Paradoxical response in HIV-negative patients with pleural tuberculosis: a retrospective multicentre study
- Affiliated Author(s)
- 최원일
- Alternative Author(s)
- Choi, Won Il
- Journal Title
- International Journal of Tuberculosis and Lung Disease
- ISSN
- 1027-3719
- Issued Date
- 2012
- Keyword
- Mycobacterium tuberculosis; pleural effusion; incidence; risk factors
- 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. KEY WORDS: Mycobacterium tuberculosis; pleural effusion; incidence; risk factors
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