Pleural infection and malignancy

2018 ◽  
Author(s):  
Seamus Grundy
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Lymphatic Drainage ◽  
Parapneumonic Effusion ◽  
Malignant Cells ◽  
Pleural Effusions ◽  
Pleuritic Chest Pain ◽  
Systemic Sepsis ◽  
Cardiovascular Instability ◽  
Pleural Infection

Pleural infection transitions from simple parapneumonic effusion, to complex parapneumonic effusion, to empyema. Primary empyema occurs without an underlying pneumonic process. Pleural infection commonly presents identically to pneumonia with dyspnoea, purulent sputum, and fevers. It may be associated with pleuritic chest pain. Empyema can cause systemic sepsis, leading to cardiovascular instability and multi-organ failure. A malignant pleural effusion arises when malignant cells infiltrate the pleura, resulting in increased production and decreased lymphatic drainage of pleural fluid. Malignant pleural effusions are either metastatic or primary mesothelioma. This chapter discusses pleural infection, malignant pleural effusion, and mesothelioma, focusing on etiology, symptoms, demographics, diagnosis, prognosis, and treatment.

scholarly journals Pleural cytokines MIF and MIP-3α as novel biomarkers for complicated parapneumonic effusions and empyema

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chia-Yu Yang ◽  
Yu-Hsuan Kuo ◽  
Min Chen ◽  
Chih-Liang Wang ◽  
Li-Jane Shih ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Characteristic Curve ◽  
Diagnostic Value ◽  
High Morbidity ◽  
Parapneumonic Effusion ◽  
Pleural Effusions ◽  
Parapneumonic Pleural Effusion ◽  
Diagnostic Values ◽  
Novel Biomarkers ◽  
Pleural Infection

AbstractPatients with complicated parapneumonic effusion (CPPE)/empyema have high morbidity and mortality, particularly when adequate management is delayed. We aimed to investigate novel dysregulated cytokines that can be used as biomarkers for infectious pleural effusions, especially for CPPE/empyema. Expression of 40 cytokines in parapneumonic effusions (PPE) was screened in the discovery phase, involving 63 patients, using a multiplex immunobead-based assay. Six cytokines were subsequently validated by enzyme-linked immunosorbent assays (ELISAs). We then used ELISA to further evaluate the diagnostic values and cutoff values of these cytokines as potential biomarkers in an expanded group that included 200 patients with uncomplicated parapneumonic effusion (UPPE), CPPE, empyema, transudates, other exudates, and malignant pleural effusion (MPE). The pleural levels of four cytokines (MIF, MIP-3α, IL-1β, ENA-78) were highest and significantly increased in CPPE/empyema compared with those in other etiologies. According to receiver operating characteristic curve analysis, the four cytokines (MIF, MIP-3α, IL-1β, and ENA-78) had areas under the curve (AUCs) greater than 0.710 for discriminating parapneumonic pleural effusion from noninfectious pleural effusions. In a comparison of nonpurulent CPPE with UPPE, logistic regression analysis revealed that pleural fluid MIF ≥ 12 ng/ml and MIP-3α ≥ 4.3 ng/ml had the best diagnostic value; MIF also displayed the highest odds ratio of 663 for nonpurulent CPPE, with 97.5% specificity, 94.44% sensitivity, and an AUC of 0.950. In conclusion, our results show that elevated MIF and MIP-3α may be used as novel biomarkers for PPE diagnosis, particularly in patients with CPPE/empyema; the findings indicate that dysregulated cytokine expression may provide clues about the pathogenesis of pleural infection.

CLINICAL SYMPTOMS, BIOCHEMISTRY AND CYTOLOGY OF PLEURAL, PERITONEAL EFFUSIONS

2016 ◽  
pp. 66-71
Author(s):  
Van Mao Nguyen ◽  
Huyen Quynh Trang Pham
Keyword(s):  
Pleural Effusion ◽  
Clinical Symptoms ◽  
Cross Sectional Study ◽  
Malignant Cells ◽  
Sectional Study ◽  
Pleural Effusions ◽  
Cross Sectional ◽  
Breath Sounds ◽  
Peritoneal Effusion ◽  
Neutrophil Leukocytes

