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Pleural Tuberculosis

  • Necla Eren Tulek
Chapter

Abstract

Pleural tuberculosis is one of the most frequent forms of extra-pulmonary involvement of tuberculosis in adults and one of the most common causes of pleural effusions. The incidence is higher in the regions with high tuberculosis prevalence. Immunocompromised conditions may predispose to its development. Pleural tuberculosis may develop as a consequence of primary tuberculosis or due to reactivation of latent tuberculosis foci. The typical clinical presentation is an acute illness with fever, pleuritic chest pain, and nonproductive cough. Chest X-rays show unilateral pleural effusion; it may resolve spontaneously, but there is a high risk of recurrence in untreated people throughout the years. For this reason, all the patients diagnosed with pleural tuberculosis must be treated with the drugs the same as in pulmonary tuberculosis. The gold standard for the diagnosis of pleural tuberculosis is the demonstration Mycobacterium tuberculosis in pleural fluid, pleural biopsy specimens, or sputum, but the sensitivity of these tests is very low. Pleural levels of biomarkers such as adenosine deaminase and interferon-γ may contribute to the diagnosis of pleural tuberculosis when used in combination with pleural fluid analysis and other biomarkers in clinically compatible patients.

Keywords

Tuberculosis Mycobacterium tuberculosis Epidemiology Tuberculosis Pleural Antitubercular agents Pleural effusion Interferon-gamma release tests Tuberculin test Adenosine deaminase PCR techniques 

