisco Suso Vargas, Maria Josefa Penon Rujula, Sidney Bombarda, David Everson Uip, and Vera Maria Nedes Galesi. "Aspectos epidemiológicos da tuberculose pleural no estado de São Paulo (1998-2005)." Jornal Brasileiro de Pneumologia 35, no. 6 (2009): 548–54. http://dx.doi.org/10.1590/s1806-37132009000600008.

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OBJETIVO: Analisar as características epidemiológicas e tendências quanto à incidência de TB pleural. MÉTODOS: Estudo descritivo, retrospectivo dos casos de TB reportados entre 1998 e 2005 e coletados do banco de dados do Sistema de Notificação de Tuberculose (Epi-TB) da Secretaria de Saúde do Estado de São Paulo. RESULTADOS: Foram notificados 144.347 casos novos de TB durante o período estudado. A forma pulmonar foi predominante (118.575 casos; 82,2%). Das formas extrapulmonares (25.773 casos; 17,8%), a pleural foi a mais referida (12.545 casos; 48,7%). A incidência (por 100.000 habitantes) de todas as formas diminuiu, (49,7 em 1998 e 44,6 em 2005; R² = 0,898; p < 0,001), enquanto a incidência de TB pleural permaneceu estável (4,1 em 1998 e 3,8 em 2005; R² = 0,433; p = 0,076). A maior incidência de TB pleural ocorreu em pacientes do sexo masculino (2:1) entre 30 e 59 anos de idade. Dos 12.545 pacientes com TB pleural, 4.018 (32,0%) apresentaram comorbidades: alcoolismo (9,5%); HIV (8,0%); diabetes (3,3%); e doença mental (1,2%). O diagnóstico referido fundamentou-se em métodos bacteriológicos (14,2%) e histológicos (30,2%), assim como outros não especificados (55,6%). CONCLUSÕES: No estado de São Paulo, a TB pleural foi a forma extrapulmonar predominante, apresentando incidência estável no período entre 1998 e 2005, apesar da tendência de diminuição das formas pulmonares. A histologia e a bacteriologia definiram o diagnóstico em 44,4% dos casos.
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Shyam, B. K., Sujeet Kumar Shah, Sumit Pandey, Sushil Baral, and Sandeep Gupta. "Significance of Adenosine Deaminase in Diagnosing Tuberculous Pleural Effusion in Nepalgunj Medical College Teaching Hospital Kohalpur." Journal of Nepalgunj Medical College 14, no. 1 (2017): 21–23. http://dx.doi.org/10.3126/jngmc.v14i1.17489.

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Background: Tuberculosis (TB) is a major public health problem in developing countries including Nepal. One of the common presentations of TB is pleural effusion. The diagnosis of tubercular pleural effusion can be difficult because of the low rate of detecting tubercular bacilli by direct stain and culture of pleural fluid for acid-fast bacilli (AFB). Pleural biopsy can be useful but is invasive and requires experts. In this context, pleural fluid Adenosine Deaminase (ADA) level has been proposed as easy, cheap and highly sensitive test for diagnosis of TB pleural effusion.Objectives: The present study was undertaken to define the role of pleural fluid ADA value in accurate diagnosis of Tubercular pleural effusion.Methods: A Prospective analysis of 68 patients admitted in Nepalgunj Medical College teaching Hospital was done from January 2014 to December 2015 with pleural effusion. Pleural fluid ADA level was evaluated in all patients, and significance of pleural fluid ADA level in TB pleural effusion was studied.Results: Age of patients were between 20 to 80 years, with the minimum being 20 years and maximum being 79 years. In this study 85% of cases had pleural effusion due to tuberculosis. Out of the 68 patients with pleural effusion, 58(85%) were finally diagnosed to be due to tuberculosis, 2 were diagnosed to be due to malignancy, 4 due to pneumonia leading to parapneumonic effusion, 1 due to congestive heart failure and 3 due to nephrotic syndrome.Conclusion: It is difficult to diagnose TB pleural effusion by other conventional methods, as it has also been shown in our study also. Previous literatures have also mentioned AFB detection rate to be low from pleural fluid sample. Determination of ADA is a cheap and easy test which we now consider in the early routine evaluation of patients with pleural effusions, particularly if diagnosis of tuberculosis is suspected and in places where prevalence of the disease is still high as is in our country. The other method considered for diagnosing TB pleural effusion is pleural biopsy which is invasive blind procedure and requires high expertise as well. JNGMC Vol. 14 No. 1 July 2016
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Ribeiro, Lucas Almeida, Nathália Jolly Araújo Soares, Raimundo Eri de Araújo Barbosa, and Elza Mara Rezende Almeida. "Tuberculose pleural em paciente sob situação de risco: Relato de caso." Núcleo do Conhecimento 04, no. 10 (2020): 121–42. https://doi.org/10.32749/nucleodoconhecimento.com.br/saude/tuberculose-pleural.

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A tuberculose (TB) é uma das enfermidades mais antigas que existem na história. O primeiro relato documentado vem do século XIX, estando intimamente ligada às condições higiênico-sanitárias. O agente etiológico é o Mycobacterium tuberculosis e sua transmissão ocorre por via aérea. Atualmente, é uma patologia que enseja ainda atenção pela alta incidência entre as doenças infectocontagiosas e provoca impacto na saúde coletiva, tanto na forma tradicional (pulmonar), quanto na extrapulmonar. Os autores apresentam um caso de tuberculose pleural em paciente privado de liberdade, sob custódia judicial, diagnosticado no curso de suas internações para tratamento de fratura do fêmur e de osteomielite consequente a fratura exposta da tíbia. Além do relato, foi feita a análise deste caso baseado na literatura. A descrição do diagnóstico do paciente está intimamente atrelada a sua própria condição social. Fato este, que não deve ser exceção no contexto brasileiro. Inúmeras pessoas não aderem ao tratamento por falta de informação, perpetuando assim, a cadeia de transmissão. A metodologia do artigo trata-se de um relato de caso descritivo. Como principal resultado, pode-se afirmar que a investigação e conduta do paciente, foram alinhadas ao que se observa na literatura médica, consequentemente, chegou-se ao desfecho correto do problema. Algumas medidas simples, como a implementação de questionários para busca de SR e a busca radiológica para os casos suspeitos, levariam a uma potencial redução do número de pessoas infectadas por TB dentro dos presídios. Diversas peculiaridades podem estar atreladas a um diagnóstico, entre eles, a condição biopsicossocial do paciente. A propagação da informação ainda é um desafio muito grande a ser vencido, a educação em saúde faz-se necessária para que inúmeros indivíduos consigam entender a respeito de sua doença, sua cadeia de transmissão e sua resolução. Este artigo foi submetido e aprovado pelo comitê de ética em pesquisa da Universidade Federal do Amapá.
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Wahid, Abdul, Afia Haque, and Mohammad Azam. "Validity of Adenosine Deaminase (ADA) Level in Pleural Fluid for the Diagnosis of Tuberculosis." Pakistan Journal of Medical and Health Sciences 17, no. 2 (2023): 299–302. http://dx.doi.org/10.53350/pjmhs2023172299.

