Keywords
Diagnóstico
Biomarcadores
Manejo clínico
How to Cite
Abstract
INTRODUCTION: Pleural tuberculosis, the most prevalent extrapulmonary form of the disease, presents a diagnostic challenge due to the low specificity of clinical signs and the need to integrate clinical, laboratory, and imaging data, with the aim of this study being to evaluate current evidence and propose pathways to improve diagnostic accuracy, therapeutic effectiveness, and the reduction of morbidity and mortality. METHODOLOGY: The literature review was conducted in the PubMed database, using the descriptor “pleural tuberculosis” with filters for the last ten years, humans, available abstracts, and exclusion of preprints, which resulted in 1,249 records, of which 76 articles were selected for qualitative analysis. CONCLUSION: Pleural tuberculosis remains a challenge due to its paucibacillary nature and nonspecific clinical presentation, requiring the combination of traditional biomarkers, such as ADA, with more precise molecular methods, such as Xpert MTB/RIF. Although rapid tests in pleural fluid show low sensitivity, thoracoscopy-guided pleural biopsy remains the gold standard, albeit invasive. Management requires the conventional therapeutic regimen combined with monitoring of complications, coinfections, and resistance, while advances in immunological biomarkers and new technologies promise faster and less invasive diagnostics, essential to reduce morbidity and the global impact of the disease.
References
AGGARWAL, A. N. et al. Comparative accuracy of pleural fluid unstimulated interferon-gamma and adenosine deaminase for diagnosing pleural tuberculosis: a systematic review and meta-analysis. PLoS One, v. 16, n. 6, p. e0253525, 24 jun. 2021. Disponível em: https://doi.org/10.1371/journal.pone.0253525. Acesso em: 28 ago. 2025.
AGGARWAL, A. N. et al. Pleural fluid tumor necrosis factor for diagnosis of pleural tuberculosis: a systematic review and meta-analysis. Cytokine, v. 141, p. e155467, maio 2021. Disponível em: https://doi.org/10.1016/j.cyto.2021.155467. Acesso em: 28 ago. 2025.
ANGUAMEA-MALDONADO, J.; SANCHEZ-ZAZUETA, E.; VIDAL-MORALES, R. Pleural tuberculosis and endocarditis as complications of multifactorial origin in granulomatosis with polyangiitis: Clinical case report. Reumatol Clin (Engl Ed), v. 20, n. 2, p. 104-107, fev. 2024. Disponível em: https://doi.org/10.1016/j.reumae.2024.01.002. Acesso em: 28 ago. 2025.
ANTAS, P. et al. Interleukin-6 and -27 as potential novel biomarkers for human pleural tuberculosis regardless of the immunological status. Microbes Infect, v. 26, n. 1-2, p. e105238, jan./fev. 2024. Disponível em: https://doi.org/10.1016/j.micinf.2023.105238. Acesso em: 28 ago. 2025.
BEUKES, A. et al. The Utility of Pleural Fluid Lactate Dehydrogenase to Adenosine Deaminase Ratio in Pleural Tuberculosis. Respiration, v. 100, n. 1, p. 59-63, 2021. Disponível em: https://doi.org/10.1159/000509555. Acesso em: 28 ago. 2025.
BOGGS, Z. H.; HEYSELL, S.; EBY, J.; ARNOLD, C. Adenosine deaminase negative pleural tuberculosis: a case report. BMC Infect Dis, v. 21, n. 1, p. 575, 15 jun. 2021. Disponível em: https://doi.org/10.1186/s12879-021-06276-4. Acesso em: 28 ago. 2025.
BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. [Título do Documento]. 2. ed. atual. Brasília, DF: Ministério da Saúde, [2019]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/manual_recomendacoes_controle_tuberculose_brasil_2_ed.pdf. Acesso em: 28 ago. 2025.
CARMO, Andréia Moreira dos Santos et al. Uso de la prueba rápida molecular en el diagnóstico de tuberculosis pericárdica: presentación de un caso. Revista Família, Ciclos de Vida e Saúde no Contexto Social, v. 5, n. 2, p. 263–268, 11 abr. 2017.
CORRÊA, R. D. S. et al. Reanalysis and validation of the transcriptional pleural fluid signature in pleural tuberculosis. Front Immunol, v. 14, p. e1256558, 15 jan. 2024. Disponível em: https://doi.org/10.3389/fimmu.2023.1256558. Acesso em: 28 ago. 2025.
CRUZ, A. T.; STARKE, J. R. Clinical Worsening in an Adolescent With Pleural Tuberculosis. J Adolesc Health, v. 72, n. 3, p. 480-482, mar. 2023. Disponível em: https://doi.org/10.1016/j.jadohealth.2022.11.013. Acesso em: 28 ago. 2025.
