Markers to differentiate between Kaposi's sarcoma and tuberculous pleural effusions in HIV-positive patients
OBJECTIVES: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
Keywords: Malawi; Xpert® MTB/Rif; resource-limited; ultrasound
Document Type: Research Article
Affiliations: 1: College of Medicine, University of Malawi, Blantyre, Malawi; Queen Elizabeth Central Hospital, Blantyre 2: Queen Elizabeth Central Hospital, Blantyre, Malawi 3: College of Medicine, University of Malawi, Blantyre, Malawi; Queen Elizabeth Central Hospital, Blantyre, Malawi 4: College of Medicine, University of Malawi, Blantyre, Malawi 5: Department of Pathology and Medical Laboratory Sciences, College of Medicine, Blantyre, Malawi 6: London School of Hygiene & Tropical Medicine, Infectious and Tropical Diseases, London, UK; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, TB Research Unit, Blantyre, Malawi
Publication date: 01 February 2015
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