Clinical and pathological differences between polymorphonuclear-rich and lymphocyte-rich tuberculous pleural effusion

Area of Science:

• Pulmonology
• Infectious Diseases
• Pathology

Background:

• Tuberculous pleural effusion (TPE) is a common form of extrapulmonary tuberculosis.
• TPE is typically characterized by lymphocyte predominance in pleural fluid.
• Neutrophil-predominant TPE represents a distinct subset with potentially different clinical implications.

Purpose of the Study:

• To analyze the occurrence factors and disease characteristics of tuberculous (TB) pleural effusion (TPE) dominated by neutrophils.
• To compare the clinical, laboratory, and pathological features of neutrophil-predominant TPE with lymphocyte-predominant TPE.

Main Methods:

• Retrospective analysis of clinical data from 304 patients with TB pleurisy.
• Comparison of clinical, laboratory, and pathological features between lymphocyte-predominant and neutrophil-predominant TPE groups.

Main Results:

• Neutrophil-predominant effusion was found in 10.9% of patients.
• Neutrophil-predominant TPE showed higher fever and decortication rates, but lower chest distress and positive TB rates.
• Elevated LDH, ADA, and C-reactive protein levels, with lower glucose and albumin, were observed in neutrophil-predominant TPE.
• Lower granuloma formation rates and more frequent pus, caseous exudate, and necrosis were noted in neutrophil-predominant TPE.

Conclusions:

• Neutrophil-predominant TPE is associated with strong inflammatory reactions and higher ADA levels.
• These characteristics can enhance the diagnostic yield of Mycobacterium tuberculosis in neutrophil-predominant TPE, particularly under thoracoscopy.