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Introduction: The pleural fluid LDH/ADA ratio, which can be determined from routine biochemical analysis, is highly predictive of TPE at a cut-off level of 16.20. Measurement of this parameter may be helpful for clinicians in distinguishing between TPE and PPE. Despite wide variations in the reported sensitivity and specificity of pleural fluid ADA level, it can be used as a surrogate for pleural biopsy when the latter is not feasible. Adenosine deaminase (ADA) is the most cost-effective pleural fluid marker and is routinely used in high prevalence settings, whereas its value is questioned in areas with low prevalence. The lymphocyte proportion (LP) is known to increase the specificity of ADA for this diagnosis. Objectives: To determine the diagnostic accuracy of ADA level in pleural fluid for the diagnosis of TB as compared to other conventional methods available like gene expert. Materials & Methods: The design of this study was a cross sectional study design. This study was conducted in Medicine Unit III, S.P.H. Quetta and the duration of this study was from 23rd October 2019 to 22nd April 2020. A total of 423 patients with pulmonary TB between the ages of 25 years to 45 years, having developed pleural effusion were included. Patients with pleural effusion due to causes other than TB, having extra pulmonary TB and those with other respiratory infections were excluded. Tests done specifically for TB in our setup include sputum AFB, CXR, and genexpert. These patients’ pleural fluid ADA were then sent. Results: Adenosine deaminase (ADA) found that 217 were True Positive and 13 were False Positive. Among 193, adenosine deaminase (ADA) negative patients, 12 (False Negative) had TB on gene expert whereas 181 (True Negative) had no TB on gene expert (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ADA level in pleural fluid for the diagnosis of TB as compared to other conventional methods available like gene expert was 94.76%, 93.30%, 94.35%, 93.78% and 94.09% respectively. Practical Implication: This study was conducted to determine the validity of ADA levels for the diagnosis of TB and the results of this study if favorable will decrease the need for other laboratory tests usually done which take longer time, thus helping to decrease the need for multiple tests, early availability of report and timely management of the disease. This will further help to reduce the contact rate of TB and the risk of developing MDR TB by starting early treatment. Conclusion: This study concluded that diagnostic accuracy of ADA level in pleural fluid for the diagnosis of TB is quite high. Keywords: Pulmonary Tuberculosis, Pleural Fluid, Adenosine Deaminase, Biochemical, Mycobacterium .
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Usami, Osamu, Haorile Chagan Yasutan, Toshio Hattori та Yugo Ashino. "Rapid Decline of IFN-γ Spot-Forming Cells in Pleural Lymphocytes during Treatment in a Patient with Suspected Tuberculosis Pleurisy". Reports 2, № 4 (2019): 27. http://dx.doi.org/10.3390/reports2040027.

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A differential diagnosis of tuberculosis pleurisy is often difficult. A 48-year-old Japanese man with no previous medical history visited the outpatient department for dyspnea and fever. His chest-XP and laboratory findings, especially high C-reactive protein levels, indicated pleuritis with pleural effusion. Pleural lymphocytes showed high numbers of spot forming responses in interferon gamma release assay (IGRA). Pleural effusion contained high levels of adenosine deaminase and hyaluronic acid, but no Mycobacterium tuberculosis (TB) antigen was detected by culture or polymerase chain reaction (PCR). Although the infectious agent was not detected, the clinical and laboratory findings strongly suggested that he was suffering from tuberculosis pleurisy. After treatment with anti-TB drugs, a rapid decline of spot-forming cells (SFCs) of pleural lymphocyte was observed, despite persistently high levels of other biomarkers and increased pleural lymphocytes. This case demonstrates that an IGRA of pleural lymphocytes would be useful for therapeutic diagnosis for TB pleurisy suspected for TB.
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Garrait, V., J. Cadranel, H. Esvant, et al. "Tuberculosis generates a microenvironment enhancing the productive infection of local lymphocytes by HIV." Journal of Immunology 159, no. 6 (1997): 2824–30. http://dx.doi.org/10.4049/jimmunol.159.6.2824.

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Abstract Tuberculosis (TB) contributes to the progression of HIV disease but, so far, the mechanism involved is not clear. Several cytokines accumulating in vivo at the site of mycobacterial infection up-regulate HIV expression in vitro. In this study, we assessed the role of pleural fluids recovered from seronegative patients with TB on HIV replication in acutely infected blast cells. Pleural fluids from subjects with congestive heart failure served as controls. In all cases, TB pleural fluids stimulated HIV replication in vitro. TNF-alpha, IL-6, IFN-gamma, and granulocyte/macrophage (GM)-CSF, as well as very low levels of IL-2, were detected in TB pleural fluids. An anti-IL-2 Ab preincubated with TB pleural fluids exhibited no blocking effect on HIV replication similarly to anti-IFN-gamma and anti-GM-CSF Abs. In contrast, anti-TNF-alpha and anti-IL-6 Abs decreased HIV replication by 60 and 90%, respectively. Recombinant TNF-alpha and IL-6 stimulated HIV replication, while IFN-gamma and GM-CSF had a more ambiguous role. The capacity of pleural fluids to stimulate HIV replication was specific for TB, since the capacity of control fluids was significantly lower. Finally, in contrast to PBL, which require in vitro activation for their productive infection by HIV, unstimulated tuberculous pleural lymphocytes were productively infectable by HIV. Taken together, our data suggest that the microenvironment generated by TB might increase the HIV burden in infected subjects, partly through cytokines other than IL-2, namely TNF-alpha and IL-6.
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Ahmed, Jamal Uddin, Mohammad Delwar Hossain, Farhana Afroz, Muhammad Abdur Rahim, and AKM Musa. "Role of Pleural Biopsy in the Etiological Diagnosis of Exudative Pleural Effusion." Bangladesh Critical Care Journal 5, no. 1 (2017): 33–36. http://dx.doi.org/10.3329/bccj.v5i1.32540.

