Markers to differentiate between Kaposi's sarcoma and tuberculous pleural effusions in HIV-positive patients.


Coleman, M; Finney, LJ; Komrower, D; Chitani, A; Bates, J; Chipungu, GA; Corbett, E; Allain, TJ; (2015) Markers to differentiate between Kaposi's sarcoma and tuberculous pleural effusions in HIV-positive patients. The international journal of tuberculosis and lung disease, 19 (2). pp. 144-50. ISSN 1027-3719 DOI: https://doi.org/10.5588/ijtld.14.0289

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Abstract

Kaposi's sarcoma (KS) and tuberculosis (TB) commonly cause pleural effusions in high human immunodeficiency virus (HIV) burden resource-limited countries. Differentiating between them is challenging, as pleural biopsy and TB culture are rarely available. To identify markers to differentiate between TB effusions and KS effusions in HIV-positive patients, and to compare liquid culture and Xpert(®) MTB/RIF in pleural fluid. Fifty HIV-positive patients with pleural effusions recruited in Malawi underwent pleural ultrasound and aspiration. Fluid visual inspection, cell count, bacterial culture, glucose/protein, solid and liquid TB culture and Xpert were performed. The mean age of the patients was 32 years; 30/50 (60%) were male and 29 (58%) had cutaneous/oral KS. Thirteen (26%) pleural fluid samples were liquid culture-positive for TB, while 9/13 (69%) were Xpert-positive. Three (10.3%) KS patients had culture-positive TB effusions; 17 (58.6%) had KS effusions. The relative risk of TB in KS patients increased with limited KS, loculated fluid and low glucose. Eleven (52.3%) non-KS patients had culture-positive TB effusions associated with male sex, straw-coloured fluid and fibrin stranding on ultrasound. KS patients were most likely to have KS effusion, but TB should be considered. Most non-KS patients had TB, supporting the use of World Health Organization guidelines. Xpert identified two thirds of liquid culture-positive results.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 25574911
Web of Science ID: 348696900006
URI: http://researchonline.lshtm.ac.uk/id/eprint/2031018

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