Pleuropulmonary Tuberculosis Following Chemotherapy for Lung Cancer at a Tertiary Care Center in India (original) (raw)
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BMJ case reports, 2013
Malignancy per se and cytotoxic chemotherapy given for its treatment both are recognised risk factors for the development of tuberculosis (TB). However, individual case descriptions of pleural tuberculosis (TB-PE) following chemotherapy for lung cancer (LC) have not been published previously. We herein report the first two cases of histopathologically proven TB-PE following LC chemotherapy. The first patient was a 38-year-old man with stage IV non-small cell LC (adenocarcinoma) who developed TB-PE following four cycles of chemotherapy (pemetrexed-cisplatin). The second patient was a 49-year-old man with extensive disease small cell LC who developed TB-PE after six cycles of chemotherapy (irinotecan-cisplatin). In both patients, diagnosis of TB-PE was established by demonstration of granulomatous inflammation, caseous necrosis and positive stain for acid-fast bacilli in pleural biopsy specimens. Both cases responded to standard four-drug antitubercular therapy. These cases highlight ...
Lung Cancer, 2001
The study was performed to explore the frequency of infections present at death and infection as the main cause of death (fatal infection -FI) in 845 consecutive patients (pts) treated for small cell lung cancer (SCLC) at the Institute of Tuberculosis and Chest Diseases in Warsaw, in the period 1980-1994. Diagnosis of infection was based on clinical signs and symptoms, the presence of new lesions on the chest X-ray, microbiological tests and/or autopsy examination. All cases of fungal infection, Pneumocystis carinii pneumonia (PCP) and tuberculosis were proved by autopsy and microscopic examination (including special staining). FI was diagnosed if no progression of cancer was noted and no other complications occurred. Infection was present at the time of death in 116 patients (13.7%) and FI was the cause of death in 39 of them (4.6%). Nine patients died from fungal infection, eight from bacterial infection, seven from PCP and two from tuberculosis. In 13 cases the aetiology of infection found at autopsy was not determined. All FI patients received chemotherapy and corticosteroids, 16 of them also had radiotherapy on the tumour and mediastinum. Thirty-two out of 35 patients had leucopenia. The risk of death from infection was greater in patients above 60 years of age. Patients in bad performance status died of infection significantly earlier than others (PB0.05). : S 0 1 6 9 -5 0 0 2 ( 0 0 ) 0 0 1 8 5 -9 P. Remiszewski et al.
AN ASSESSMENT OF PLEUROPULMONARY POST-TUBERCULOSIS PATIENTS IN A TEACHING HOSPITAL IN EAST INDIA
Asian Journal of Pharmaceutical and Clinical Research, 2022
Objectives: Quality of life of a patient may be impaired seriously in the aftermath of pleuropulmonary tuberculosis (TB) even after being cured or taking adequate treatment. Proper evaluation of post-TB sequelae is of extreme clinical importance. The study objective was to assess demographic, clinical, radiological, and spirometric pattern of pleuropulmonary post-TB patients in a teaching hospital. Methods: An observational cross-sectional study was carried out in a teaching hospital in India over a period of 14 months. A total of 300 patients of more than 12 years of age from both genders were included in the study. Detailed history, clinical, radiological, microbiological, and spirometric evaluation were being carried out. Results: It was a male predominant study with male: female ratio of 2.29:1 and mean age of patient was 52.97 ± 0.51 (mean±standard error of mean) years. History of pleural and pulmonary TB was present in 11% and 89% of cases, respectively. Cough was present in all patients. Shortness of breath (86.33%) and hemoptysis (58.33%) were among other common presenting symptoms. In majority of cases, pulmonary involvement was unilateral (57%). Pleural fibrosis/thickening was seen in 11% of cases, lung parenchymal fibrosis 38.67%, bronchiectasis in 12.67%, and aspergilloma found in 7% of cases. Bacteriological positivity was detected in 14.33% of cases. Spirometric evaluation revealed restrictive pattern (50.20%) in most of the cases followed by obstructive pattern in 38.13% of cases. Conclusion: Respiratory symptoms, radiological, and spirometric abnormalities can present among pleuropulmonary post-TB patients as a sequelae. It may be considered as an important cause of chronic lung disease, particularly in high TB burden countries.
The Study of Mycobacterium tuberculosis in Iranian Patients With Lung Cancer
Jundishapur Journal of Microbiology, 2013
Background: Mycobacterium tuberculosis has the ability to invade type II alveolar epithelial cells. As a result, the associations between invasion of alveolar epithelial cells and pathogenesis of lung infection seem strong. Objectives: The current study aimed to evaluate the presence of M. tuberculosis in patients with lung cancer. Patients and Methods: This cross-sectional study was performed on samples collected from 380 patients with lung cancer who referred to two state-run hospitals in Mashhad, Iran. Microscopic and cultural methods were utilized to assess the presence of M. tuberculosis in the patients` specimens. Results: The subjects included 252 (66.3%) males and 128 (33.7%) females. Based on cultural and microscopic methods, M. tuberculosis infection was observed in twenty six (6.8%) of cases. Conclusions: Results of the current study showed the high prevalence of M. tuberculosis among the patients with lung cancer; therefore, it seems that continuous surveillance is essential to monitor the M. tuberculosis in the patients with lung cancer.
