Cytological Study of Effusions.

Background: Effusion fluid analysis plays an important role in clinical medicine. Clinicians rely on the reports of effusion fluids and use them as complement to their clinical assessment for the diagnosis and management. Aim: To study the incidence of neoplastic and non neoplastic effusions. Objectives: i) To study the gross and microscopic features of effusions; ii) To study the pattern of effusions in various neoplastic and non neoplastic conditions. Material and Method: 550 specimens of pleural, peritoneal and pericardial fluid were studied. Fluid samples were centrifuged for five minutes at 2000 rpm and smears prepared from deposit were stained by Haematoxylin and Eosin (H and E), Giemsa and Papanicolaou stains (Pap). Result: Out of 550, 315 were pleural effusions, 234 peritoneal and one was pericardial. Out of total 315 cases of pleural effusions, 297 were non neoplastic and 18 were neoplastic effusion. Out of total 234 peritoneal effusions 214 were non neoplastic and 20 neoplatic. Commonest malignancy in pleural and peritoneal fluid was adenocarcinoma. Conclusion: Pleural effusion was the commonest fluid in this study. Exudates were predominant in pleural effusion and transudates were predominant in peritoneal effusion. Common causes of exudates in pleural effusion were tuberculosis (TB), pneumonia and malignancy. Common causes of transudates in peritoneal effusion were liver cirrhosis and congestive cardiac failure (CCF). Adenocarcinoma was the commonest malignancy in both pleural and peritoneal effusion (30 cases).

Diagnostic potential of 16 kDa (HspX, α-crystalline) antigen for serodiagnosis of tuberculosis.

Background & objectives: Tuberculosis (TB) is a public health problem worldwide. Rapid and accurate diagnosis of tuberculosis is crucial to facilitate early treatment of infectious cases and to reduce its spread. The present study was aimed to evaluation of 16 kDa antigen as a serodiagnostic tool in pulmonary and extra-pulmonary tuberculosis patients in an effort to improve diagnostic algorithm for tuberculosis. Methods: In this study, 200 serum samples were collected from smear positive and culture confirmed pulmonary tuberculosis patients, 30 tubercular pleural effusions and 21 tubercular meningitis (TBM) patients. Serum samples from 36 healthy, age matched controls (hospital staff), along with 60 patients with non-tubercular respiratory diseases were also collected and evaluated. Humoral response (both IgG and IgA) was looked for 16 kDa antigen using indirect ELISA. Results: Sensitivity of detection in various categories of pulmonary TB patients ranged between 73.8 and 81.2 per cent. While in the extra-pulmonary TB samples the sensitivity was 42.8 per cent (TBM) and 63.3 per cent (tubercular pleural effusion). The test specificity in both the groups was high (94.7%). All of the non-disease controls were negative. Among non-tubercular disease controls, five patients gave a positive humoral response against 16 kDa. Interpretation & conclusions: Serodiagnostic tests for TB have always had drawbacks of suboptimal sensitivity and specificity. The antigen used in this study gave encouraging results in pulmonary TB only, while in extra-pulmonary TB (tubercular meningitis and tubercular pleural effusion), this has shown a limited role in terms of sensitivity. Further work is required to validate its role in serodiagnosis of TB especially extra-pulmonary TB.

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

Brucella pleuritis in a 12-year old child; a case report

Brucellosis is a zoonotic disease involving several organs. Pulmonary involvement especially pleuritis is extremely rare. We report a 12-year old boy presented with a 3-week history of fever, chills, and profuse sweating, especially at night. He complained of fatigue, lack of appetite, weight loss, exertional dyspnea, nonproductive cough and mild pleuretic chest pain. Diagnosis of brucella pleuritis was verified by positive blood and pleural fluid culture and serology. Having completed a combined therapy [doxycycline/rifarnpin] for 3 months, no relapse occurred. Almost all radiological findings disappeared at the end of the therapy. Pulmonary involvement is a rare manifestation of brucellosis, however, it responds well to a combination therapy of rifampin and doxycycline

Telomerase hert catalytic subunit expression in pleural effusions and sputum in lung malignancies

The aim of the present study was to investigate the diagnostic efficacy of telomerase enzyme activity for discrimination of malignant and non malignant pleural effusion and to compare the results with those of cytological examination. Pleural effusions were collected from 40 patients. 31 of them had malignancy, either primary or secondary, confirmed by histopatholological examination and the other 9 patients had non-malignant pleural effusion. Of 31 patients with malignant pleural effusion 10 sputum samples were collected to be subjected to telomerase activity, as a probable early diagnostic marker of lung cancer. 9 sputum samples were collected from control patients. Telomerase activity was determined with telomerase catalytic subunit hTERT-mRNA Gene expression assay using [QRT multiplex real-time PCR]. Telomerase activity was detected in 27/31 [87.1%] and in 2/9 [22.2%] samples from the malignant and non malignant pleural effusion groups, respectively. The X +/- SD of hTERT were significantly different between the malignant and non malignant effusion groups. In sputum samples, telomerase activity was detected in 8/10 [80%] of malignant samples. The X +/- SD of sputum hTERT were also significantly different between the malignant and non malignant groups. The sensitivity and specificity of pleural cytology were 67.8% and 100%, while, the sensitivity and specificity of telomerase activity were [87.1%] and [78%] respectively. Generally, the diagnostic values of cytology were lower than those of hTERT in pleural effusion. However, the sensitivity and specificity rates of pleural cytological examination when combined with telomerase activity were [90.3%] and [100%]. Also, the sensitivity and specificity of sputum cytological examination when combined with telomerase activity were [80%] and [100%], while the sensitivity and specificity of sputum cytology alone were 70% and 100% and those of telomerase activity alone in sputum were [80%] and [78%]. It could be concluded that telomerase activity is a highly sensitive diagnostic biomarker for malignancy and may be used as an adjunct to cytological findings in determining pleural effusion and lung malignancies

Spontaneous bacterial empyema in cirrhotic patients: complements 3 and 4, opsonic power and C-reactive protein as pathogenic mechanisms and diagnostic tools

Hepatic hydrothorax occurs in approximately 5-12% of patients with cirrhosis and portal hypertension and may be complicated by spontaneous bacterial empyema [SBE]. Pathogenic mechanisms of SBE still need to be investigated. The present work assesses the role of complement components [C3, C4], opsonizing power and C-reactive protein in the pathogenesis of SBE in cirrhotic patients. Twenty five cirrhotic patients with hepatic hydrothorax were randomly selected and 10 patients with hydrothorax secondary to heart failure were included as controls in the study. Pleural fluid [PF] and serum samples were analyzed for: total protein [TP], albumin, lactic dehydrogenase [LDH], glucose, polymorph nuclear leukocytic count [PMNL], complement components [C3, C4], opsonic activity [on the basis of log-kill] and high sensitive C-reactive protein [CRP]. SBE was diagnosed when pleural fluid PMNL was > 250 cells/mm[3] with a positive culture or >500 cells/ mm[3] with a negative culture after exclusion of pulmonary infections. Thirteen patients [52%] [Group I] were diagnosed as SBE and 12 patients [48%] had no SBE [Group II]. There was no significant difference between patients and controls [GIII] as regards age, gender, serum proteins, serum C3, serum WBC and effusion CRP. Levels of serum albumin, total pleural effusion proteins, PT% and opsonic activity of groups I and II were significantly lower than in GIII with no significant difference between groups I and II. Levels of serum bilirubin and C4 of groups I and II were significantly higher than group III with no significant difference between groups I and II. Level of pleural effusion C3 in group I was significantly lower than in groups II and III and level of C3 in group II was significantly lower than in group III. Level of pleural effusion C4 in group I was significantly lower than group III, but there was no significant difference between groups I and II. In hepatic patients, 7 patients [28%] belonged to Child's class B and 18 [72%] to class C. Spontaneous bacterial empyema was detected in 56% of hepatic patients with Child's class C and in 43% of Child's class B. There was no significant difference between hepatic patients with and without SBE with regard to Child-Pugh's score. In patients with SBE, levels of C3 and C4 were significantly less in pleural fluid than in serum but there was no significant difference with regard to opsonic activity. Local complement defects [especially C3] and opsonic activity in cirrhotic patients predispose to SBE. Serum CRP increases, but effusion CRP level should be reassessed as a cheap diagnostic tool