References

  1. 1.
    Zhai K, Lu Y, Shi H-Z. Tuberculous pleural effusion. J Thoracic Dis. 2016;8(7):E486–94.  https://doi.org/10.21037/jtd.2016.05.87.CrossRefGoogle Scholar
  2. 2.
    Porcel JM, Esquerda A, Vives M, et al. Etiology of pleural effusions: analysis of more than 3000 consecutive thoracenteses. Arch Broncopneumol. 2014;50:161–5.Google Scholar
  3. 3.
    Global tuberculosis report 2017. Geneva: World Health Organization; 2017 http://www.who.int/tb/publications/global_report/MainText_13Nov2017.pdf?ua=1. Accessed 25 Nov 2017.
  4. 4.
    Qiu L, Teeter LD, Liu Z, Ma X, Musser JM, Ea G. Diagnostic associations between pleural and pulmonary tuberculosis. J Inf Secur. 2006;53(6):377–86.Google Scholar
  5. 5.
    Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Physician. 2005;72(9):1761–8.PubMedGoogle Scholar
  6. 6.
    Chamie G, Luetkemeyer A, Walusimbi-Nantenza M, et al. Significant variation in presentation of pulmonary tuberculosis across a high resolution of CD4 strata. Int J Tuberc Lung Dis. 2010;14:1295–302.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Cooper AM. Cell-mediated immune responses in tuberculosis. Annu Rev Immunol. 2009;27(1):393–422.CrossRefGoogle Scholar
  8. 8.
    Vorster MJ, Allwood BW, Diacon AH, Koegelenberg CFN. Tuberculous pleural effusions: advances and controversies. J Thoracic Dis. 2015;7(6):981–91.Google Scholar
  9. 9.
    Porcel JM. Tuberculous pleural effusion. Lung. 2009;187(5):263–70.CrossRefGoogle Scholar
  10. 10.
    Jeong YJ, Lee KS. Pulmonary tuberculosis: up-to-date imaging and management. Am J Roentgenol. 2008;191:834–44.CrossRefGoogle Scholar
  11. 11.
    Porcel JM. Advances in the diagnosis of tuberculous pleuritis. Ann Transl Med. 2016;4(15):282.  https://doi.org/10.21037/atm.2016.07.23.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Mcgrath EE, Anderson PB. Diagnostic tests for tuberculous pleural effusion. Eur J Clin Microbiol Infect Dis. 2010;29(10):1187–93.CrossRefGoogle Scholar
  13. 13.
    Seiscento M, Vargas FS, Bombarda S, et al. Pulmonary involvement in pleural tuberculosis: how often does it mean disease activity. Respiratory Med. 2011;105:1079–83.CrossRefGoogle Scholar
  14. 14.
    Koegelenberg CF, von Groote-Bidlingmaier F, Bolliger CT. Transthoracic ultrasonography for the respiratory physician. Respiration. 2012;84:337–50.CrossRefGoogle Scholar
  15. 15.
    Conde MB, Loivos AC, Rezende VM, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med. 2003;167:723–5.CrossRefGoogle Scholar
  16. 16.
    Aljohaney A, Amjadi K, Alvarez GG. A systematic review of the epidemiology, immunopathogenesis, diagnosis, and treatment of pleural TB in HIV-infected patients. Clin Dev Immunol. 2012;2012:842045.  https://doi.org/10.1155/2012/842045.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77(4):507–13.CrossRefGoogle Scholar
  18. 18.
    Jolobe OM. Atypical tuberculous pleural effusions. Eur J Inter Med. 2011;22:456–9.CrossRefGoogle Scholar
  19. 19.
    Kitinya JN, Richter C, Perenboom R, et al. Influence of HIV status on pathological changes in tuberculous pleuritis. Tuber Lung Dis. 1994;75:195–8.CrossRefGoogle Scholar
  20. 20.
    Marjani M, Yousefzadeh A, Baghaei P, et al. Impact of HIV infection on tuberculous pleural effusion. Int J STD AIDS. 2016;27:363–9.CrossRefGoogle Scholar
  21. 21.
    Ruan SY, Chuang YC, Wang JY, et al. Revisiting tuberculous pleurisy: pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area. Thorax. 2012;67:822–7.CrossRefGoogle Scholar
  22. 22.
    Ko Y, Song J, Lee SY, et al. Does repeated pleural culture increase the diagnostic yield of Mycobacterium tuberculosis from tuberculous pleural effusion in HIV-negative individuals? PLoS One. 2017;12(7):e0181798.  https://doi.org/10.1371/journal.pone.0181798.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Rageade F, Picot N, Blanc-Michaud A, et al. Performance of solid and liquid culture media for the detection of Mycobacterium tuberculosis in clinical materials: metaanalysis of recent studies. Eur J Clin Microbiol Infect Dis. 2014;33:867–70.CrossRefGoogle Scholar
  24. 24.
    Denkinger CM, Schumacher SG, Boehme CC, et al. Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2014;44:435–46.CrossRefGoogle Scholar
  25. 25.
    Saeed M, Ahmad M, Iram S, Riaz S, Akhtar M, Aslam M. GeneXpert technology A breakthrough for the diagnosis of tuberculous pericarditis and pleuritic in less than 2 hours. Saudi Med J. 2017;38(7):699–705.CrossRefGoogle Scholar
  26. 26.
    Trajman A, da Silva Santos Kleiz de Oliveira EF, Bastos ML, et al. Accuracy of polimerase chain reaction for the diagnosis of pleural tuberculosis. Respir Med. 2014;108:918–23.CrossRefGoogle Scholar
  27. 27.
    Sehgal IS, Dhooria S, Aggarwal AN, et al. Diagnostic performance of xpert MTB/RIF in tuberculous pleural effusion: systematic review and meta-analysis. J Clin Microbiol. 2016;54:1133–6.CrossRefGoogle Scholar
  28. 28.
    Sahn SA, Huggins JT, San José ME, et al. Can tuberculous pleural effusions be diagnosed by pleural fluid analysis alone? Int J Tuberc Lung Dis. 2013;17:787–93.CrossRefGoogle Scholar
  29. 29.
    DePew ZS, Maldonado F. The role of interventional therapy for pleural diseases. Expert Rev Respir Med. 2014;8(4):465–77.CrossRefGoogle Scholar
