C-reactive Protein Measurement for the Differentiation Between Tuberculous and Malignant Pleural Effusion

Abstract

The incidence of tuberculosis has increased in recent decade. It is one of the major causes of morbidity and mortality worldwide. Tuberculous pleural effusion is common in patients with tuberculosis. Tuberculous pleural effusion contains a variety of immunological cytokines & markers, because of the accumulation of immunocompetent cells in pleural cavity. Among the most common cause of lymphocytic exudative pleural effusion is malignant and tuberculous pleural effusion. Various biological markers for differentiating these two conditions have been proposed; however, there is a limitation, in terms of both expense and availability of these tests and so simple markers is required. CRP is an acute phase protein predominantly produced and secreted by hepatocytes. Other cells including lymphocytes, kupffer’s cells, monocytes and macrophages can also produce CRP. The induction of CRP synthesis is triggered by a number of cytokines, chiefly IL-6, which is released from a variety of cell types, but mainly from macrophages and monocytes at inflammatory sites. The present study conducted to evaluate pleural fluid CRP concentration in tuberculous and malignant pleural effusion. Two group are included: Group A: Twenty-five patients with exudative lymphocytic pleural effusion secondary to malignancy of different primary etiology diagnosed by cytological examination and / or pleural biopsy either Abram’s needle biopsy, thoracoscopic, or open pleural biopsy. Group B: Twenty-five patients with exudative lymphocytic pleural effusion secondary to tuberculosis, diagnosed by high positive tuberculin test by Mantoux method, chemical analysis, cytological examination revealed lymphocytic predominance and/or pleural biopsy showing caseating granuloma.