Journal of Clinical Immunology

, Volume 22, Issue 6, pp 345–352

Cytokine Polarization in Miliary and Pleural Tuberculosis


  • Surendra K. Sharma
    • Department of Medicine, All
  • Dipender K. Mitra
    • Department of Transplant Immunology and Immunogenetics, All
  • Arumugam Balamurugan
    • Department of Transplant Immunology and Immunogenetics, All
  • Ravindra M. Pandey
    • Department of Biostatistics, All
  • Narinder K. Mehra
    • Department of Transplant Immunology and Immunogenetics, All

DOI: 10.1023/A:1020604331886

Cite this article as:
Sharma, S.K., Mitra, D.K., Balamurugan, A. et al. J Clin Immunol (2002) 22: 345. doi:10.1023/A:1020604331886


Cytokines were measured in patients with pleural effusion and miliary tuberculosis (TB). Patients with pleural effusion had significantly higher interferon-gamma (IFN-γ) 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-γ levels in the peripheral blood as compared to their bronchoalveolar lavage fluid. Moreover, the median IFN-γ : 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-γ, 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.

Tuberculosispleural effusionmiliary tuberculosiscytokines
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© Plenum Publishing Corporation 2002