Background: The cytology and the support of clinical symptoms, biochemistry for diagnosis of the cases of effusions are very important. Objectives: - To describe some of clinical symptoms and biochemistry of effusions. - To compare the results between cytology and biochemistry by the causes of pleural, peritoneal fluids. Material & Method: A cross-sectional study to describe all of 47 patients with pleural, peritoneal effusions examinated by cytology in the Hospital of Hue University of Medicine and Pharmacy from April 2013 to January 2014. Results: In 47 cases with effusions, pleural effusion accounting for 55.32%, following peritoneal effusions 29.79% and 14.89% with both of them. The most common symptoms in patients with pleural effusions were diminished or absent tactile fremitus, dull percussion, diminished or absent breath sounds (100%), in patients with peritoneal effusions was ascites (95.24%). 100% cases with pleural effusions, 50% cases with peritoneal effusions and 80% cases with pleural and peritoneal effusions were exudates. The percentage of malignant cells in patients with pleural effusions was 26.92%, in peritoneal effusions was 28.57%, in pleural and peritoneal effusions was 42.86%. The percentage of detecting the malignant cells in patients with suspected cancer in the first test was 57.14%, in the second was 9.53% and 33.33% undetectable. Most of cases which had malignant cells and inflammatory were exudates, all of the cases which had a few cells were transudates. Besides, 7.5% cases which had high neutrophil leukocytes were transudates. Conclusion: Cytology should be carry out adding to the clinical examinations and biochemistry tests to have an exact diagnosis, especially for the malignant ones. For the case with suspected cancer, we should repeat cytology test one more time to increase the ability to detect malignant cells. Key words: Effusion, pleural effusion, peritoneal effusion, cytology, biochemistry

scholarly journals The Differential Diagnostic Values of Cytokine Levels in Pleural Effusions

2005 ◽  
Vol 2005 (1) ◽  
pp. 2-8 ◽  
Author(s):  
Saadet Akarsu ◽  
A. Nese Citak Kurt ◽  
Yasar Dogan ◽  
Erdal Yilmaz ◽  
Ahmet Godekmerdan ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Parapneumonic Effusion ◽  
Pleural Effusions ◽  
Tuberculous Pleural Effusion ◽  
Cytokine Levels ◽  
Diagnostic Values

The aim is to examine whether the changes in pleural fluid interleukin (IL)-1β, IL-2, IL-6, and IL-8 levels were significant in differential diagnosis of childhood pleural effusions. IL-1β, IL-2, IL-6, and IL-8 levels in pleural fluids of all 36 patients were measured. The levels of IL-1β, IL-2, IL-6, and IL-8 in pleural fluids were statistically significantly higher in the transudate group compared with those of the exudate group. The levels of IL-1β, IL-6, and IL-8 were also found to be statistically significantly higher in the empyema group compared with both the parapneumonic and the tuberculous pleural effusion groups. The levels of IL-2 and IL-6 were detected to be statistically significantly higher in the tuberculous pleural effusion group in comparison with those of the parapneumonic effusion group. The results showed that pleural fluids IL-1β, IL-2, IL-6, and IL-8 could be used in pleural fluids exudate and transudate distinction.

Heparan sulfate chains contribute to the anticoagulant milieu in malignant pleural effusion

Thorax ◽  
2019 ◽  
Vol 75 (2) ◽  
pp. 143-152 ◽  
Author(s):  
Emilia Hardak ◽  
Eli Peled ◽  
Yonatan Crispel ◽  
Shourouk Ghanem ◽  
Judith Attias ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Pleural Effusion ◽  
Heparan Sulfate ◽  
Tumour Cell ◽  
Malignant Pleural Effusion ◽  
Pleural Cavity ◽  
Therapeutic Option ◽  
Factor Xa ◽  
Pleural Effusions ◽  
Cell Proliferation Inhibition

BackgroundWhile malignant pleural effusion (MPE) is a common and significant cause of morbidity in patients with cancer, current treatment options are limited. Human heparanase, involved in angiogenesis and metastasis, cleaves heparan sulfate (HS) side chains on the cell surface.AimsTo explore the coagulation milieu in MPE and infectious pleural effusion (IPE) focusing on the involvement of heparanase.MethodsSamples of 30 patients with MPE and 44 patients with IPE were evaluated in comparison to those of 33 patients with transudate pleural effusions, using heparanase ELISA, heparanase procoagulant activity assay, thrombin and factor Xa chromogenic assays and thromboelastography. A cell proliferation assay was performed. EMT-6 breast cancer cells were injected to the pleural cavity of mice. A peptide inhibiting heparanase activity was administered subcutaneously.ResultsLevels of heparanase, factor Xa and thrombin were significantly higher in exudate than transudate. Thromboelastography detected almost no thrombus formation in the whole blood, mainly on MPE addition. This effect was completely reversed by bacterial heparinase. Direct measurement revealed high levels of HS chains in pleural effusions. Higher proliferation was observed in tumour cell lines incubated with exudate than with transudate and it was reduced when bacterial heparinase was added. The tumour size in the pleural cavity of mice treated with the heparanase inhibitor were significantly smaller compared with control (p=0.005).ConclusionsHS chains released by heparanase form an anticoagulant milieu in MPE, preventing local thrombosis and enabling tumour cell proliferation. Inhibition of heparanase might provide a therapeutic option for patients with recurrent MPE.

