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• W2007472074 abstract "We have read with great interest the article by Relkin et al (Chest 1994; 105:1338–41), which appeared in Chest in May 1994, about the characteristics of pleural tuberculosis in patients infected by HIV. In this report the authors found that patients with pleural tuberculosis and HIV infection, had compared with a group of HIV-negative patients, significantly fewer positive tuberculin skin tests, more acid-fast bacteria identifiable in pleural tissue, higher proportion of positive Mycobacterium tuberculosis (MT) cultures of sputum and pleural biopsy (PB), and similar pleural biopsy histologic conditions. It has been suggested that delayed hypersensitivity plays a major role in the pathogenesis of tuberculous pleural effusion,1Light RW Pleural diseases. 2nd. Lea & Febiger, Philadelphia1990: 151-161Google Scholar and T-lymphocytes play a central role in cell-mediated defences against MT.2Jones BE Young SMM Antoniskis D et al.Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection.Am Rev Respir Dis. 1993; 148: 1292-1297Crossref PubMed Scopus (491) Google Scholar Because HIV infection results in specific depletion of CD4 cells, we might therefore expect to find more acid-fast bacteria identifiable in pleural tissue, sputum, and pleural fluid (PF), and fewer granulomas on PB specimens. To evaluate this hypothesis, we retrospectively studied all cases with a definitive diagnosis of pleural tuberculosis from 1986 through December 1991 at our hospital. Inclusion criteria in the study were (1) positive culture of PF, PB specimen(s), or both for MT, (2) presence of granuloma on PB with PF, PB, and negative sputum cultures for fungi, parasite, and atypical mycobacteria and with a clear clinical response to antituberculous treatment, and (3) positive sputum culture for MT associated with exudative pleural effusion, if all other causes of effusion have been ruled out. One hundred and three patients with a definite diagnosis of pleural tuberculosis were finally included. Ten subjects (10%), eight men and two women whose mean age was 29 years (SD=7) were infected with HIV. The remaining 93 patients (90%), 60 men and 33 women whose mean age was 28 years (SD=15) had no HIV infection. We found that the HIV-positive group had significantly higher rate of positive sputum cultures for MT (4/10 [40%] against 10/78 [13%] in noninfected patients, p<0.05), and fewer positive tuberculin skin tests (2/10 [20%], against 57/88 [65 %] in HIV-negative patients, p<0.05). In our series, granuloma on pleural biopsies, however, were present in only 4 of 9 (44%) patients infected with HIV, against 72 (84%) in the HIV-negative group, p<0.05, and there were significantly more positive cultures of pleural fluid for MT, 4 of 9 patients (44%) in the HIV-positive group, against 13 (15%) of patients without HIV infection, p<0.05. We conclude that in our study, patients infected with HIV show a lower rate of granulomas on pleural biopsy, however, we agree with Relkin et al that pleural tuberculosis in HIV-positive patients presented itself more often as a manifestation of a greater burden of microorganisms and impaired host response. Nevertheless, as with any retrospective investigation, the results of these studies must be interpreted with caution, and further research is needed to determine the pathophysiologic mechanisms of pleural tuberculosis in patients with HIV infection." @default.
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• W2007472074 date "1995-06-01" @default.
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• W2007472074 title "Pleural Tuberculosis in HIV-Infected Patients" @default.
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• W2007472074 doi "https://doi.org/10.1378/chest.107.6.1775-b" @default.
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