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Purpose: Exudative pleural effusion usually indicates an underlying pulmonary pathology. Sometimes etiological diagnosis of exudative pleural effusion is difficult despite cytological, biochemical and microbiological tests. Aim of present study was to make an etiological diagnosis of exudative pleural effusion by pleural biopsy.Methods: This cross-sectional observational study was performed from January 2012 to December 2014 in the Department of Internal Medicine & Pulmonology of BIRDEM General Hospital, Dhaka, Bangladesh. A total of 51 patients with exudative pleural effusion in whom the diagnosis was uncertain after routine biochemical, cytological and microbiological evaluation of pleural fluid were included in the study. These patients underwent pleural biopsy by Abram’s needle and histopathology was done to determine the etiology of pleural effusion.Results: Majority (74.5%) of the patients were male. Mean age of the patients was 52.7±16.0 years. Most (52.9%) patients had right sided pleural effusion. Histopathology report of the pleural biopsy showed granulomatous inflammation compatible with tuberculosis (TB) in 15 (29.4%), metastatic malignancy in 10 (19.6%) and chronic inflammation in 9 (17.6%) cases. In 17 (33.3%) cases the histopathology did not reveal any abnormality. Among 10 cases of metastatic malignancy, most (7, 70%) were adenocarcinoma. Compared to malignancy cases, TB cases were younger in age (Mean age: TB - 45.0±17.9 vs malignancy - 61.8±13.0 years). Pleural fluid was straw color in all (100%) cases of TB and hemorrhagic in almost all (90%) cases of metastatic malignancy (p 0.000). Mean value of pleural fluid protein (59.1±4.8 vs 47.3±4.2 gm/L; p 0.003), lactate dehydrogenase (LDH) (917.3±219.3 vs 464.3±112.3 U/L; p 0.101), adenosine deaminase (ADA) (39.0±3.7 vs 15.615.6±2.3 U/L; p 0.016), total leukocyte count (1039.3±776.8 vs 439.2±138.2 cells/cmm; p 0.328) and lymphocyte percentage (94.4±4.3 vs 68.3±9.3; p 0.003) were all raised in TB compared to metastatic malignancyConclusions: Pleural biopsy was definitive diagnostic in almost half the patients with exudative pleural effusion. Tuberculosis was more common than malignancy particularly in young persons. Pleural fluid protein, LDH and ADA are significantly raised in TB compared to malignancy.Bangladesh Crit Care J March 2017; 5(1): 33-36
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Sumalani, K. K., N. Akhter, D. Chawla, and N. A. Rizvi. "Diagnostic yield of sputum induction in patients with pleural tuberculosis at a tertiary care hospital in Karachi." International Journal of Tuberculosis and Lung Disease 23, no. 11 (2019): 1213–16. http://dx.doi.org/10.5588/ijtld.18.0830.

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OBJECTIVE: To evaluate the diagnostic yield of acid-fast bacilli (AFB) smear, culture for Mycobacterium tuberculosis and Xpert® MTB/RIF assay in induced sputum (IS) specimens in patients with pleural tuberculosis (TB).DESIGN: A total of 156 patients were evaluated at Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from April 2016 to December 2017. Patients with exudative lymphocytic pleural effusions with normal lung parenchyma on chest radiography were included in the study: 102 were due to tuberculous and 54 due to non-tuberculous infections as diagnosed using thoracoscopic pleural biopsy. IS samples were sent for acid-fast bacilli (AFB) smear, AFB culture and Xpert assay.RESULT: In patients with a clinical diagnosis of TB, mycobacteria were detected in IS AFB smear in 7.8%, AFB culture in 21.6% and Xpert assay in 34.3% of cases. All sputum samples collected from patients with non-tuberculous aetiology were negative.CONCLUSION: Testing IS samples for M. tuberculosis provides another approach to diagnosing pleural TB, especially in settings in which invasive procedures are less accessible. Our study also emphasises the contagiousness of pleural TB, and the need to screen the household contacts of these patients and possible isolation of patients with pleural TB admitted to hospital.
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Shah, Naveed Nazir, Nazia Mehfooz, Syed Suraya Farooq, Khurshid A. Dar, Shumayl, and Tariq. "Medical thoracoscopy- an experience." International Journal of Research in Medical Sciences 5, no. 5 (2017): 2176. http://dx.doi.org/10.18203/2320-6012.ijrms20171865.

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Background: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases especially undiagnosed exudative pleural effusion. It is cost effective and safe. The diagnostic yield in undiagnosed pleural effusion is excellent.Methods: This prospective observational study was done in Government Chest Disease hospital of Government Medical College, Srinagar during the period between December 2015 to Dec 2016.Thirty undiagnosed pleural effusion patients after thoracocentesis and who fulfilled inclusion and exclusion criteria’s were included in the study. Medical thoracoscopy using rigid thoracoscope was started for the first time in our hospital and was done in these enrolled patients. Clinical, Thoracoscopic findings and histopathological data of the patients were collected prospectively and analysed.Results: Maximum patients were in the age group of 41-50 years. Most common Thoracoscopic finding was multiple nodules (40%) followed by sago grain infiltration (33.4%). Malignancy was the most common HPE finding of pleural biopsy (46.6%) followed by TB (33.3%). All nodules (13) turned out to be malignant while all sago grain appearance pleura (10) turned out of to be TB. The overall diagnostic yield is 80% as a whole and 96% among patients who had thoracoscopic pleural findings.Conclusions: Medical Thoracoscopy is a safe and easy outpatient procedure and an excellent diagnostic tool for undiagnosed exudative pleural effusion. The diagnostic yield is quite high and complications of procedure are negligible.
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Petrakova, I. Yu, M. F. Gubkina, M. A. Bagirov, et al. "APPROACHES TO TIMING OF SURGICAL MANAGEMENT OF TUBERCULOUS PLEURISY IN CHILDREN IN THE CONTEXT OF GROWING INCIDENCE OF MULTIDRUG–RESISTANT TB." Вестник ЦНИИТ, no. 3 (2022): 74–87. http://dx.doi.org/10.57014/2587-6678-2022-3-74-87.