Pleural Tuberculosis and its Treatment Outcomes
Tropical Journal of Pharmaceutical Research, 2013
Purpose: To evaluate the incidence, treatment and clinical outcomes of tuberculosis pleuritis at a hospital in the state of Penang, Malaysia. Methods: A retrospective study was conducted in Hospital of Penang, Malaysia. Patient records were reviewed retrospectively to identify patients with confirmed diagnosis of tuberculous pleuritis from January 2006 to December 2008. Chest x-ray (CXR) and pleural biopsy were carried out on all patients. Directly observed therapy (DOT) was given to all patients. Data were analyzed using SPSS version 16. Results: Of 1548 tuberculosis cases, 80 (5.2 %) patients had tuberculous pleuritis. The mean age of the patients was 35.4 ± 12.87 years, with a male to female ratio of 3.4:1. Ethnically, a plurality (n = 30, 37.7 %) of cases among tuberculosis pleuritis patients were Chinese, followed by Malay (31.2 %). Out of the 80 patients with tuberculous pleuritis, 10 (12.5 %) also had diabetes mellitus, and 8 (10.0 %) HIV/AIDS. Fever, cough, chest pain and shortness of breathing were the most frequently reported symptoms. Treatment success rate was 1.558 times higher among TB group than pleuritis TB group (Odds ratio, 95 % CI, p = 0.025). Conclusion: The incidence of TB pleuritis was gender-and race-related, with DM and HIV the most commonly reported risk factors. Treatment success rate was higher among pulmonary TB group than in those with TB pleuritis (extra pulmonary TB).
Diagnostic and Treatment Dilemma of Dual Pathology of Lung Cancer and Disseminated Tuberculosis
Journal of Clinical Oncology, 2014
An 80-year-old male smoker was referred to us with a 1.5month history of chest pain and breathlessness, with diagnosis of right-sided pleural effusion and left lower lobe mass. He had an Eastern Cooperative Oncology Group performance status of 2. On examination, he had right supraclavicular lymphadenopathy and decreased breath sounds on the right side of chest. Fine needle aspiration cytology (FNAC) of the lung lesion was consistent with adenocarcinoma, and FNAC from the supraclavicular lymph node revealed necrotizing granulomatous lymphadenitis suggestive of tuberculosis (TB). Acid-fast bacillus (AFB) culture or DNA tests were not attempted on the FNAC specimen; however, AFB stain was done which was negative. Pleural fluid analysis revealed strawcolored fluid with glucose of 106 mg/dL, protein 5.4g/dL, LDH 279
Clinical spectrum of pulmonary and pleural tuberculosis: a report of 5,480 cases
European Respiratory Journal, 1996
The aim of the present study was to investigate the epidemiological, clinical, laboratory and radiological features of patients with active pulmonary tuberculosis (TB) (with or without pleural involvement) or with pleural TB (in the absence of radiological parenchymal disease). A systematic predetermined form, including 60 items regarding the above-mentioned features, was completed for 5,480 patients. Sputum smear and culture data, radiological findings, and additional extrapulmonary involvement were evaluated in the patients with pulmonary TB (n=5,094). Epidemiological features, and other clinical and laboratory characteristics were investigated in all patients (n=5,480). TB was more common among persons aged 20-39 yrs, males, and those living in large urban centres in our region. There were 4,268 newly detected patients (78%), and 1,212 active ex-patients (22%) who had history of previous antituberculosis treatment. Additional extrapulmonary involvement was found in 455 patients (9%). Sputum samples were smear-positive in 3,916 (79%), and culture-positive in 3,748 cases (76%). Most common radiological patterns were parenchymal infiltrate in 5,017 (99%), and cavitation in 3,363 (66%). Unusual radiological patterns were also noted, i.e. lower lung field TB (LLFTB) in 317 cases (6.2%), pneumothorax in 78 cases (1.5%), and miliary pattern in 66 cases (1.3%). In conclusion, because of the more frequent occurrence in the younger age group, it is considered that the prevalence of disease is still high and that the transmission of tubercle bacilli is not decreasing in our region. The highest risk group consisted of male subjects and those living in urban centres. The high percentage of active ex-patients suggests that new control programmes for tuberculosis are required in Turkey.
