Comparative characteristics of tuberculous pleurisy depending on HIV status

Goal of the study: to study specific manifestations of tuberculous pleurisy in HIV patients, to evaluate the efficiency of video-assisted thoracoscopy when diagnosing tuberculous pleurisy in case of different HIV status of the patients.

Materials and methods: 241 tuberculous pleurisy patients were examined. 88 – HIV positive (group 1), 153 – HIV negative (group 2). Average CD4 count in group 1 made 189 cells/mcl. The following parameters were compared in those groups: clinical and X-ray manifestations, microbiological, cytologic and biochemical rates in blood and effluent. 77 patients with isolated pleurisy (of them 33 HIV positive) had video-assisted thoracoscopy with biopsy for diagnostic purposes. The data of histological examination of pleura, obtained through video-assisted thoracoscopy and autopsy have been presented.

Results: tuberculous pleurisy with concurrent HIV infection is characterized by frequent occurrence of hemorrhagic effusion, scarce cellular sediment of effluent, expressed reduction of glucose level and increase of thymol test rates in effluent. Regardless of HIV status the frequency of tuberculous mycobacteria detection through microscopy and culture is low and does not exceed 10%. Histological testing of specimens obtained through video-assisted thoracoscopy allowed proving tuberculosis in all patients thus differentiating tuberculous changes from metastases. Thus video-assisted thoracoscopy can be recommended for diagnostics of difficult cases of tuberculous pleurisy regardless of HIV status.

From morphological point of view tuberculous pleurisy was characterized by specific granulomas which were presented by lymphoid and epithelioid cells with Pirogov-Langhans cells with minor caseous necrosis in the center (9.1%) or its complete absence (90.9%). 

1. Аntipov А.G., Аralova I.S., Matrosov M.V., Bormotov B.А., Lovacheva O.V. Comparative analysis of bronchial tuberculosis depending HIV status of the patients. Tub., 2014, no. 9, pp. 8-9. (In Russ.)

2. Gubler E.V. Vychislitelnye metody analiza i raspoznaniye patologiacheskikh protsessov. [Analysis computational methods and identification of pathological process]. Leningrad, Meditsina Publ., 1978, 293 p.

3. Kolomiets V.M., Guseva V.А., Rubleva N.V. et al. Specific clinical course and treatment of HIV-associated tuberculosis. Chelovek i Ego Zdorovye, 2012, no. 1, pp. 142-147. (In Russ.)

4. Lyakh Yu.Е. et al. Osnovy kompyuternoy biostatistiki. Аnaliz informatsii v biologii, meditsine i farmatsii statisticheskim paketom MedStat. [Basics of computer biostatistics. Data analysis in biology, medicine and pharmacy by MedStat software]. Donetsk, Papakitsa E.K., 2006, 214 p.

5. Rakhmanova А.G., Yakovlev А.А., Komarova D.V. et al. Characteristics of lethal outcomes due to tuberculosis in HIV patients. VICH-Infektsiya i Immunosuprssiya, 2012, vol. 4, no. 2, pp. 120-123. (In Russ.)

6. Suslov E.S. Efficiency of pathomorphological diagnostics of tuberculosis. Ukr. Pulmonolog. Journal, 2007, no. 3, pp. 53-55.

7. Costantini A. et al. Abnormalities of erythropoiesis during HIV-1 disease: a longitudinal analysis. J.Acquir.Immune Defic. Syndr., 2009, vol. 52, no. 1, pp. 70-74.

8. Daljit Singh MD еt al. Clinical and radiological finding of tuberculosis inpatient with TB/HIV coinfection. Chest, 2010, vol. 11, pp. 138-518.

9. Denis Jones еt al. Mesothelial Cells in  Tuberculous Pleural Effusions of HIV-Infected Patients. http://chestjournal.chestpubs.org/content/117/1/289.full-target-1. Chest, 2000, vol. 117, no. 1, pp. 289-291.

10. Forssbohm M. еt al. Demographic characteristics of patients with extrapulmonary tuberculosis in Germany. Eur. Respir. J., 2008, vol. 31, pp. 99-105.

11. Frye M.D., Tuberculous pleural effusions in  HIV-infected patients [Internet resource]. http://www.uptodate.com/patients// content/topic.do?topicKey=~qOHCbFAh58gA6O#H2. 2012,

12. Getachew A., Kibrebeal M., Guta Z. Pleural tuberculosis in patients infected with HIV in Addis Ababa xt. Int. Conf AIDS, 1996, vol. 11, pp. 117.

13. Light R., Richard W. Update on tuberculous pleural effusion. Respirology, 2010, no. 15, pp. 451-458.

14. Mostert C., Pannell N. The pleural effusion in HIV – an approach to diagnosis. SA FamPract., 2009, vol. 51, no. 4, pp. 280-282.