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

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Abstract:

OBJECTIVE: To evaluate the incidence, clinical characteristics and predicting factors for the development of paradoxical response in human immunodeficiency virus negative patients with isolated pleural tuberculosis (TB).

DESIGN: A multicentre, retrospective cohort study including 458 patients who were diagnosed and treated with isolated pleural TB between March 2005 and February 2010.

RESULTS: Paradoxical response developed in 72 patients (16%) with isolated pleural TB. The mean time to development of paradoxical response was 8.8 ± 6.4 weeks after initiation of anti-tuberculosis treatment. The main presentation of paradoxical response was aggravation of pre-existing pleural effusion in 58 patients (81%). However, the majority of the patients who developed paradoxical response had no associated symptoms (n = 49, 68%). In multiple logistic regression analysis, development of paradoxical response was independently associated with the proportion of eosinophils (adjusted OR 1.293, 95%CI 1.077–1.553) and protein concentrations (adjusted OR 0.590, 95%CI 0.397–0.878) in the pleural fluid at the time of diagnosis.

CONCLUSION: Paradoxical response developed in 16% of the patients approximately 2 months after initiation of anti-tuberculosis treatment, presenting with aggravation of pre-existing pleural effusion. Development of paradoxical response was associated with the proportion of eosinophils and protein concentrations in the pleural fluid at the time of diagnosis.

Keywords: Mycobacterium tuberculosis; incidence; pleural effusion; risk factors

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.11.0642

Affiliations: 1: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea 2: Department of Internal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea 3: Division of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea 4: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea 5: Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, South Korea 6: Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Gyeongju, South Korea 7: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, South Korea 8: Department of Pulmonary and Critical Care Medicine, Dongguk University Gyeongju Hospital, Gyeongju, South Korea 9: Department of Internal Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, South Korea 10: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea 11: Department of Internal Medicine, Konyang University Hospital, Daejeon, South Korea 12: Department of Multimedia, Seoul Women's University, Seoul, South Korea

Publication date: June 1, 2012

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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