Abstract
Objectives
Tuberculous pleural effusion (TPE) is generally characterized by lymphocytic exudative
effusion, either free-flowing or loculated. However, patients can also have neutrophilic
loculated TPE, although little data are available concerning the incidence and characteristics
of this form of TPE. It is important to differentiate between neutrophilic loculated
TPE and complicated parapneumonic effusion (PPE), which also shows neutrophilic loculated
effusion but needs a different management approach. The present study evaluated the
incidence and characteristics of neutrophilic loculated TPE and differentiated it
from complicated PPE.
Materials and Methods
Between 2009 and 2014, a cohort of patients with TPE was retrospectively reviewed
in a South Korean referral hospital. Clinical, laboratory, computed tomography and
pleural fluid findings of patients with neutrophilic loculated TPE were compared to
those of patients with neutrophilic free-flowing TPE and complicated PPE, respectively.
Results
Neutrophilic TPE was observed in 33 (10%) out of 344 patients with TPE. Of these,
10 (30%) patients exhibited loculation of the pleural fluid. These patients showed
distinct pleural fluid characteristics. The classical pleural fluid biomarker levels
were more intense than those observed in 23 patients with neutrophilic free-flowing
TPE, but similar to those of 54 patients with complicated PPE. A high mycobacterial
burden was observed in the pleural fluid, and favorable outcomes were achieved with
antituberculosis drug administration alone. Nodular parenchymal lesions and pleural
fluid adenosine deaminase levels were independent discriminators of neutrophilic loculated
TPE and PPE.
Conclusions
These results may be helpful to understand and manage patients with neutrophilic loculated
TPE and differentiate them from patients with complicated PPE.
Key Indexing Terms
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of the Medical SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Etiology and pleural fluid characteristics of large and massive effusions.Chest. 2003; 124: 978-983
- Role of common investigations in aetiological evaluation of exudative pleural effusions.J Clin Diagn Res. 2013; 7: 2223-2226
- Tuberculous pleural effusions.Eur J Intern Med. 2003; 14: 77-88
- Tuberculous pleural effusion.Lung. 2009; 187: 263-270
- Resolution of residual pleural disease according to time course in tuberculous pleurisy during and after the termination of antituberculosis medication.Chest. 2005; 128: 3240-3245
- A study of loculated tuberculous pleural effusions treated with intrapleural urokinase.Respir Med. 2006; 100: 2037-2042
- Tuberculous pleurisy: a study of 254 patients.Arch Intern Med. 1998; 158: 2017-2021
- Mycobacterium tuberculosis and polymorphonuclear pleural effusion: incidence and clinical pointers.Respir Med. 2009; 103: 820-826
- Revisiting tuberculous pleurisy: pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area.Thorax. 2012; 67: 822-827
- Radiologic and laboratory differences in patients with tuberculous and parapneumonic pleural effusions showing non-lymphocytic predominance and high adenosine deaminase levels.Infection. 2015; 43: 65-71
World Health Organization. Tuberculosis. WHO report. Available at: http://www.who.int./tb; 2012.
- Comparison of polymorphonuclear- and lymphocyte-rich tuberculous pleural effusions.Int J Tuberc Lung Dis. 2013; 17: 85-89
- The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis.Chest. 2006; 129: 1253-1258
- Diagnostic performance of adenosine deaminase activity in pleural fluid: a single-center experience with over 2100 consecutive patients.Eur J Intern Med. 2010; 21: 419-423
- Clinical value of whole-blood interferon-gamma assay in patients with suspected pulmonary tuberculosis and AFB smear- and polymerase chain reaction-negative bronchial aspirates.Diagn Microbiol Infect Dis. 2012; 73: 252-256
- Factors influencing residual pleural opacity in tuberculous pleural effusion.J Korean Med Sci. 2008; 23: 616-620
- Tuberculous empyema.Semin Respir Infect. 1999; 14: 82-87
- Inflammatory responses in experimental tuberculosis pleurisy.Acta Cytol. 1983; 27: 355-361
- Pleural adenosine deaminase determination: an inter-laboratory comparison is required.J Infect. 2014; 68: 103
- Usefulness of the British Thoracic Society and the American College of Chest Physicians guidelines in predicting pleural drainage of non-purulent parapneumonic effusions.Respir Med. 2006; 100: 933-937
- Pulmonary changes of pleural tuberculosis: up-to-date CT imaging.Chest. 2014; 146: 1604-1611
- Treatment of complicated pleural effusions in 2013.Clin Chest Med. 2013; 34: 47-62
Article info
Publication history
Accepted:
September 17,
2015
Received:
May 21,
2015
Footnotes
The authors have no financial or other conflicts of interest to disclose.
Identification
Copyright
© 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