scholarly journals PAI-1 Level Differences in Malignant Plural Effusion, Parapneumonic Pleuritis, and Cardiac Hydrothorax

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 567
Author(s):  
Zentina ◽  
Stukena ◽  
Krams ◽  
Lejnieks
Keyword(s):  
Pleural Effusion ◽  
Fibrinolytic Activity ◽  
Malignant Pleural Effusion ◽  
Clinical Manifestations ◽  
Plasminogen Activator Inhibitor ◽  
Pleural Effusions ◽  
Plasminogen Activator Inhibitor 1 ◽  
Significant Difference ◽  
Activator Inhibitor ◽  
Pai 1

Background and Objectives: Plasminogen activator inhibitor-1 (PAI-1) is a fibrinolytic system enzyme whose role in various fibrinolytic processes is currently unknown. In clinical manifestations of pleural liquids of diverse etiology, various levels of fibrinolytic activity can be observed—parapneumonic processes tend to loculate in fibrin septa, while malignant pleural effusion (MPE) does not. The purpose of this study was to determine possible differences in PAI-1 levels in pleural effusions of varied etiology. Material and Methods: PAI-1 level in pleural effusion and serum was determined in 144 patients with pleural effusions of various etiology (cardiac hydrothorax—42 patients (29.2%), MPE—67 patients (46.5%), parapneumonic pleuritis—27 (18.8%), tuberculous pleuritis—6 patients (4.1%), pancreatogenic pleuritis—1 patient (0.7%) and pulmonary artery thromboembolism with pleuritis—1 patient (0.7%)). Results: The median PAI-1 level (ng/mL) was the highest in the parapneumonic pleuritis group both in the effusion and the serum, with values of 291 (213–499) ng/mL and 204 (151–412) ng/mL, respectively, resulting in a statistically significant difference (p < 0.001) from the cardiac hydrothorax and MPE groups. However, there was no statistically significant difference between PAI-1 levels in the pleural effusion and serum in the cardiac hydrothorax and MPE groups. Conclusion: The PAI-1 level in MPE and cardiac hydrothorax was statistically significantly lower than in parapneumonic pleuritis.

Suspicious for Malignancy Diagnoses on Pleural Effusion Cytology

2020 ◽  
Vol 154 (3) ◽  
pp. 394-402
Author(s):  
Erika F Rodriguez ◽  
Ricardo G Pastorello ◽  
Paul Morris ◽  
Mauro Saieg ◽  
Sayanan Chowsilpa ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Sample Volume ◽  
Definitive Diagnosis ◽  
Cell Tumor ◽  
Pleural Effusions ◽  
Not Otherwise Specified ◽  
Significant Difference ◽  
Pathology Reports ◽  
Average Sample

Abstract Objectives A definitive diagnosis of malignancy may not be possible in pleural effusions. We report our experience with the diagnosis of suspicious for malignancy (SFM) in pleural effusion. Methods A search for pleural effusions diagnosed as SFM (2008-2018) was performed. Patient records and pathology reports were reviewed. Specimens were subdivided into groups depending on volume (&lt;75, 75-400, &gt;400 mL). Diagnoses of malignant pleural effusion (MPE) served as controls. Results We identified 90 patients, with a mean age of 60.6 years. Diagnoses included suspicious for involvement by carcinoma/adenocarcinoma in 64.4%, leukemia/lymphoma in 15.6%, melanoma in 2.2%, sarcoma in 3.3%, germ cell tumor in 1.1%, and not otherwise specified in 13.3%. Immunostains were performed in 47.8% and considered inconclusive in 24%. Average sample volume was 419 mL. There was a statistically significant difference between the SFM vs MPE groups for volumes greater than 75 mL (P = .001, χ 2 test), with SFM having increased proportion of volumes  greater than 400 mL, compared with the MPE group. There was no statistically significant difference in mean overall survival when the groups were compared (P = .49). Conclusions Samples with low cellularity, scant cell blocks, and inconclusive immunostains may contribute to a suspicious category diagnosis in pleural effusions.

