Status of Exudative Pleural Effusion in Adults of South Khorasan Province, Northeast Iran: Pleural Tuberculosis Tending toward Elderly

Mortazavi-Moghaddam, Sayyed Gholam Reza; Sharifzadeh, Gholam Reza; Rezvani, Mohammad Reza

Status of Exudative Pleural Effusion in Adults of South Khorasan Province, Northeast Iran: Pleural Tuberculosis Tending toward Elderly

Document Type : Brief Report(s)

Authors

Sayyed Gholam Reza Mortazavi-Moghaddam ¹

Gholam Reza Sharifzadeh ²

Mohammad Reza Rezvani ¹

¹ Department of Internal Medicine, Pulmonary Division, Vali-e-Asre Hospital, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran

² Department of Epidemiology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran

Abstract

The causes and situation of exudative pleural effusion vary from one area to another. A cross-sectional study was conducted on 327 patients with exudative pleural effusion in South Khorasan province (Iran). The patients were older than 12 years and comprised 172 (52.6%) males and 155 (47.4%) females. The study commenced in 2007 with seven years duration. The Light’s criteria were used to define exudative effusion. Procedures including pleural fluid analysis, microbiological study, pleural biopsy, and systemic investigations were conducted to determine the special cause of pleural effusion. The mean age of the patients was 63.4±18.4 years. Malignancies, tuberculosis, and parapneumonia pleural exudation were diagnosed in 125 (38.2%), 48 (14.7%), and 45 (13.8%) cases, respectively. Among malignant effusions, metastasis from lung cancer made 48 (38.4%) of the cases. The origin of metastasis was not determined in 44 (35.2%) patients. The mean age of patients was not significantly different between malignant (66.9±14.3 years) and tuberculosis (63.9±19.7 years) cases (P=0.16). The older age of tuberculosis patients could be a new discussion point on the overall impression created on the subject of tuberculosis pleural exudation (TB-PLE) occurring in young people.