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Objective: to develop criteria for timing of surgical management of paediatric tuberculous pleurisy in the context of growing incidence of multidrug-resistant TB. Materials and methods. We analyzed case histories of 39 children aged 3–12 years treated in our hospital for tuberculous pleurisy in 2010–2019. Criteria for optimal timing of surgery for tuberculous pleurisy in children were elaborated considering clinical features and imaging-based examinations before and during TB treatment. Results. We developed criteria for timing of surgical management of paediatric tuberculous pleurisy. Thirty-one patients underwent surgery for tuberculous pleural empyema before TB treatment (6 patients), 2 months after TB treatment initiation (22 patients), and 6 or more months after TB treatment initiation (3 patients). Eight children with tuberculous exudative pleurisy did not need surgery. Conclusion. Surgical management before TB treatment is indicated for the combination of the following criteria: single or multiple pleural encapsulations detected by imaging-based examinations, lack of dominating TB processes in other anatomical sites. Surgical management after 2–3 months of TB treatment is indicated if exudative pleurisy transforms into pleural empyema in the absence of dominating TB processes in other anatomical sites. Surgical management after 6 or more months of TB treatment is indicated in the presence of a dominating TB process in the lungs after its stabilization.Keywords: TB, pleurisy, pleural empyema, children, surgery, multidrug resistance
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Yahiaoui, Rachida, Abdelbassat Ketfi, Fethi Meçabih, Djennette Hakem, Nadjia Ramdani, and Rabah Amrane. "Contribution of QuantiFERON TB gold in tube to the diagnosis of tuberculous pleurisy: a monocentric prospective study." Egyptian Journal of Chest Diseases and Tuberculosis 73, no. 4 (2024): 389–97. http://dx.doi.org/10.4103/ecdt.ecdt_89_23.

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Introduction The diagnosis of tuberculous (TB) pleurisy remains difficult because of its paucibacillary character. Several authors have studied the usefulness of interferon gamma release assays in the early diagnosis of TB pleurisy, whereas these tests are designed for the detection of latent TB infection. Our objective is to study the performance and clinical relevance of QuantiFERON TB Gold in Tube (QFT-GIT) in the diagnosis of TB pleurisy in Algeria. Patients and methods QFT-GIT was tested in vitro in serum and pleural fluid on a prospective recruitment of 158 immunocompetent patients with pleural effusion. Results Of the 158 cases of pleurisy identified, 84 (53.84%) were TB, diagnosed and proven by conventional methods, and 72 (46.15%) were non-TB, of whom 67 (93%) were confirmed of neoplastic origin, five (7%) secondary to a systemic disease and two of nonspecific inflammatory origin. Our results showed a high pleural sensitivity of QFT-GIT (97.62%) compared to serum sensitivity (80.95%). In contrast, serum specificity (83.78%) was higher than pleural specificity (72.97%). When we used the optimal values from the receiver operation characteristics curve analysis, the area under the curve of interferon-gamma produced by the QFT-GIT test was significantly higher in the pleural fluid than in the blood. Area under the curve of TB antigen interferon-gamma response was 92, 18 [95% confidence interval (CI)=87.56–96.79], nil tube was 95.71% (95% CI=92.43–99), and mitogen tube was 65.34 (95% CI=57.71–72.98). Conclusion QFT-GIT in pleural fluid appears in our study as a useful test for the diagnosis of TB pleurisy, but its diagnostic accuracy needs to be validated in further large-scale research.
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Ko, Jeong Min, Hyun Jin Park, and Chi Hong Kim. "Pulmonary Changes of Pleural TB." Chest 146, no. 6 (2014): 1604–11. http://dx.doi.org/10.1378/chest.14-0196.

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Manaktala, Rohini, Ricardo Perez, and Prashant Grover. "A Case of Pleural TB." Chest 152, no. 4 (2017): A177. http://dx.doi.org/10.1016/j.chest.2017.08.208.

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Cojocaru, Viorica, Elena Dantes, Mariana Gabriela Novac, et al. "The Value of Adenosine Deaminase Enzime Level in the Positive Diagnosis of Tuberculous Pleural Effusion." Revista de Chimie 69, no. 12 (2019): 3688–91. http://dx.doi.org/10.37358/rc.18.12.6820.

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The etiologic diagnosis of pleural effusion is often difficult, requiring invasive investigations to determine it. In Romania, tuberculosis is a frequent cause of pleural effusion, with the diagnosis of certainty being based on the bacteriological or histopathological examination. Adenosine deaminase (ADA) is an enzyme found in T lymphocytes, stimulated by Mycobacterium tuberculosis, which is why it is considered to be an essential marker of etiologic diagnosis in countries where the TB endemic is elevated. A case-control study was conducted in the Clinical Pneumophthisiology Hospital of Constanta, Romania, in patients diagnosed with tuberculous pleural effusion. The primary endpoint was to establish the cut-off value for ADA in supporting the positive diagnosis of TB pleural effusion, and the secondary objective was to identify the differences between TB pleural effusion and other etiologic types of pleural effusion. A cut-off of 55 UI has a good specificity (80%) and good sensitivity (85%). The study confirms other features of tuberculous pleural effusion as younger age, lower levels of white blood cells and neutrophils, increased number of lymphocytes in pleural fluid, low protein serum level, increased values of pleural lactic dehydrogenase (LDH) and pleural ADA.
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Goyal, Amit, Amanpreet Kaur, and N. C. Kajal. "Diagnostic value of pleural fluid adenosine deaminase level in patients of tubercular pleural effusion." International Journal of Advances in Medicine 8, no. 1 (2020): 93. http://dx.doi.org/10.18203/2349-3933.ijam20205479.

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Background: The diagnosis of tuberculosis (TB) continues to be a challenge in clinical practice. Traditional diagnostic methods are very useful but don't provide enough sensitivity and specificity. Adenosine deaminase (ADA) has been developed and widely used for the diagnosis of TB. This article reviews the characteristics, metabolism and clinical uses of ADA for the diagnosis of TB in clinical practices.Methods: This study was carried out in the department of chest and TB, GMC, Amritsar, Punjab, India. In this study total 50 who attended outpatient department (OPD) and indoor patients of adult age and either sex were taken. Patients with pleural effusion as determined by clinical and or radiological means, thoracocentesis on who yield a minimum amount of fluid enough to carry out routine test were included in the study.Results: Most of the patients were between the age group of 15-34 years, of those 72% were males and 28% female. Most of the patients of tuberculous effusion were from younger age group between 25-34 years. Most common symptom was breathlessness (90%) followed by fever (75%), cough (75%) then chest pain (72%). The diagnosis of TB was made in 40 patients (80%), while in 10 patients (20%) TB were excluded (malignancy and miscellaneous disease) based on history, clinical and laboratory findings. Sensitivity of ADA in diagnosing TB pleural effusion was 95% and specificity 80%.Conclusions: ADA level of the pleural fluid is a non-invasive test. Pleural fluid ADA is useful in early diagnosing of tuberculosis pleural effusion. So the analysis of ADA levels can be done simply, quickly and cheaply.
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Lee, Dongjun, Min Ji Son, Seung Min Yoo, Hwa Yeon Lee, and Charles S. White. "Phlegmonous Appearance in the Ipsilateral Paracardiac Fat without Paracardiac Lymph Node Enlargement on Chest CT Favors the Diagnosis of Pleural Tuberculosis over Malignant Pleural Effusion." Diagnostics 10, no. 12 (2020): 1041. http://dx.doi.org/10.3390/diagnostics10121041.

