Exudative pleural effusion: effectiveness of pleural fluid analysis and pleural biopsy

The study compared pleural fluid analysis and pleural biopsy in the diagnosis of 100 patients with exudative pleural effusion [PE] in Babol, Islamic Republic of Iran. Tuberculous pleurisy and malignant pleural effusion were confirmed by the identification of acid-fast bacilli from body fluids or tumour cells from tissue specimens. Malignant diseases and tuberculosis were the causes of exudative PE in 43% and 33% of patients respectively. The diagnostic sensitivity of pleural biopsy in patients with tuberculous PE and malignant PE was 70% and 54%, and the diagnostic sensitivity of pleural fluid analysis was 33% and 70% respectively. Combined pleural biopsy and pleural fluid analysis were positive in 97% of tuberculous PE cases and 91% of malignant PE

Pulmonary tuberculosis with normal chest radiography in a region with a high incidence of tuberculosis

To describe the early symptoms of pulmonary tuberculosis [TB] when the chest radiograph [CXR] is normal. Seventy patients with culture-positive pulmonary TB and a normal CXR were identified from reviewing 377 patients with smear or culture-positive pulmonary TB in Babol-Iran from 1994-2000. Patients with abnormal CXR at the time of diagnosis were excluded from analysis. Sixty-eight of the seventy patients [98%] were symptomatic at the time of diagnosis, with cough sputum [97%] being reported most commonly. Two patients were identified because of contact tracing from cases of infections pulmonary TB, while the other 68 patients were identified by investigation of symptoms. Sixty-eight patients [97%] had cough for more than one month, sputum in 63[90%], fever for more than one week in 18 patients [25%], haemoptysis in 28 patients [40%], weight loss in 21 patients [30%], Hoarseness in 1 patient [1/4%], Dyspnea in 5 patients [7%]. The sputum smear of five patients [7%] were positive. None of them had underlying disease. Fifty-six patients [80%] had positive mantoux skin-test. The incidence of culture positive pulmonary TB with a normal chest radiograph was less than one percent from 1988 to 1989 and steadily increased to 10 percent from 1996 to 1997. culture-positive pulmonary TB with a normal CXR is not uncommon, and the incidence of this presentation is increasing. Patients with this presentation of TB are typically symptomatic and /or are detected by contact tracing of infectious cases of pulmonary TB. The results suggest that patients presenting with a cough for more than one month, with a fever for more than one week, or with documented weight loss after known exposure to known cases of TB should have their sputum submitted for mycobacterium tuberculosis culture despite a normal CXR

Poncet's disease: a report of four cases and review of the literature

Four cases of polyarthritis concomitant with active tuberculosis are reported. In three patients pulmonary tuberculosis was confirmed by identification of Mycobacterium tuberculosis in the sputum and bronchoalveolar lavage specimens, and in another one tuberculous lymphadenitis was confirmed by excisional biopsy. In all patients arthritis resolved by tuberculosis treatment and did not recur during a follow up period of 18 months to 12 years. The findings of the presented cases are compatible with Poncet's disease [tuberculous reactive arthritis]