Skip to main content

Advertisement

SpringerLink
Log in

Radiologic and laboratory differences in patients with tuberculous and parapneumonic pleural effusions showing non-lymphocytic predominance and high adenosine deaminase levels

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

Tuberculous pleural effusion (TPE) is characterized by lymphocytic predominance and high adenosine deaminase (ADA) levels. However, TPEs sometimes present non-lymphocytic predominance, and parapneumonic effusion (PPE) often exceeds the cutoff value of ADA for TPE. Thus, the differential diagnosis of cases with pleural fluid (PF) showing non-lymphocytic predominance and high ADA levels is challenging. However, limited data concerning the clinical differences in these patients are available.

Methods

A retrospective study was conducted on TPE and PPE patients with PF showing non-lymphocytic predominance and ADA levels ≥40 U/L in 2009–2013 in a South Korean tertiary referral hospital. The clinical, laboratory, and computed tomography (CT) findings between the groups were analyzed using multivariate logistic regression to develop a prediction model with independent factors for TPE.

Results

Among 353 patients with TPE, 24 (6.8 %) showed PF with non-lymphocytic predominance and ADA levels of ≥40 U/L. Twenty-eight PPE patients who presented PF findings comparable with those of TPE patients were included in the control group. In the final analysis, PF ADA levels >58 U/L and nodular lung lesions on CT were independent positive predictors, while loculated effusion was an independent negative predictor for TPE. Using the prediction model, a score ≥ +3 provided a sensitivity of 88 %, specificity of 93 %, positive predictive value of 91 %, and negative predictive value of 90 % for TPE.

Conclusion

PF ADA levels, nodular lung lesions, and loculated pleural effusion may help differentiate TPE from PPE in patients with PF showing non-lymphocytic predominance and ADA levels ≥40 U/L.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Krenke R, Korczynski P. Use of pleural fluid levels of adenosine deaminase and interferon gamma in the diagnosis of tuberculous pleuritis. Curr Opin Pulm Med. 2010;16:367–75.

    Article  CAS  PubMed  Google Scholar 

  2. Liang QL, Shi HZ, Wang K, et al. Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: a meta-analysis. Respir Med. 2008;102:744–54.

    Article  PubMed  Google Scholar 

  3. Porcel JM. Tuberculous pleural effusion. Lung. 2009;187:263–70.

    Article  PubMed  Google Scholar 

  4. Levine H, Szanto PB, Cugell DW. Tuberculous pleurisy. An acute illness. Arch Intern Med. 1968;122:329–32.

    Article  CAS  PubMed  Google Scholar 

  5. Gopi A, Madhavan SM, Sharma SK, et al. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest. 2007;131:880–9.

    Article  CAS  PubMed  Google Scholar 

  6. Lin MT, Wang JY, Yu CJ, et al. Mycobacterium tuberculosis and polymorphonuclear pleural effusion: incidence and clinical pointers. Respir Med. 2009;103:820–6.

    Article  PubMed  Google Scholar 

  7. Porcel JM, Esquerda A, Bielsa S. Diagnostic performance of adenosine deaminase activity in pleural fluid: a single-center experience with over 2100 consecutive patients. Eur J Intern Med. 2010;21:419–23.

    Article  CAS  PubMed  Google Scholar 

  8. Sahn SA, Huggins JT, San Jose ME, et al. Can tuberculous pleural effusions be diagnosed by pleural fluid analysis alone? Int J Tuberc Lung Dis. 2013;17:787–93.

    Article  CAS  PubMed  Google Scholar 

  9. Light RW. Pleural disease. 3rd ed. Baltimore: Williams and Wilkins; 1995. Chapter 9. Parapneumonic effusions and empyema. p. 129–53.

  10. World Health Organization. Tuberculosis. Available at: http://www.who.int./tb. WHO report. 2012.

  11. Bielsa S, Palma R, Pardina M, et al. Comparison of polymorphonuclear- and lymphocyte-rich tuberculous pleural effusions. Int J Tuberc Lung Dis. 2013;17:85–9.

    Article  CAS  PubMed  Google Scholar 

  12. Lee J, Lee SY, Yoo SS, et al. Clinical value of whole-blood interferon-gamma assay in patients with suspected pulmonary tuberculosis and AFB smear- and polymerase chain reaction-negative bronchial aspirates. Diagn Microbiol Infect Dis. 2012;73:252–6.

