title: Pleural tuberculosis in patients with early HIV infection is associated with increased TNF-alpha expression and necrosis in granulomas.
abstract: Although granulomas may be an essential host response against persistent antigens, they are also associated with immunopathology. We investigated whether HIV co-infection affects histopathological appearance and cytokine profiles of pleural granulomas in patients with active pleural tuberculosis (TB). Granulomas were investigated in pleural biopsies from HIV positive and negative TB pleuritis patients. Granulomas were characterised as necrotic or non-necrotic, graded histologically and investigated for the mRNA expression of IL-12, IFN-gamma, TNF-alpha and IL-4 by in situ hybridisation. In all TB patients a mixed Th1/Th2 profile was noted. Necrotic granulomas were more evident in HIV positive patients with a clear association between TNF-alpha and necrosis. This study demonstrates immune dysregulation which may include TNF-alpha-mediated immunopathology at the site of disease in HIV infected pleural TB patients.
authors.affiliation: Department of Histopathology, Tygerberg Hospital, Cape Town, Western Cape, South Africa.
authors.forename: Juanita
authors.initials: J
authors.lastname: Bezuidenhout
authors.forename: Teri
authors.initials: T
authors.lastname: Roberts
authors.forename: Liesel
authors.initials: L
authors.lastname: Muller
authors.forename: Paul
authors.initials: P
authors.lastname: van Helden
authors.forename: Gerhard
authors.initials: G
authors.lastname: Walzl
mesh_terms: D000328:Adult; D001706:Biopsy; D016022:Case-Control Studies; D005260:Female; D005786:Gene Expression Regulation; D006099:Granuloma / Q000378:metabolism* / Q000473:pathology* / Q000821:virology*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D009336:Necrosis; D012333:RNA, Messenger / Q000378:metabolism; D018417:Th1 Cells / Q000378:metabolism; D018418:Th2 Cells / Q000378:metabolism; D014396:Tuberculosis, Pleural / Q000150:complications / Q000821:virology*; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis*
chemical_list: D012333:RNA, Messenger; D014409:Tumor Necrosis Factor-alpha