title: Paradoxical response in HIV-negative patients with pleural tuberculosis: a retrospective multicentre study.
abstract: OBJECTIVE
  To evaluate the incidence, clinical characteristics and predicting factors for the development of paradoxical response in human immunodeficiency virus negative patients with isolated pleural tuberculosis (TB).
  
  
  METHODS
  A multicentre, retrospective cohort study including  458 patients who were diagnosed and treated with isolated pleural TB between March 2005 and February 2010.
  
  
  RESULTS
  Paradoxical response developed in 72 patients (16%) with isolated pleural TB. The mean time to development of paradoxical response was 8.8 ± 6.4 weeks after initiation  of anti-tuberculosis treatment. The main presentation of paradoxical response was aggravation of pre-existing pleural effusion in 58 patients (81%). However, the majority of the patients who developed paradoxical response had no associated symptoms (n = 49, 68%). In multiple logistic  regression analysis, development of paradoxical response was independently associated with the proportion of eosinophils (adjusted OR 1.293, 95%CI 1.077-1.553) and protein concentrations (adjusted OR 0.590, 95%CI 0.397-0.878) in the pleural fluid at the time of diagnosis.
  
  
  CONCLUSIONS
  Paradoxical response developed in 16% of the patients approximately 2 months after initiation of anti-tuberculosis treatment, presenting with aggravation of pre-existing pleural effusion. Development of paradoxical response was associated with the proportion of eosinophils and protein concentrations  in the pleural fluid at the time of diagnosis.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: K
authors.initials: K
authors.lastname: Jeon
authors.forename: W-I
authors.initials: WI
authors.lastname: Choi
authors.forename: J S
authors.initials: JS
authors.lastname: An
authors.forename: S Y
authors.initials: SY
authors.lastname: Lim
authors.forename: W J
authors.initials: WJ
authors.lastname: Kim
authors.forename: G M
authors.initials: GM
authors.lastname: Park
authors.forename: S S
authors.initials: SS
authors.lastname: Park
authors.forename: H S
authors.initials: HS
authors.lastname: Choi
authors.forename: B H
authors.initials: BH
authors.lastname: Lee
authors.forename: J C
authors.initials: JC
authors.lastname: Choi
authors.forename: M J
authors.initials: MJ
authors.lastname: Na
authors.forename: J
authors.initials: J
authors.lastname: Park
authors.forename: J Y
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004804:Eosinophils; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010996:Pleural Effusion / Q000175:diagnosis / Q000382:microbiology; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014396:Tuberculosis, Pleural / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents