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PubMed2026

Exploratory proteomic and metabolomic profiling of pleural effusions identifies histone H4 and alanine as promising complementary markers for pleural tuberculosis.

The diagnosis of pleural tuberculosis (Pl-TB) remains challenging. Histopathological analysis and pathogen detection in pleural biopsies are informative but limited. We investigated differentially expressed proteins and metabolites in pleural effusions from patients with Pl-TB, malignancies, and other pathologies. A proteomic analysis of pooled pleural effusions identified 45 proteins exclusively detected or upregulated in Pl-TB samples, many linked to infectious processes. Conversely, 18 proteins were uniquely found or upregulated in malignant pleural effusions, mainly associated with detoxification and hemostasis. To validate these findings, we employed targeted proteomics in individual samples. Eight proteins were validated: S100-A9, histone H4, insulin-like growth factor-binding protein 2, fibrinogen beta chain, ficolin-3, immunoglobulin heavy constant alpha 1, sulfhydryl oxidase 1, and histidine-rich glycoprotein. Additionally, NMR-based metabolomics identified 13 metabolites with differential abundance between Pl-TB and non-TB samples. Notably, N-acetyl-glycoprotein and the branched-chain amino acids, alanine and lysine differed between groups. Proteomic and metabolomic analyses revealed distinct molecular profiles between Pl-TB and non-TB patients, despite intra-group variability. To address this, we applied classification models. Histone H4 and alanine consistently emerged as discriminative features. Overall, this study provides novel insights into the molecular landscape of Pl-TB. The combined quantification of proteins and metabolites may improve differential diagnosis, although should be further validated in larger, independent cohorts before clinical application.

Humans↗
PubMed1975

Pleural effusion associated with aortitis syndrome.

A patient with aortitis syndrome had a pleural effusion which subsided but reappeared with an exacerbation of aortitis symptoms while under antituberculosis treatment. The character of the fluid was that of an exudate, and the glucose concentration was normal. Clinical and laboratory features of the case suggest that the effusion was part of the aortitis syndrome per se.

Adult↗
PubMed2026

Differentiating tuberculous pleurisy from pulmonary tuberculosis using mNGS: a multicenter cohort analysis.

BACKGROUND: Tuberculous pleurisy (TBP), a major extrapulmonary form of tuberculosis, is characterized by a paucibacillary state that makes diagnosis challenging. Metagenomic next-generation sequencing (mNGS) has emerged as a promising approach for MTB detection; however, its discriminatory value between TBP and pulmonary tuberculosis (PTB) among mNGS-confirmed cases, and its integration with clinical features for differential diagnosis, remain insufficiently defined. METHODS: This multicenter retrospective cohort included hospitalized patients with MTB-positive mNGS results from January 2020 to January 2025. As only mNGS-positive cases were included, overall mNGS diagnostic sensitivity cannot be estimated. Twelve TBP patients were matched 1:2 with twenty-four PTB patients by age and sex; patients with immunosuppressive conditions were excluded prior to matching. Clinical, laboratory, mNGS, and conventional TB test data were collected. Logistic regression and ROC analyses were performed. RESULTS: Conventional tests showed limited sensitivity in TBP despite universal mNGS positivity. MTB read counts were similar between groups (median 1976.5 vs. 990.0, P = 0.920). Pleural-derived specimens predominated in TBP (41.7% vs. 4.2%, P = 0.007). CRP demonstrated the highest individual discriminatory value (AUC = 0.658, P = 0.131), though no single predictor reached significance. A combined model (cough, fever, CRP, WBC) showed modest non-significant improvement (AUC = 0.722, overall P = 0.359; sensitivity 66.7%, specificity 83.3%). Given EPV ≈ 3, all findings are exploratory only. No significant prognostic predictors were identified in TBP; a non-significant trend toward lower lymphocyte counts was observed in patients with unfavorable outcomes (0.60 vs. 1.10 ×109/L, P = 0.115). CONCLUSIONS: Among mNGS-confirmed cases, MTB read counts were comparable between TBP and PTB. No single parameter reliably distinguished the two; a combined clinical model showed modest improvement but requires prospective validation in larger cohorts. Integrating mNGS with systematic clinical evaluation remains essential for accurate TB diagnosis.

Humans↗
PubMed1975

Tuberculosis in Tanzania: a national sampling survey of drug resistance and other factors.

This survey was conducted in 1969/70 in a random sample of 15 of the 61 administrative districts in Tanzania. It included clinics with a long established tuberculosis service (A group), those with a tuberculons service of recent inception (B group) and those with no specialised tuberculosis service (C group), and 3 additional centres of special interest. The aim was to obtain, for tuberculous patients newly registered for treatment during a specified 6-month period, information on: a) the proportions of patients with pulmonary and/or extra-pulmonary tuberculosis; b) the history of previous chemotherapy with antituberculosis drugs: c) the prevalence of bacteriologically-positive pulmonary tuberculosis; d) the prevalence of initial and acquired resistance to the standard antituberculosis drugs; e) the radiographic extent and type of disease and of cavitation. Of 1884 patients in the random sample, 87.4 per cent had pulmonary tuberculosis only, 2.5 per cent had pulmonary and extra-pulmonary tuberculosis and 10.1 per cent had extra-pulmonary tuberculosis only. Although there were differences in the proportions with extra-pulmonary disease in individual districts in each group there were no important differences in the average levels for the A, B and C groups. Of 256 extra-pulmonary tuberculous lesions in 237 patients, 58 per cent were lymph node, 26 per cent bone and joint and 12 per cent pleural, pericardial or peritoneal. Of 1694 patients with pulmonary tuberculosis with or without extra-pulmonary tuberculosis, 96.3 per cent gave no history of previous chemotherapy and 3.6 per cent a definite history. A sputum specimen from each of 1338 patients with pulmonary tuberculosis was examined by direct smear; 675 (50 per cent) were positive as were 694 (55 per cent) of 1257 cultures. For the patients with no history of previous chemotherapy the positivity rates were 59 per cent on smear and 66 per cent on culture for the A group, 53 per cent and 57 per cent for the B group and 35 per cent and 38 per cent for the C group. Of 636 patients with no history of previous chemotherapy and sensitivity test results, 9 per cent had a strain resistant to isoniazid and/or streptomycin. The total prevalence of resistance to isoniazid was 6 per cent and to streptomycin 4 per cent. Of 1278 patients aged 5 or more with a postero-anterior chest radiography available and a diagnosis of intra-thoracic tuberculosis in Tanzania, 86 per cent were reported at an independent assessment in London as having a lung lesion. Among the 1171 patients of all ages reported as having a lung lesion, gross extensive or moderate disease was present in 73 per cent of the radiographs and cavitation in 66 per cent. The type of radiographic disease was assessed as acute in 36 per cent, mixed-acute in 40 per cent, mixed in 19 per cent and chronic in 5 per cent. There was no evidence of associations between drug resistance and the extent or type of disease of presence of cavitation...

Adolescent↗
PubMed1979

Diagnostic significance of pH, lactic acid dehydrogenase, lactate and glucose in pleural fluid.

The pH, lactic acid dehydrogenase, lactate and glucose of pleural fluid simultaneous with serum lactic acid dehydrogenase, blood lactate and glucose were determined in 105 pediatric patients. The patients were classified into groups according to the diagnosis. The pleural fluid of empyema cases was found to have the lowest pH with a mean value of 6.83 (p less than 0.0075). The malignant pleural fluid has a relatively low pH with a mean value of 7.32. The lactic acid dehydrogenase in pleural fluid of empyema cases has the highest mean of 1,470.68 (p less than 0.05). The lactic acid dehydrogenase was found increased in malignancy, tuberculosis and parapneumonic effusion cases. Lactate level was found extremely high in empyema cases with a mean value of 13.68. It was also found extremely high in malignancy, tuberculosis and parapneumonic effusion cases. The glucose level was markedly decreased in empyema cases. There exists correlation of pleural fluid lactate to pH, lactic acid dehydrogenase and glucose, as well as that of pH to lactic acid dehydrogenase.

Child↗