title: Pleural tuberculosis: is radiological evidence of pulmonary-associated disease related to the exacerbation of the inflammatory response?
abstract: OBJECTIVE
  Pleural tuberculosis is the most frequently occurring form of extra pulmonary disease in adults. In up to 40% of cases, the lung parenchyma is concomitantly involved, which can have an epidemiological impact. This study aims to evaluate the pleural and systemic inflammatory response of patients with pleural or pleuropulmonary tuberculosis.
  
  
  METHODS
  A prospective study of 39 patients with confirmed pleural tuberculosis. After thoracentesis, a high resolution chest tomography was performed to evaluate the pulmonary involvement. Of the 39 patients, 20 exhibited only pleural effusion, and high resolution chest tomography revealed active associated-pulmonary disease in 19 patients. The total protein, lactic dehydrogenase, adenosine deaminase, vascular endothelial growth factor, interleukin-8, tumor necrosis factor-α, and transforming growth factor-β(1) levels were quantified in the patient serum and pleural fluid.
  
  
  RESULTS
  All of the effusions were exudates with high levels of adenosine deaminase. The levels of vascular endothelial growth factor and transforming growth factor-β(1) were increased in the blood and pleural fluid of all of the patients with pleural tuberculosis, with no differences between the two forms of tuberculosis. The tumor necrosis factor-α levels were significantly higher in the pleural fluid of the patients with the pleuropulmonary form of tuberculosis. The interleukin-8 levels were high in the pleural fluid of all of the patients, without any differences between the forms of tuberculosis.
  
  
  CONCLUSIONS
  Tumor necrosis factor-α was the single cytokine that significantly increased in the pleural fluid of the patients with pulmonary involvement. However, an overlap in the results does not permit us to suggest that cytokine is a biological marker of concomitant parenchymal involvement. Although high resolution chest tomography can be useful in identifying these patients, the investigation of fast acid bacilli and cultures for M. tuberculosis in the sputum is recommended for all patients who are diagnosed with pleural tuberculosis.
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Pleural Laboratory, São Paulo/SP, Brazil.
authors.forename: Leila
authors.initials: L
authors.lastname: Antonangelo
authors.forename: Francisco S
authors.initials: FS
authors.lastname: Vargas
authors.forename: Juliana
authors.initials: J
authors.lastname: Puka
authors.forename: Márcia
authors.initials: M
authors.lastname: Seiscento
authors.forename: Milena M P
authors.initials: MM
authors.lastname: Acencio
authors.forename: Lisete R
authors.initials: LR
authors.lastname: Teixeira
authors.forename: Ricardo M
authors.initials: RM
authors.lastname: Terra
authors.forename: Roberta K B
authors.initials: RK
authors.lastname: Sales
mesh_terms: D000243:Adenosine Deaminase / Q000032:analysis; D000328:Adult; D015415:Biomarkers / Q000032:analysis*; D016207:Cytokines / Q000032:analysis; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005122:Exudates and Transudates / Q000737:chemistry; D006801:Humans; D008875:Middle Aged; D010088:Oxidoreductases / Q000032:analysis; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000378:metabolism*; D011446:Prospective Studies; D011859:Radiography; D053773:Transforming Growth Factor beta1 / Q000032:analysis; D014396:Tuberculosis, Pleural / Q000000981:diagnostic imaging / Q000378:metabolism*; D014397:Tuberculosis, Pulmonary / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis; D055815:Young Adult
chemical_list: D015415:Biomarkers; D016207:Cytokines; D053773:Transforming Growth Factor beta1; D014409:Tumor Necrosis Factor-alpha; D042461:Vascular Endothelial Growth Factor A; D010088:Oxidoreductases; D000243:Adenosine Deaminase