Keywords

Tuberculosis

Pleural Effusion

Neoplasms

Kalaajieh WK. Etiology of exudative pleural effusions in adults in North Lebanon. Can Respir J. 2001;8:93-7. PubMed PMID: 11320400.
Liam CK, Lim KH, Wong CM. Causes of pleural exudates in a region with a high incidence of tuberculosis. Respirology. 2000;5:33-8. PubMed PMID: 10728729. doi: 10.1046/j.1440-1843.2000.00223.x.
Boloursaz M, Khalilzadeh S, Abbaszadeh M, Velayati A. Tuberculous Pleural Effusion in Children. Iranian Journal of Pediatric Society. 2010;2:15-9.
Ibrahim WH, Ghadban W, Khinji A, Yasin R, Soub H, Al-Khal AL, et al. Does pleural tuberculosis disease pattern differ among developed and developing countries. Respir Med. 2005;99:1038-45. doi: 10.1016/j.rmed.2004.12.012. PubMed PMID: 15950146.
Baumann MH, Nolan R, Petrini M, Lee YC, Light RW, Schneider E. Pleural tuberculosis in the United States: incidence and drug resistance. Chest. 2007;131:1125-32. doi: 10.1378/chest.06-2352. PubMed PMID: 17426219.
Heidari B, Bijani K, Eissazadeh M, Heidari P. Exudative pleural effusion: effectiveness of pleural fluid analysis and pleural biopsy. East Mediterr Health J. 2007;13:765-73. PubMed PMID: 17955757.
Khan FY, Alsamawi M, Yasin M, Ibrahim AS, Hamza M, Lingawi M, et al. Etiology of pleural effusion among adults in the state of Qatar: a l-year hospital-based study. East Mediterr Health J. 2011;17:611-8. PubMed PMID: 21972486.
Mekonnen D, Amare A, Alemu A, Hurissa Z, Ali J. Pleural effusion: presentation, causes and treatment outcome in a resource limited area, Ethiopia. Health. 2012;4, 15-19.
Towhidi M, FARID HR, Nazari A. Frequency of Tuberculous Pleural Effusion in Northeast of Iran. Iran Red Crescent Med J. 2003;6:57-60.
Golshan M, Faghihi M, Ghanbarian K, Ghanei M. Common causes of pleural effusion in referral hospital in Isfahan, Iran 1997-1998. Asian Cardiovasc Thorac Ann. 2002;10:43-6. doi: 10.1177/021849230201000111. PubMed PMID: 12079970.
Rafiee S, Besharat S, Jabbari A, Golalipour F, Nasermoaadeli A. Epidemiology of tuberculosis in northeast of Iran: a population-based study. Iran J Med Sci. 2015;34:193-7.
Porcel JM, Vives M. Etiology and pleural fluid characteristics of large and massive effusions. Chest. 2003;124:978-83. doi: 10.1378/chest.124.3.978. PubMed PMID: 12970026.
Light RW. Update on tuberculous pleural effusion. Respirology. 2010;15:451-8. doi: 10.1111/j.1440-1843.2010.01723.x. PubMed PMID: 20345583.
Ghoshal AG, Sarkar S, Majumder A, Chakrabarti S. Unilateral massive pleural effusion: a presentation of unsuspected multiple myeloma. Indian J Hematol Blood Transfus. 2010;26:62-4. doi: 10.1007/s12288-010-0016-4. PubMed PMID: 21629638; PubMed Central PMCID: PMC3002069.
Luo Y, Zhang Y, Lou SF. Bilateral pleural effusion in a patient with an extensive extramedullary hematopoietic mass. Case Rep Hematol. 2013;2013:857610. doi: 10.1155/2013/857610. PubMed PMID: 24024051; PubMed Central PMCID: PMC3759280.
Koksal D, Bayiz H, Gulgosteren M, Basay N, Mutluay N, Boyaci E, et al. Recurrence of thymoma after 11 years presenting as diffuse pleural thickening. Tuberk Toraks. 2012;60:62-5. doi: 10.5578/tt.1993. PubMed PMID: 22554370.
Vega F, Padula A, Valbuena JR, Stancu M, Jones D, Medeiros LJ. Lymphomas involving the pleura: a clinicopathologic study of 34 cases diagnosed by pleural biopsy. Arch Pathol Lab Med. 2006;130:1497-502. doi: 10.1043/1543-2165(2006)130[1497:LITPAC]2.0.CO;2. PubMed PMID: 17090191.
McGrath EE, Anderson PB. Diagnosis of pleural effusion: a systematic approach. Am J Crit Care. 2011;20:119-27. doi: 10.4037/ajcc2011685. PubMed PMID: 21362716.
Gottehrer A, Roa J, Stanford GG, Chernow B, Sahn SA. Hypothyroidism and pleural effusions. Chest. 1990;98:1130-2. doi: 10.1378/chest.98.5.1130. PubMed PMID: 2135384.
Shadmehr MB, Arab M, Dezfouli AA, Keshoofi M, Amjadi MR, Farzanegan R, et al. Role of VATS in pleural effusions with unknown etiology. Tanaffos. 2004;3:25-33.
Thijsen SF, Luderer R, van Gorp JM, Oudejans SJ, Bossink AW. A possible role for Epstein-Barr virus in the pathogenesis of pleural effusion. Eur Respir J. 2005;26:662-6. doi: 10.1183/09031936.05.00131204. PubMed PMID: 16204598.
Mortazavi Moghaddam S, Khazaee Z. Vaginal delivery related hempothorax: Report of two cases. Horizon Med Sci. 2011;17:72-7. Persian
. DÄ°kensoy E. The Prevalence of Pleural Effusion in Pregnant Women: A Pilot Study. Turk J Med Sci. 2006;36:291-3.
Pfefferkorn U, Viehl CT, Barras JP. Ruptured hydatid cyst in the right thorax: differential diagnosis to pleural empyema. Thorac Cardiovasc Surg. 2005;53:250-1. doi: 10.1055/s-2005-837643. PubMed PMID: 16037874.
Aktogu Ozkan S, Erer OF, Y AY, Yuncu G, Aydogdu Z. Hydatid cyst presenting as an eosinophilic pleural effusion. Respirology. 2007;12:462-4. doi: 10.1111/j.1440-1843.2007.01054.x. PubMed PMID: 17539858.