    Article  CAS  PubMed  Google Scholar 

  13. Kim HJ, Lee HJ, Kwon SY, et al. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest. 2006;129:1253–8.

    Article  PubMed  Google Scholar 

  14. Maji A, Maikap MK, Jash D, et al. Role of common investigations in aetiological evaluation of exudative pleural effusions. J Clin Diagn Res. 2013;7:2223–6.

    PubMed Central  PubMed  Google Scholar 

  15. Valdes L, San Jose E, Alvarez D, et al. Diagnosis of tuberculous pleurisy using the biologic parameters adenosine deaminase, lysozyme, and interferon gamma. Chest. 1993;103:458–65.

    Article  CAS  PubMed  Google Scholar 

  16. Ocana I, Martinez-Vazquez JM, Segura RM, et al. Adenosine deaminase in pleural fluids. Test for diagnosis of tuberculous pleural effusion. Chest. 1983;84:51–3.

    Article  CAS  PubMed  Google Scholar 

  17. Lee J, Lee SY, Choi KJ, et al. Clinical utility of CT-based bronchial aspirate TB-PCR for the rapid diagnosis of pleural tuberculosis. Tuberc Respir Dis (Seoul). 2013;75:150–6.

    Article  Google Scholar 

  18. Im JG, Itoh H, Shim YS, et al. Pulmonary tuberculosis: CT findings–early active disease and sequential change with antituberculous therapy. Radiology. 1993;186:653–60.

    Article  CAS  PubMed  Google Scholar 

  19. Hatipoglu ON, Osma E, Manisali M, et al. High resolution computed tomographic findings in pulmonary tuberculosis. Thorax. 1996;51:397–402.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Wang YH, Lin AS, Lai YF, et al. The high value of high-resolution computed tomography in predicting the activity of pulmonary tuberculosis. Int J Tuberc Lung Dis. 2003;7:563–8.

    CAS  PubMed  Google Scholar 

  21. Lee HM, Shin JW, Kim JY, et al. HRCT and whole-blood interferon-gamma assay for the rapid diagnosis of smear-negative pulmonary tuberculosis. Respiration. 2010;79:454–60.

    Article  CAS  PubMed  Google Scholar 

  22. Kim CH, Lim JK, Lee SY, et al. Predictive factors for tuberculosis in patients with a TB-PCR negative bronchial aspirate. Infection. 2013;41:187–94.

    Article  CAS  PubMed  Google Scholar 

  23. Kwon JS, Cha SI, Jeon KN, et al. Factors influencing residual pleural opacity in tuberculous pleural effusion. J Korean Med Sci. 2008;23:616–20.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Han DH, Song JW, Chung HS, et al. Resolution of residual pleural disease according to time course in tuberculous pleurisy during and after the termination of antituberculosis medication. Chest. 2005;128:3240–5.

    Article  PubMed  Google Scholar 

  25. Cases Viedma E, Lorenzo Dus MJ, Gonzalez-Molina A, et al. A study of loculated tuberculous pleural effusions treated with intrapleural urokinase. Respir Med. 2006;100:2037–42.

    Article  PubMed  Google Scholar 

  26. Muller NL. Imaging of the pleura. Radiology. 1993;186:297–309.

    Article  CAS  PubMed  Google Scholar 

  27. Valdes L, Alvarez D, San Jose E, et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med. 1998;158:2017–21.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-Gu, Daegu, 700-842, Republic of Korea

    J. Lee, S. Y. Lee, S. S. Yoo, S. Y. Lee, S. I. Cha, J. Y. Park & C. H. Kim

  2. Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea

    J. K. Lim

Authors
  1. J. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Y. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. K. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. S. Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Y. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. I. Cha
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Y. Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. H. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. H. Kim.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J., Lee, S.Y., Lim, J.K. et al. Radiologic and laboratory differences in patients with tuberculous and parapneumonic pleural effusions showing non-lymphocytic predominance and high adenosine deaminase levels. Infection 43, 65–71 (2015). https://doi.org/10.1007/s15010-014-0697-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-014-0697-y

Keywords

Search

Navigation