Paradoxical response in HIV-negative patients with pleural tuberculosis: a retrospective multicentre study

Area of Science:

• Infectious Diseases
• Pulmonology
• Immunology

Background:

• Pleural tuberculosis (TB) is a significant extrapulmonary manifestation of TB.
• Paradoxical response, a worsening of TB despite treatment, can occur in patients with TB.
• Understanding factors predicting paradoxical response is crucial for managing pleural TB.

Purpose of the Study:

• To determine the incidence and clinical features of paradoxical response in human immunodeficiency virus-negative patients with isolated pleural TB.
• To identify factors that predict the development of paradoxical response in this patient group.

Main Methods:

• A multicentre, retrospective cohort study.
• Included 458 patients diagnosed and treated for isolated pleural TB between March 2005 and February 2010.
• Analyzed clinical characteristics and pleural fluid parameters to identify predicting factors.

Main Results:

• Paradoxical response developed in 16% of patients, with a mean onset of 8.8 weeks after anti-TB treatment initiation.
• The most common presentation was worsening pleural effusion (81%), often without additional symptoms (68%).
• Independent predictors for paradoxical response included higher pleural fluid eosinophil proportion (aOR 1.293) and lower protein concentration (aOR 0.590).

Conclusions:

• Paradoxical response is a notable complication in 16% of HIV-negative patients with isolated pleural TB, typically manifesting as increased pleural effusion.
• The development of paradoxical response is associated with specific pleural fluid biomarkers: eosinophil proportion and protein concentration at diagnosis.
• These findings aid in predicting and potentially managing paradoxical reactions in pleural TB patients.