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This study investigated the potential role of paracardiac fat stranding (FS) interspersed with multiple fluid collections (FC) as a clue to differentiate between pleural tuberculosis (pleural TB) and malignant pleural effusion (MPE). The authors retrospectively analyzed chest computed tomography (CT) findings of 428 patients, 351 with pleural TB and 77 with MPE, focusing on the paracardiac fat, and level of pleural adenosine deaminase (ADA) and blood C-reactive protein (CRP). Two radiologists independently evaluated the chest CT findings regarding the paracardiac fat pad ipsilateral to the effusion, including FS, FC, phlegmonous appearance (a combination of the FS and multiple FC), and the presence of lymph node enlargement (>1 cm in short axis diameter). There were significant differences between patients with pleural TB and those with MPE with respect to the prevalence of phlegmonous appearance in the ipsilateral paracardiac fat (47.6% and 10.4%, p < 0.001, OR = 7.8; 95% CI 3.7–16.8) and paracardiac lymph node enlargement (1.4% and 19.5%, p < 0.001, OR = 0.06; 95% CI 0.02–0.2) on CT. In contrast, there was no difference in the prevalence of isolated FS or multiple FC within the ipsilateral paracardiac fat between the two groups. Median pleural ADA and serum CRP level were higher in patients with pleural TB accompanied by phlegmonous appearance in paracardiac fat compared to those without that appearance (ADA: median 104 IU/L versus 90 IU/L, p < 0.001; CRP: 6.5 mg/dL versus 4.2 mg/dL, p < 0.001). In conclusion, phlegmonous appearance in the ipsilateral paracardiac fat without paracardiac lymph node enlargement on chest CT favors a diagnosis of pleural TB over MPE.
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Collins, Kalonji R., Miguel E. Quiñones-Mateu, Mianda Wu, et al. "Human Immunodeficiency Virus Type 1 (HIV-1)Quasispecies at the Sites of Mycobacterium tuberculosis InfectionContribute to Systemic HIV-1 Heterogeneity." Journal of Virology 76, no. 4 (2002): 1697–706. http://dx.doi.org/10.1128/jvi.76.4.1697-1706.2002.

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ABSTRACT We have recently reported an increased heterogeneity in the human immunodeficiency virus type 1 (HIV-1) envelope gene (env) in HIV-1-infected patients with pulmonary tuberculosis (TB) compared to patients with HIV-1 alone. This increase may be a result of dissemination of lung-derived HIV-1 isolates from sites of Mycobacterium tuberculosis infection and/or the systemic activation of the immune system in response to TB. To distinguish between these two mechanisms, blood and pleural fluid samples were obtained from HIV-1-infected patients with active pleural TB in Kampala, Uganda (CD4 cell counts of 34 to 705 cells/μl, HIV-1 plasma loads of 2,400 to 280,000 RNA copies/ml, and HIV-1 pleural loads of 7,600 to 4,500,000 RNA copies/ml). The C2-C3 coding region of HIV-1 env was PCR amplified from lysed peripheral blood mononuclear cells and pleural fluid mononuclear cells and reverse transcriptase-PCR amplified from plasma and pleural fluid HIV-1 virions of eight HIV-1 patients with pleural TB. Phylogenetic and phenetic analyses revealed a compartmentalization of HIV-1 quasispecies between blood and pleural space in four of eight patients, with migration events between the compartments. There was a trend for a greater genetic heterogeneity in the pleural space, which may be the result of an M. tuberculosis-mediated increase in HIV-1 replication and/or selection pressure at the site of infection. Collectively, these findings suggest that HIV-1 quasispecies in the M. tuberculosis-infected pleural space may leak into the systemic circulation and lead to increased systemic HIV-1 heterogeneity during TB.
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Ankit, Grover. "A complex case of eosinophilic pleural effusion: an unconventional response to anti-tubercular therapy." International Journal of Research in Medical Sciences 11, no. 11 (2023): 4213–15. http://dx.doi.org/10.18203/2320-6012.ijrms20233404.

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Eosinophilic tuberculosis (TB) is a rare form of TB characterized by the presence of eosinophils in pleural fluid. It remains an uncommon presentation and often poses a diagnostic challenge due to its resemblance to other conditions with eosinophilic pleural effusions. Here, we present a detailed case report of a 26-year-old female who presented with a two-week history of on-and-off fever, non-productive cough, and exertional dyspnea. Physical examination revealed absent air entry in the left infra-scapular and intra-axillary areas. Routine investigations and chest X-ray indicated a moderate left-sided pleural effusion with peripheral eosinophilia. Liver and kidney function tests were within the normal range. A left pleural tap was performed, and the pleural fluid analysis demonstrated an exudative effusion with predominantly eosinophils. Additional investigations, including ADA levels, Genexpert for TB, TB PCR, C-ANCA, P-ANCA, and total IgE levels, were performed to rule out other possible causes of eosinophilia, but the results were all negative or normal. No growth was observed on culture. Based on clinical history, examination findings, and investigation results, a diagnosis of eosinophilic TB was considered. The patient was started on empirical anti-tubercular drugs, which led to a favorable response and near-complete resolution of pleural effusion after 6 weeks of treatment. Regular follow-up and monitoring were conducted, and the patient completed a 6-month course of anti-tubercular treatment. This case report highlights the importance of considering eosinophilic TB in the differential diagnosis of pleural effusions, especially in young patients with no history of allergies or other underlying conditions.
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Meghaja, Sebastian. "Tetraplegia: Beyond Neuromuscular Respiratory Dysfunction." Indian Journal of Physical Medicine and Rehabilitation 28, no. 2 (2017): 69–70. http://dx.doi.org/10.5005/jp-journals-10066-0005.

