Tuberculous pleuritis and HIV

Q: In HIV patient with tuberculous pleural effusion, CD4 count can remarkably affect the pleural fluid cell count and composition.

A) True

B) False

Answer: B

Tuberculous pleural fluid is usually a straw-colored exudate with protein concentration of>3.0 g/dL (30 g/L). LDH is commonly above 500 international units/L. The pH stays lower than 7.40 in most cases. Glucose is between 60 and 100 mg/dL but can be lower. An abundance of mesothelial cells may be present.

The nucleated cell count in pleural exudate is usually between 1000 and 6000 cells/mm3. It is primarily lymphocyte-predominant but can be neutrophil-predominant in the early phase.

There is no major correlation between the peripheral CD4 count and pleural exudate cell count or composition in HIV patients.

A less known fact is that TB pleural effusion accounts for about 5 percent of eosinophilic pleural effusions.

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References:

1. Frye MD, Pozsik CJ, Sahn SA. Tuberculous pleuritis and HIV disease. Chest 1995; 108:102S.

2. Riantawan P, Chaowalit P, Wongsangiem M, Rojanaraweewong P. Diagnostic value of pleural fluid adenosine deaminase in tuberculous pleuritis with reference to HIV coinfection and a Bayesian analysis. Chest 1999; 116:97.

3. McNally E, Ross C, Gleeson LE. The tuberculous pleural effusion. Breathe (Sheff). 2023 Dec;19(4):230143. doi: 10.1183/20734735.0143-2023. Epub 2023 Dec 19. PMID: 38125799; PMCID: PMC10729824.

4. Shaw JA, Diacon AH, Koegelenberg CFN. Tuberculous pleural effusion. Respirology. 2019 Oct;24(10):962-971. doi: 10.1111/resp.13673. Epub 2019 Aug 16. PMID: 31418985.