Successful drainage of complex haemoserous malignant pleural effusion with a single modified low-dose intrapleural alteplase and dornase alfa

2021 ◽  
Vol 14 (2) ◽  
pp. e239702
Author(s):  
Boon Hau Ng ◽  
Nur Husna Mohd Aminudin ◽  
Mona Zaria Nasaruddin ◽  
Jamalul Azizi Abdul Rahaman
Keyword(s):  
High Risk ◽  
Pleural Effusion ◽  
Alternative Treatment ◽  
Malignant Pleural Effusion ◽  
Low Dose ◽  
Significant Risk ◽  
Fibrinolytic Therapy ◽  
Dornase Alfa ◽  
Pleural Infection

Patients with symptomatic complex malignant pleural effusion (MPE) are frequently unfit for decortication and have a poorer prognosis. Septations can develop in MPE, which may lead to failure of complete drainage and pleural infection. Intrapleural fibrinolytic therapy (IPFT) is an alternative treatment. The use of IPFT in patients with anaemia and high risk for intrapleural bleeding is not well established. We report a successful drainage of complex haemoserous MPE with a single modified low-dose of intrapleural 5 mg of alteplase and 5 mg of dornase alfa in a patient with pre-existing anaemia with no significant risk of intrapleural bleeding.

scholarly journals Novel pleural-bladder pump in malignant pleural effusions: from animal model to man

Thorax ◽  
2020 ◽  
Vol 75 (5) ◽  
pp. 432-434 ◽  
Author(s):  
Philippe Astoul ◽  
Sophie Laroumagne ◽  
Jeroen Capel ◽  
Nicholas A Maskell
Keyword(s):  
Quality Of Life ◽  
Animal Model ◽  
Pleural Effusion ◽  
Management Strategy ◽  
Malignant Pleural Effusion ◽  
Pleural Space ◽  
Optimal Management ◽  
Pleural Effusions ◽  
Pump System

Malignant pleural effusion is common and causes disabling symptoms such as breathlessness. Treatments are palliative and centred around improving symptoms and quality of life but an optimal management strategy is yet to be universally agreed. A novel pump system, allowing fluid to be moved from the pleural space to the urinary bladder, may have a role for the management of recurrent malignant pleural effusion. We hereby describe the first animal study using this device and the results of the first application in patients.

Adequacy of Pleural Fluid for EGFR Mutation Analysis in Malignant Pleural Effusion Based on Percentage of Malignant Cells

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 556A
Author(s):  
Hassan Hatoum ◽  
Ylagan Lourdes ◽  
Samjot Dhillon ◽  
Grace Dy ◽  
Juan Mena-Guerrero ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Mutation Analysis ◽  
Malignant Pleural Effusion ◽  
Egfr Mutation ◽  
Malignant Cells

scholarly journals Potential diagnostic value of pleural fluid cytokines levels for tuberculous pleural effusion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Neda Dalil Roofchayee ◽  
Majid Marjani ◽  
Neda K. Dezfuli ◽  
Payam Tabarsi ◽  
Afshin Moniri ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Diagnostic Value ◽  
Parapneumonic Effusion ◽  
Pleural Effusions ◽  
Tuberculous Pleural Effusion ◽  
New Biomarkers ◽  
High Level

AbstractPatients with tuberculous pleural effusion (TPE) or malignant pleural effusions (MPE) frequently have similar pleural fluid profiles. New biomarkers for the differential diagnosis of TPE are required. We determined whether cytokine profiles in the PE of patients could aid the differential diagnosis of TPE. 30 patients with TPE, 30 patients with MPE, 14 patients with empyema (EMP) and 14 patients with parapneumonic effusion (PPE) were enrolled between Dec 2018 and 2019. The levels of interleukin (IL)-6, IL-18, IL-27, CXCL8, CCL-1 and IP-10 were determined in PE by ELISA along with measurements of adenosine deaminase (ADA). The best predictors of TPE were combined ADA.IL-27 [optimal cut-off value = 42.68 (103 U ng/l2), sensitivity 100%, specificity 98.28%], ADA [cut off value 27.5 (IU/l), sensitivity 90%, specificity 96.5%] and IL-27 [cut-off value = 2363 (pg/ml), sensitivity 96.7%, specificity 98.3%, p ≤ 0.0001]. A high level of IL-6 [cut-off value = 3260 (pg/ml), sensitivity 100%, specificity 67.2%], CXCL8 [cut-off value = 144.5 (pg/ml), sensitivity 93.3%, specificity 58.6%], CCL1 [cut-off value = 54 (pg/ml), sensitivity 100%, specificity 70.7%] and IP-10 [cut-off value = 891.9 (pg/ml), sensitivity 83.3%, specificity 48.3%] were also predictive of TPE. High ADA.IL-27, ADA and IL-27 levels differentiate between TPE and non-TPE with improved specificity and diagnostic accuracy and may be useful clinically.

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