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ABSTRACT In developing countries like India, tuberculosis (TB) is responsible for 30 to 80% of all pleural effusions encountered and may complicate TB in 31% of all cases. Among the extrapulmonary presentations, pleural TB is second in frequency after tubercular lymphadenitis. Here, we present the case of a 46-yearold lady with high-level spinal cord injury (SCI), who came to the outpatient department for regular follow-up. She had no specific complaints; however, respiratory system examination revealed decreased breath sounds and on further probing, patient revealed that she had mild breathlessness of 2-day duration. She had no history of contact with TB. On evaluation, she had left-sided pleural effusion; pleural tap was done, which showed increased number of cells with lymphocytosis and mildly elevated adenosine deaminase (ADA). The diagnosis of extrapulmonary TB was made and anti-TB therapy (ATT) (direct observation of drug intake (DOTS) category 1) was started. Conclusion Tuberculosis is a common infection in a developing country like India. All cases of breathlessness in a tetraplegic are not due to neuromuscular respiratory dysfunction. How to cite this article Meghaja S. Tetraplegia: Beyond Neuromuscular Respiratory Dysfunction. Indian J Phy Med Rehab 2017;28(2):69-70.
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Quadry, Shafiul Azam, Abir Hasan Dip, Uma Dhar, et al. "Evaluation of usefulness of pleural fluid/serum alkaline phosphatase in the diagnosis of tubercular pleural effusion." International Journal of Research in Medical Sciences 12, no. 9 (2024): 3176–81. http://dx.doi.org/10.18203/2320-6012.ijrms20242591.

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Background: Tuberculosis (TB) remains a common cause of pleural effusions, diagnosed by detecting Mycobacterium tuberculosis in pleural fluid or biopsy specimens through microscopy, culture, or histological demonstration of caseating granulomas and acid-fast bacilli (AFB). In high-burden settings, the diagnosis is frequently inferred. Objective was to assess the usefulness of pleural fluid/serum alkaline phosphatase in the diagnosis of tubercular pleural effusion. Methods: This cross-sectional observational study took place at the department of respiratory medicine, NIDCH, Dhaka, from December 2018 to December 2019. Seventy new cases of pleural effusion meeting specific criteria were enrolled with informed consent obtained. Diagnostic assessments included Gene Xpert, cytology, culture and sensitivity testing, biochemical analyses, and alkaline phosphatase testing on pleural fluid and blood samples. Closed needle pleural biopsies using an Abrams needle were performed for histopathological examination. Data analysis was carried out using SPSS version. Results: In this study of 70 patients, mean age 48.67±17.99 years (range: 17-83 years), with 42.9% aged 51-70 years, males predominated (6:1). Histopathology showed TB in 45.7%. TB patients had lower neutrophil and platelet counts, lower serum alkaline phosphatase, higher ESR, and higher pleural fluid alkaline phosphatase and P/S ALP ratio. The P/S ALP ratio had an AUC of 0.881 (95% CI 0.798-0.964), with a cut-off of 0.49, sensitivity/NPV of 93.8%, and specificity/PPV of 78.9% for diagnosing TB pleural effusion. Conclusions: The pleural fluid/serum alkaline phosphatase ratio is a valuable diagnostic tool for tuberculous pleural effusion. Further validation through a multicenter randomized trial with a larger sample size is recommended.
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Ricky Septafianty, Anita Widyoningroem, M. Yamin S. S, Rosy Setiawati, and Soedarsono. "Comparison of Chest X-Ray Findings Between Primary and Secondary Multidrug Resistant Pulmonary Tuberculosis." Bioscientia Medicina : Journal of Biomedicine and Translational Research 5, no. 10 (2021): 903–10. http://dx.doi.org/10.32539/bsm.v5i10.356.

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Introduction: Radiological imaging has a key role in multidrug-resistant (MDR) pulmonary tuberculosis (TB) screening and diagnosis. However, new cases of MDR pulmonary TB are often overlooked; therefore, its transmission might continue before its diagnosis. The most widely used and affordable radiological modality is a chest radiograph. This study aims to describe the characteristics of primary and secondary MDR pulmonary TB chest x-ray findings for differential diagnosis.
 Methods: This study was an analytic observational study with a retrospective design. Researchers evaluated medical record data of primary and secondary MDR pulmonary TB patients who underwent chest x-ray examinations. The patient's chest x-rays were then evaluated. Evaluated variables were lung, pleural, and mediastinal abnormalities and severity category.
 Results: The most common chest x-ray finding in primary MDR pulmonary TB was consolidation (96.2%), which was mostly unilateral (52.0%), accompanied by cavities (71.2%), most of which were multiple (83.8%) with a moderate category of severity. The most common chest x-ray finding in secondary MDR pulmonary TB was consolidation (100%), which was mostly bilateral (60.4%), accompanied by cavities (80.2%), most of which were multiple (90.1%) with severe category of severity. Pleural thickening (47.5%) was also found.
 Conclusion: There was a significant difference between primary and secondary MDR pulmonary TB in terms of mild severity category, and pleural thickening. Mild severity category is mostly found in primary MDR-TB and pleural thickening is mostly found in secondary TB.
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Ricky Septafianty, Anita Widyoningroem, M. Yamin S. S, Rosy Setiawati, and Soedarsono. "Comparison of Chest X-Ray Findings Between Primary and Secondary Multidrug Resistant Pulmonary Tuberculosis." Bioscientia Medicina : Journal of Biomedicine and Translational Research 5, no. 4 (2021): 855–62. http://dx.doi.org/10.32539/bsm.v5i4.356.

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Introduction: Radiological imaging has a key role in multidrug-resistant (MDR) pulmonary tuberculosis (TB) screening and diagnosis. However, new cases of MDR pulmonary TB are often overlooked; therefore, its transmission might continue before its diagnosis. The most widely used and affordable radiological modality is a chest radiograph. This study aims to describe the characteristics of primary and secondary MDR pulmonary TB chest x-ray findings for differential diagnosis.
 Methods: This study was an analytic observational study with a retrospective design. Researchers evaluated medical record data of primary and secondary MDR pulmonary TB patients who underwent chest x-ray examinations. The patient's chest x-rays were then evaluated. Evaluated variables were lung, pleural, and mediastinal abnormalities and severity category.
 Results: The most common chest x-ray finding in primary MDR pulmonary TB was consolidation (96.2%), which was mostly unilateral (52.0%), accompanied by cavities (71.2%), most of which were multiple (83.8%) with a moderate category of severity. The most common chest x-ray finding in secondary MDR pulmonary TB was consolidation (100%), which was mostly bilateral (60.4%), accompanied by cavities (80.2%), most of which were multiple (90.1%) with severe category of severity. Pleural thickening (47.5%) was also found.
 Conclusion: There was a significant difference between primary and secondary MDR pulmonary TB in terms of mild severity category, and pleural thickening. Mild severity category is mostly found in primary MDR-TB and pleural thickening is mostly found in secondary TB.
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Abdugapparov, Fazlkhan, Lochin Mamatov, and Dauranbek Ongarbayev. "Tuberculous Pleurisy: the role of the ADA Enzyme in Diagnosis and Treatment Outcomes." Biomedical and Pharmacology Journal 17, no. 4 (2024): 2585–92. https://doi.org/10.13005/bpj/3050.

