title: Cytokine polarization in miliary and pleural tuberculosis.
abstract: Cytokines were measured in patients with pleural effusion and miliary tuberculosis (TB). Patients with pleural effusion had significantly higher interferon-gamma (IFN-gamma) levels (P < 0.001) in their pleural fluid as compared to that of peripheral blood of the same patients, thus exhibiting localization of predominantly Th1-type immunity in the pleural fluid. On the contrary, patients with miliary TB had higher IFN-gamma levels in the peripheral blood as compared to their bronchoalveolar lavage fluid. Moreover, the median IFN-gamma: IL-4 ratio in the peripheral blood of miliary TB patients was two-fold higher as compared to bronchoalveolar lavage fluid, suggesting that the cytokine profile at the disease site is skewed toward a Th2-like bias. Further, flow cytometry data revealed a significantly higher (P < 0.001) percentage of CD4+ pleural fluid lymphocytes expressing IFN-gamma, whereas in the miliary TB, a nine-fold higher percentage of lymphocytes in bronchoalveolar lavage fluid expressed IL-4 in comparison with their peripheral CD4 T cells. Our data indicate, respectively, a Th1-like and Th2-like response in tuberculous pleural effusion and miliary TB, suggesting that these clinical forms of extrapulmonary tuberculosis probably reflect the extreme ends of a Th1-Th2 spectrum of the disease.
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. surensk@hotmail.com
authors.forename: Surendra K
authors.initials: SK
authors.lastname: Sharma
authors.forename: Dipender K
authors.initials: DK
authors.lastname: Mitra
authors.forename: Arumugam
authors.initials: A
authors.lastname: Balamurugan
authors.forename: Ravindra M
authors.initials: RM
authors.lastname: Pandey
authors.forename: Narinder K
authors.initials: NK
authors.lastname: Mehra
mesh_terms: D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D016207:Cytokines / Q000032:analysis* / Q000097:blood; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D010996:Pleural Effusion / Q000737:chemistry / Q000166:cytology; D014391:Tuberculosis, Miliary / Q000097:blood / Q000276:immunology*; D014396:Tuberculosis, Pleural / Q000097:blood / Q000276:immunology*
chemical_list: D016207:Cytokines