  30. 30.
    Bibby AC, Maskell NA. Pleural biopsies in undiagnosed pleural effusions; Abrams vs image-guided vs thoracoscopic biopsies. Curr Opin Pulm Med. 2016;22(4):392–8.CrossRefGoogle Scholar
  31. 31.
    Gopi A, Madhavan SM, Sharma SK, et al. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest. 2007;131:880–9.CrossRefGoogle Scholar
  32. 32.
    Aggarwal AN, Agarwal R, Gupta D, Dhooria S, Behera D. Interferon gamma release assays for diagnosis of pleural tuberculosis: a systematic review and meta-analysis. Carroll KC, ed. J Clin Microbiol. 2015;53(8):2451–9.CrossRefGoogle Scholar
  33. 33.
    Villegas MV, Labrada LA, Saravia NG. Evaluation of polymerase chain reaction, adenosine deaminase, and interferon-gamma in pleural fluid for the differential diagnosis of pleural tuberculosis. Chest. 2000;118:1355–64.CrossRefGoogle Scholar
  34. 34.
    Baba K, Hoosen AA, Langeland N, Dyrhol-Riise AM. Adenosine deaminase activity is a sensitive marker for the diagnosis of tuberculous pleuritis in patients with very low CD4 counts. Zaas AK, ed. PLoS One. 2008;3(7):e2788.  https://doi.org/10.1371/journal.pone.0002788.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Arnold DT, Bhatnagar R, Fairbanks LD, et al. Pleural Fluid Adenosine Deaminase (Pfada) in the diagnosis of tuberculous effusions in a low incidence population. Caylà JA, ed. PLoS ONE. 2015;10(2):e0113047.  https://doi.org/10.1371/journal.pone.0113047.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Liang QL, Shi HZ, Wang K, Qin SM, Qin XJ. Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: a meta-analysis. Respir Med. 2008;102(5):744–54.CrossRefGoogle Scholar
  37. 37.
    Jiménez Castro D, Díaz Nuevo G, Pérez-Rodríguez E, Light RW. Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions. Eur Respir J. 2003;21(2):220–4.CrossRefGoogle Scholar
  38. 38.
    Light RW. Update on tuberculous pleural effusion. Respirology. 2010;15:451–8.CrossRefGoogle Scholar
  39. 39.
    Wang H, Yue J, Yang J, Gao R, Liu J. Clinical diagnostic utility of adenosine deaminase, interferon-γ, interferon-γ-induced protein of 10 kDa, and dipeptidyl peptidase 4 levels in tuberculous pleural effusions. Heart Lung. 2012;41(1):70–5.  https://doi.org/10.1016/j.hrtlng.2011.04.049.CrossRefPubMedGoogle Scholar
  40. 40.
    Jiang J, Shi HZ, Liang QL, Qin SM, Qin XJ. Diagnostic value of interferon-γ in tuberculous pleurisy: a meta-analysis. Chest. 2007;2007131(4):1133–41.CrossRefGoogle Scholar
  41. 41.
    Wu YB, Ye ZJ, Qin SM, Wu C, Chen YQ, Shi HZ. Combined detections of interleukin 27, interferon-γ, and adenosine deaminase in pleural effusion for diagnosis of tuberculous pleurisy. Chin Med J (Engl). 2013;126(17):3215–21.Google Scholar
  42. 42.
    Skouras VS, Magkouta SF, Psallidas I, et al. Interleukin-27 improves the ability of adenosine deaminase to rule out tuberculous pleural effusion regardless of pleural tuberculosis prevalence. Infect Dis (Lond). 2015;47:477–83.CrossRefGoogle Scholar
  43. 43.
    Wallis RS, Kim P, Cole S, et al. Tuberculosis biomarkers discovery: developments, needs, and challenges. Lancet Infect Dis. 2013;13(4):362–72.CrossRefGoogle Scholar
  44. 44.
    Zeng N, Wan C, Qin J, et al. Diagnostic value of interleukins for tuberculous pleural effusion: a systematic review and meta-analysis. BMC Pulm Med. 2017;17:180.  https://doi.org/10.1186/s12890-017-0530-3.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Porcel JM, Azzopardi M, Koegelenberg CF, et al. The diagnosis of pleural effusions. Expert Rev Respir Med. 2016;9:801–15.CrossRefGoogle Scholar
  46. 46.
    Maldonado F, Lentz RJ, Light RW. Diagnostic approach to pleural diseases: new tricks for an old trade. F1000Res. 2017;17(6):1135.  https://doi.org/10.12688/f1000research.11646.1.CrossRefGoogle Scholar
  47. 47.
    Guidelines for treatment of drug-susceptible tuberculosis and patient care (2017 update). Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.Google Scholar
  48. 48.
    Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines. Treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016;63(7):e147–95.  https://doi.org/10.1093/cid/ciw376.CrossRefPubMedGoogle Scholar
  49. 49.
    Dheda K, Barry CE, Maartens G. Tuberculosis. Lancet. 2016;387:1211–26.CrossRefGoogle Scholar
  50. 50.
    Geri G, Passeron A, Heym B, et al. Paradoxical reactions during treatment of tuberculosis with extrapulmonary manifestations in HIV-negative patients. Infection. 2013;41(2):537–43.CrossRefGoogle Scholar
  51. 51.
    Ryan H, Yoo J, Darsini P. Corticosteroids for tuberculous pleurisy. Cochrane Database Syst Rev. 2017;(3):CD001876.  https://doi.org/10.1002/14651858.CD001876.pub3.
  52. 52.
    Elliott AM, Luzze H, Quigley MA, et al. A randomized, double-blind, placebo-controlled trial of the use of prednisolone as an adjunct to treatment in HIV-1-associated pleural tuberculosis. J Infect Dis. 2004;190:869–78.CrossRefGoogle Scholar
  53. 53.
    Bhuniya S, Arunabha DC, Choudhury S, et al. Role of therapeutic thoracentesis in tuberculous pleural effusion. Ann Thorac Med. 2012;7:215–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Necla Eren Tulek
    • 1
  1. 1.Ankara Training and Research HospitalAltındağ/AnkaraTurkey

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