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Extrapulmonary TB, representing nearly 15% of the global TB burden, is more difficult to diagnose. Tuberculous pleural effusion (TPE), one of the commonest forms of extrapulmonary TB, is a diagnostic challenge with rather poor microbiologic confirmation rates from pleural fluid analysis2,3. Even diagnostic tools like CBNAAT and interferon-gamma release assays have shown suboptimal diagnostic accuracy4,5. Adenosine deaminase (ADA), an enzyme produced from lymphocytes and involved in purine metabolism, has been extensively studied as a biochemical marker in pleural fluid during investigation for TPE. The test is simple, cheap, rapid, minimally invasive, and can be performed in most laboratories3.
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Kumar, Avdhesh, Brijesh Kumar, Sanjay Kumar Verma, et al. "A study to know the various causes of pleural effusion and role of pleural fluid adenosine deaminase enzyme in tuberculous pleural effusion." International Journal of Research in Medical Sciences 8, no. 4 (2020): 1231. http://dx.doi.org/10.18203/2320-6012.ijrms20201099.

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Background: India has the maximum burden of both non MDR tuberculosis (TB) and Multidrug-Resistant (MDR) TB, as per data reported in Global TB Report 2018 and tuberculosis is remains one of the most common cause of pleural effusions.Methods: This was a cross-sectional study conducted in Department of Respiratory Diseases and a total of 110 patients with pleural effusion were included in the study, which were enrolled for treatment from July 2018 to June 2019.Results: One hundred and ten patients with pleural effusion were enrolled during the study period. There were 65 males (59%) and 45 (40.9%) females. The overall mean age for males and females were 44.4±18.84 years (35-87 years) and 38.28±17.66 years (35-87 years) respectively. Tuberculous Pleural Effusion group (TPE) seen in 82 patients. Right sided pleural effusion (69.5 %) were more common than left sided (30.4 %). In TPE group the mean pleural fluid ADA level were 86.41±38.08 IU/L (range: 14-195 IU/L). The Malignant Pleural Effusion (MPE) group included 21 patients. In MPE group the mean pleural fluid ADA level were 34.10±32.88 IU/L (range: 8-144 IU/L). The difference in pleural fluid ADA levels between TPE and MPE group was statistically highly significant.Conclusions: Tuberculous pleural effusion was the most common cause of pleural effusion in present study and observed in 74.5% cases.
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Anupam Patra, Ritabrata Mitra, Swapnendu Misra, Ankan Bandyopadhyay, Amitabha Sengupta, and Sudipta Pandit. "Role of Medical Thoracoscopy in undiagnosed exudative pleural effusion with low Adenosine Deaminase level: Prospective Observational study in a tertiary care hospital from Eastern India." International Journal of Science and Research Archive 13, no. 1 (2024): 636–43. http://dx.doi.org/10.30574/ijsra.2024.13.1.1671.

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Background: Establishing the etiology of exudative pleural effusions in low ADA level (<40IU/L) often requires biopsies from the pleura. Medical thoracoscopy (MT) is a minimally invasive procedure performed under local anesthesia. Aim: To assess diagnostic yield of medical thoracoscopy in undiagnosed exudative pleural effusion with low ADA (<40 IU/L). To detect the association of pleural fluid ADA in different thoracoscopic diagnosis. Methods: This was a prospective observational study over a period of one year. Patients with undiagnosed exudative pleural effusion were enrolled in the study. MT was performed with rigid thoracoscope (OptymetCE0197) under local anesthesia. ADA level of pleural fluid was noted. Pleural biopsy material was subjected to histopathology examination and culture for mycobacteria along with cartridge‑based nucleic acid amplification test for TB. Incidence of percentage of tuberculosis and malignancy in low ADA level was calculated. Results: 106 patients with undiagnosed exudative pleural effusion underwent thoracoscopy of which were 56 male and 50 female. MT was able to establish the diagnosis in 96 cases, providing a diagnostic yield of 90.5%. Pleural TB contributed to 35.8% of undiagnosed pleural effusions in the present study. The mean ADA value was 33.9 and 19.6 in tuberculosis and malignant pleural effusion respectively which was found to be statistically significant. Among patients diagnosed as tuberculosis Mycobacterial Tuberculosis was detected on CBNAAT in 18%, while CBNAAT was negative in 82% cases. A cut off 28.5 IU/L for pleural fluid ADA, the sensitivity and specificity were 88.5% and 76.7% respectively based on receiver‑operating characteristic analysis (AUC0.88). Conclusion: Medical Thoracoscopy is a valuable diagnostic tool for undiagnosed exudative pleural effusion. It is a simple and safe procedure without significant morbidity and mortality. Thoracoscopy should be done as soon as possible in low ADA value whenever it is available. As significant number of tuberculosis patients are seen in even in low ADA(<40IU/L) setting.
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Norsworthy, Jessica, Sara Huda, Gulru Sharifova, and Walter Chua. "TB PLEURAL EFFUSION: AN ANOMALOUS DIAGNOSIS." Chest 156, no. 4 (2019): A702. http://dx.doi.org/10.1016/j.chest.2019.08.679.

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48

Chang, J. "Enhanced diagnosis in suggested malignant pleural effusion using combined modality of genetic and biochemical tumor markers." Journal of Clinical Oncology 24, no. 18_suppl (2006): 17137. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.17137.