Invited Review Series: Tuberculosis
2010
The possibility of tuberculous pleuritis should be considered in every patient with an undiagnosed pleural effusion, for if this diagnosis is not made the patient will recover only to have a high likelihood of subsequently developing pulmonary or extrapulmonary tuberculosis Between 3% and 25% of patients with tuberculosis will have tuberculous pleuritis. The incidence of pleural tuberculosis is higher in patients who are HIV positive. Tuberculous pleuritis usually presents as an acute illness with fever, cough and pleuritic chest pain. The pleural fluid is an exudate that usually has predominantly lymphocytes. Pleural fluid cultures are positive for Mycobacterium tuberculosis in less than 40% and smears are virtually always negative. The easiest way to establish the diagnosis of tuberculous pleuritis in a patient with a lymphocytic pleural effusion is to generally demonstrate a pleural fluid adenosine deaminase level above 40 U/L. Lymphocytic exudates not due to tuberculosis almost always have adenosine deaminase levels below 40 U/L. Elevated pleural fluid levels of g-interferon also are virtually diagnostic of tuberculous pleuritis in patients with lymphocytic exudates. In questionable cases the diagnosis can be established by demonstrating granulomas or organisms on tissue specimens obtained via needle biopsy of the pleura or thoracoscopy. The chemotherapy for tuberculous pleuritis is the same as that for pulmonary tuberculosis.
Is tuberculosis a challenge for the management of lung cancer?
Eurasian Journal of Pulmonology, 2016
Objective: The coincidence of tuberculosis (TB) and lung cancer (LC) at the initial diagnosis or the development of TB during the course of LC is a challenge in the management of both diseases. Herein we reviewed 10 LC patients who coincidentally had TB and evaluated the challenges in the management of both diseases. Methods: The files of patients were retrieved from an archive, and available study forms were completed. Results: The study included 10 LC and TB patients during a 4 year-period. The sites of TB were the lung (seven patients), mediastinal lymph nodes (LN) (one patient), cervical LN (one patient), and subcutaneous nodules (one patient). LC and TB were simultaneously diagnosed in four patients. The diagnosis of pulmonary TB was confirmed by sputum culture two months after LC diagnosis in four patients. TB was diagnosed later in the follow-up period in two patients. Only one patient with early-stage LC who had undergone surgical resection tolerated anti-TB therapy well. In one patient, TB caused the over-staging of LC. In one patient, LC had progressed during the course of anti-TB therapy. Hepatotoxicity was the leading adverse reaction due to anti-TB therapy. Conclusion: These patients highlighted the importance of considering TB in the course of LC, especially in countries with a high TB prevalence. TB may cause the advanced staging of LC at the initial diagnosis; chemotherapy may worsen the TB course or cause reactivation TB. Reactivation TB may be considered as the progression of LC without tissue diagnosis or sputum analysis. The tolerability of anti-TB therapy is poor in these patients.
The profile of pleural tuberculosis patients in Turkey
Medicine Science | International Medical Journal, 2012
Tuberculosis is the leading cause of exudative pleural effusion. The present study was designed to evaluate the patient profile in a 3-year cohort of pleural tuberculosis patients. A total of 174 patients with pleural tuberculosis (mean age was 36.1 years, 64.9% were male) followed up in our clinic from 2004 to 2007 were included in this study. Data on diagnostic methods, pleural fluid findings and clinical features of patients were recorded based on retrospective evaluation of the medical records. Diagnostic thorasynthesis was performed in patients with pleural effusion. Concomitant analysis of pleural fluid and blood biochemistry (glucose, LDH, protein levels), ADA values and cytology of pleural fluid were performed. Tuberculosis patients were categorized and treated in accordance with WHO guidelines. Patients were invited to attend monthly visits for the cohort analysis after discharge. The frequency of patients below and above 35 years of age was 51.1 and 48.9%, respectively. Parenchymal lesion was evident in 22.4% of patients while pleural fluid was detected in 50.6% of patients within right hemithorax and in 47.1% within the left hemithorax. Lymphocytic fluid was detected in 98%. Mean level for ADA in the pleural fluid was 76.9 U/L. Pleural biopsy revealed granulomatous infection in 53.8% and chronic pleuritis in 46.2% of patients. There was a significant relation of age over 35 years to presence of chronic infection in pleural biopsy (OR: 3.11) and co-morbid disorder (OR: 23.53). Pleural biopsy was performed in 38.2% of patients who were younger than 35 years while in 51.7% of patients who were older than 35 years. The frequency of granulomatous infection diagnosis was significantly higher in patients younger than 35 years when compared to older patients (54.8% vs. 45.2 %; p=0.02). In our study including homogenous distribution of patients in terms of being younger and older than 35 years of age, pleural biopsy was performed more commonly in older patient in order to eliminate possible underlying malignancy. However the diagnostic power of pleural biopsy was determined to be poor. Accordingly, after elimination of other causes of the exudate development, initiation of tuberculosis treatment based on ADA and cell count results seems reasonable.