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Vol. 55. Num. 1.January 2019
Pages 1-64
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Vol. 55. Num. 1.January 2019
Pages 1-64
Original Article
DOI: 10.1016/j.arbr.2018.11.006
Tuberculous Pleural Effusion: Clinical Characteristics of 320 Patients
Derrame pleural tuberculoso: características clínicas de 320 pacientes
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Silvia Bielsaa, Cristina Acostaa, Marina Pardinab, Carmen Civita, José M. Porcela,
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jporcelp@yahoo.es

Corresponding author.
a Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
b Servicio de Radiología, Hospital Universitario Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
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Tables (5)
Table 1. Main Characteristics of the Population With Tuberculous Pleural Effusion.
Table 2. Factors That Influence Positive Microbiological Identification in Tuberculous Pleural Effusion.
Table 3. Factors Associated With Pleural ADA <35U/l in Tuberculous Pleural Effusion.
Table 4. Factors Associated With the Presence of a Pulmonary Opacity on Standard X-ray of the Chest of Patients With Tuberculous Pleural Effusion.
Table 5. Predictive Factors of Death in Tuberculous Pleural Effusion.
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Abstract
Objectives

To analyze the clinical and radiological characteristics and features of pleural fluid (PF) in patients with tuberculous pleural effusion (TPE).

Methods

Retrospective analysis of TPEs treated in our clinic over the last 23 years.

Results

We included 320 patients with TPE (70% men; median age 33 years). Mycobacterium tuberculosis was identified in the sputum or PF of 36% of the patients by microscopic examination, solid and liquid media cultures, or nucleic acid amplification tests. The greatest percentage of positive microbiological findings were associated with human immunodeficiency virus (HIV) co-infection (OR: 3.27), and with the presence in PF of proteins <4g/dl (OR: 3.53), neutrophils >60% (OR: 3.23), and glucose <40mg/dl (OR: 3.17). Pleural adenosine deaminase <35U/l was associated with TPEs that occupied less than half of the hemithorax (OR: 6.36) and with PF lactate dehydrogenase levels <500U/l (OR: 8.09). Radiological pulmonary opacities (30%) were more common in TPE occupying less than half of the hemithorax (OR: 2.73), in bilateral TPE (OR: 4.48), and in older patients (OR: 1.02). Factors predicting mortality were: HIV co-infection (OR: 24), proteins in PF <5g/dl (OR: 10), and greater age (OR: 1.05).

Conclusions

Patients with TPE and HIV co-infection and those with lower concentrations of proteins in PF had higher rates of positive microbiological results and death. Moreover, older patients had more pulmonary opacities and a higher incidence of death.

Keywords:
Tuberculous pleural effusion
Pleural fluid
Adenosine deaminase
Resumen
Objetivos

Analizar las características clinicorradiológicas y del líquido pleural (LP) de los pacientes con derrame pleural tuberculoso (DPT).

Métodos

Análisis retrospectivo de los DPT atendidos en nuestro centro durante los últimos 23 años.

Resultados

Se estudiaron 320 pacientes con DPT (70% varones; mediana de edad 33 años). En el 36% de los casos se identificó Mycobacterium tuberculosis en esputo o LP mediante examen microscópico, cultivos en medios sólidos y líquidos, o amplificación de ácidos nucleicos. El mayor porcentaje de identificaciones microbiológicas se relacionó con una co-infección por el virus de la inmunodeficiencia humana (VIH) (OR: 3,27) y con la presencia en LP de unas proteínas <4g/dl (OR: 3,53), neutrófilos >60% (OR: 3,23) o glucosa <40mg/dl (OR: 3,17). Una adenosina desaminasa pleural <35U/l se asoció con DPT que ocupaban <1/2 del hemitórax (OR: 6,36) y con niveles de lactato deshidrogenasa <500U/l (OR: 8,09) en LP. Las opacidades pulmonares radiológicas (30%) fueron más comunes si el DPT no alcanzaba la mitad del hemitórax (OR: 2,73), era bilateral (OR: 4,48) o los pacientes tenían mayor edad (OR: 1,02). Los factores predictores de mortalidad fueron: una co-infección VIH (OR: 24), proteínas en LP <5g/dl (OR: 10) y una mayor edad (OR: 1,05).

Conclusiones

Los pacientes con DPT co-infectados por VIH o que presentan concentraciones bajas de proteínas en LP tienen mayor frecuencia de aislamientos microbiológicos y fallecimientos. Asimismo, los pacientes de mayor edad muestran más opacidades pulmonares y mortalidad.

Palabras clave:
Derrame pleural tuberculoso
Líquido pleural
Adenosina desaminasa

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