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17137 Background: Cancer is influenced by oncogenes and tumor suppressor genes. Several tumor markers have been applied clinically in malignancy. A malignant pleural effusion may be an initial presentation of cancer and the presence of malignancy is confirmed by pleural cytology and biopsy. However, other diagnostic modalities are limited and not defined clearly, especially in cases of negative results from traditional diagnostic tool. Here, I investigated p53 and FHIT mutations and microsatellite alterations(MA) in the pleural effusion associated with malignancy(ME). Also, the diagnostic values of CEA, NSE, and CYFRA 21–1 as markers of malignant pleural effusion in lung cancer were assessed together. Methods: The genetic analyses of pleural fluid were done in 40 patients with ME and in the pleural fluid of 17 patients with tuberculous pleurisy(TB) as a control group. Levels of CEA, NSE, and CYFRA 21–1 were measured by immunoassay in the serum and pleural fluid of 34 patients with primary lung cancer and of 16 patients with TB. Results: p53 mutations were detected in 13% of ME and 0% of TB, and FHIT mutations were detected in 18% of ME and 12% of TB. Among 4 microsatellite markers; D3S1234, D3S1285, D9S171, and TP53, loss of heterozygosity(LOH) and microsatellite instability(MI) were observed for each group. MA including LOH and MI in at least one marker was seen 63% of ME cases vs. 35% of TB cases. Patients with lung cancer were found to have significantly higher serum and pleural fluid levels of CEA and CYFRA 21–1 than patients with tuberculous pleurisy. Using cut-off values of 5 ng/ml, 20 ng/ml, and 45 ng/ml for pleural fluid CEA, NSE, and CYFRA 21–1, the sensitivities and specificities were as follows: CEA; 82% and 94%, NSE; 36% and 94%, and CYFRA 21–1; 61% and 81%. A combination of pleural fluid CEA and NSE increased sensitivity and specificity. Conclusions: Although still limited in terms of sensitivity and specificity, this study shows that the determinations of CEA and NSE in pleural fluid enhance diagnostic yield better than all the other combination of tumor markers in malignant pleural effusion, especially in lung cancer and molecular diagnostic strategies including microsatellite alterations are possibly applied for the diagnosis of malignant effusion. No significant financial relationships to disclose.
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Labiba, Sayed, Ibraheem Dwidar, Eman Riad, and Basma B. Hasan. "The diagnostic utility of pleural fluid viscosity in lymphocytic pleural effusion." Egyptian Journal of Bronchology 9, no. 1 (2015): 73–78. http://dx.doi.org/10.4103/1687-8426.153656.

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Abstract Context The first step in the diagnostic work up of pleural effusion is the distinction between transudative and exudative pleural effusions (TPEs and EPEs). This discrimination is based on some biochemical tests that are relatively costly and time consuming. Lymphocyte-predominant EPE is the result of many diseases with malignancy, tuberculosis being the most common among them. Aims The aim of this study was to assess the role of pleural fluid viscosity in the differentiation between exudates and transudates and to identify the cause of pleural effusion. Patients and methods The study comprised 10 patients with TPE and 48 patients with EPE: 18 of them had tuberculous (TB) effusion, 25 patients had malignant pleural effusion (MPE) (patients with MPE included 10 with lung cancer and 15 with other known or unknown cancers) and five patients had connective tissue disease (CTD)-associated effusion. Pleural fluid protein, albumin, lactic dehydrogenase, and viscosity were measured in all patients. Results Pleural fluid viscosity was higher in patients with EPE with a highly significant difference (P < 0.01), and a cutoff value of 1.01 cP could distinguish between TPE and EPE with a sensitivity of 97.7%, a specificity of 93.9%, a positive predictive value of 97.5%, and a negative predictive value of 92.5%. It also showed significant positive correlation with protein, albumin, and lactic dehydrogenase. It was also higher in TB effusion than in MPE, with a highly significant difference (P < 0.01), and in CTD-associated effusion with a significant difference (P < 0.05). At a cutoff value of 1.5 cP, pleural fluid viscosity could discriminate between TB effusion and MPE with a sensitivity of 67%, a specificity of 84%, a positive predictive value of 75%, and a negative predictive value of 77%. There was also a nonsignificant difference between MPE secondary to lung cancer versus other known or unknown primary cancer (P > 0.05). Conclusion Pleural fluid viscosity can reliably differentiate between TPE and EPE. It can also help in the discrimination between TB effusion and MPE with moderate sensitivity and high specificity.
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Saghazadeh, Amene, and Nima Rezaei. "Vascular endothelial growth factor levels in tuberculosis: A systematic review and meta-analysis." PLOS ONE 17, no. 5 (2022): e0268543. http://dx.doi.org/10.1371/journal.pone.0268543.

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Background Changes in endothelial function are implicated in the spread of tuberculosis (TB). Studies suggest a role for the vascular endothelial growth factor (VEGF) in TB-related endothelial function changes. However, the findings of studies investigating the VGEF profile in TB are not consistent, and no formal systematic review and meta-analysis exists summarizing these studies. Methods We did a meta-analysis of studies assessing VEGF levels in patients with TB. A systematic search on June 25, 2021, was conducted for eligible studies that made VEGF measurements in an unstimulated sample, e.g., a blood fraction (plasma or serum), cerebrospinal fluid (CSF), pleural effusion (PE), or bronchoalveolar lavage fluid, and ascites or pericardial fluid for patients with TB and controls without TB. Also, studies that made simultaneous measurements of VEGF in blood and PE or CSF in the same patients with TB were included. Longitudinal studies that provided these data at baseline or compared pre-post anti-tuberculosis treatment (ATT) levels of VEGF were included. The primary outcome was the standardized mean difference (SMD) of VEGF levels between the comparison groups. Results 52 studies were included in the meta-analysis. There were 1787 patients with TB and 3352 control subjects of eight categories: 107 patients with transudative pleural effusion, 228 patients with congestive heart failure (CHF)/chronic renal failure (CRF), 261 patients with empyema and parapneumonic effusion (PPE), 241 patients with cirrhosis, 694 healthy controls (with latent TB infection or uninfected individuals), 20 patients with inactive tuberculous meningitis (TBM), 123 patients with non-TBM, and 1678 patients with malignancy. The main findings are as follows: (1) serum levels of VEGF are higher in patients with active TB compared with healthy controls without other respiratory diseases, including those with latent TB infection or uninfected individuals; (2) both serum and pleural levels of VEGF are increased in patients with TPE compared with patients with transudative, CHF/CRF, or cirrhotic pleural effusion; (3) ascitic/pericardial fluid, serum, and pleural levels of VEGF are decreased in patients with TB compared with patients with malignancy; (4) pleural levels of VEGF are lower in patients with TPE compared with those with empyema and PPE, whereas serum levels of VEGF are not different between these patients; (5) both CSF and serum levels of VEGF are increased in patients with active TBM compared with controls, including patients with inactive TBM or non-TBM subjects; (6) post-ATT levels of VEGF are increased compared with pre-ATT levels of VEGF; and (7) the mean age and male percentage of the TB group explained large and total amount of heterogeneity for the meta-analysis of blood and pleural VEGF levels compared with healthy controls and patients with PPE, respectively, whereas these moderators did not show any significant interaction with the effect size for other analyses. Discussion The important limitation of the study is that we could not address the high heterogeneity among studies. There might be unmeasured factors behind this heterogeneity that need to be explored in future research. Meta-analysis findings align with the hypothesis that TB may be associated with abnormal vascular function, and both local and systemic levels of VEGF can be used to trace this abnormality.
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