CRUZ, J. et al. Biópsia pleural cega no diagnóstico de tuberculose pleural. In: 1 jun. 2014. Disponível em: <https://www.semanticscholar.org/paper/Bi%C3%B3psia-pleural-cega-no-diagn%C3%B3stico-de-tuberculose-Cruz-Vale/7e9fa0ec87feb0dde8e1bd79df0e5b505571db85>. Acesso em: 28 ago. 2025
CUNHA, D. L. et al. Relevância da correlação entre achados tomográficos e laboratoriais na precisão diagnóstica da tuberculose pulmonar. Radiologia Brasileira, São Paulo, v. 57, p. e20230079, 2024. Disponível em: https://doi.org/10.1590/0100-3984.2023.0079. Acesso em: 28 ago. 2025.
CUNHA, D. L. et al. Relevância da correlação entre achados tomográficos e laboratoriais na precisão diagnóstica da tuberculose pulmonar. Radiologia Brasileira, São Paulo, v. 57, p. e20230079, 2024. Disponível em: https://doi.org/10.1590/0100-3984.2023.0079. Acesso em: 28 ago. 2025.
DONG, Z. et al. Paradoxical development of pleural-based masses in patients with pleural tuberculosis during treatment: a clinical observational study in China. BMC Pulm Med, v. 22, n. 1, p. 126, 4 abr. 2022. Disponível em: https://doi.org/10.1186/s12890-022-01910-6. Acesso em: 28 ago. 2025.
DU, F. et al. T-cell receptor and B-cell receptor repertoires profiling in pleural tuberculosis. Front Immunol, v. 15, p. e1473486, 27 nov. 2024. Disponível em: https://doi.org/10.3389/fimmu.2024.1473486. Acesso em: 28 ago. 2025.
FIELLI, M. et al. Determinación del valor de adenosina deaminasa en tuberculosis pleural. Medicina (B Aires), v. 81, n. 6, p. 954-957, 2021.
GARCIA-ZAMALLOA, A. et al. Diagnostic accuracy of adenosine deaminase for pleural tuberculosis in a low prevalence setting: a machine learning approach within a 7-year prospective multi-center study. PLoS One, v. 16, n. 11, p. e0259203, 4 nov. 2021. Disponível em: https://doi.org/10.1371/journal.pone.0259203. Acesso em: 28 ago. 2025.
GUO, S.; HAN, C.; HE, Y.; WANG, M. S. Diagnostic incremental value of sputum in patients with pleural tuberculosis. Infect
HAN, X. F. et al. Factors associated with negative pleural adenosine deaminase results in the diagnosis of childhood pleural tuberculosis. BMC Infect Dis, v. 21, n. 1, p. 473, 25 maio 2021. Disponível em: https://doi.org/10.1186/s12879-021-06209-1. Acesso em: 28 ago. 2025.
HERIKURNIAWAN, H. et al. Unusual co-existence of drug-susceptible lung tuberculosis and drug-resistant pleural tuberculosis: a rare case presentation of dual infection. Acta Med Indones, v. 57, n. 2, p. 237-240, abr. 2025.
LI, Z. et al. Use of Pleural Fluid Digital PCR Analysis to Improve the Diagnosis of Pleural Tuberculosis. Microbiol Spectr, v. 10, n. 6, p. e0163222, 21 dez. 2022. Disponível em: https://doi.org/10.1128/spectrum.01632-22. Acesso em: 28 ago. 2025.
LIMA, D.; COLARES, J. K. B.; FONSECA, B. A. L. Importância da adenosina deaminase no diagnóstico da tuberculose pleural. Revista Da Sociedade Brasileira De Medicina Tropical, 2002.
LING, Yuyang et al. Accuracy of next-generation sequencing for rapid diagnosis of tuberculous pleurisy: A protocol of systematic review and meta-analysis. PLOS One, v. 20, n. 2, p. e0319175, 25 fev. 2025.
LUNELLI, M. et al. Pleural tuberculosis: experiences from two centers in Brazil. J Pediatr (Rio J), v. 98, n. 6, p. 621-625, nov./dez. 2022. Disponível em: https://doi.org/10.1016/j.jped.2022.03.006. Acesso em: 28 ago. 2025.
LUNELLI, Magda et al. Pleural tuberculosis: experiences from two centers in Brazil. Jornal de Pediatria, v. 98, n. 6, p. 621–625, 20 maio 2022.
MATURU, V. N. et al. Pleural Pustule-a Novel Thoracoscopic Appearance of Pleural Tuberculosis. J Bronchology Interv Pulmonol, v. 30, n. 4, p. 354-362, 1 out. 2023. Disponível em: https://doi.org/10.1097/LBR.0000000000000887. Acesso em: 28 ago. 2025.
MELO, Fernando Augusto Fiuza de et al. Diagnóstico da tuberculose pleural pela ADA, isolada ou combinada a outras variáveis, inclusive em HIV-positivos. In: 1 set. 2000. Disponível em: <https://www.semanticscholar.org/paper/Diagn%C3%B3stico-da-tuberculose-pleural-pela-ADA%2C-ou-a-Melo-Afiune/a2d507e49aa494200595f335efb1bac508969ed6>. Acesso em: 28 ago. 2025
MOHANTY, T. et al. Pleural tuberculosis in Bhubaneswar, Odisha, during 2016 to 2022. Indian J Med Microbiol, v. 46, p. e100479, nov./dez. 2023. Disponível em: https://doi.org/10.1016/j.ijmmb.2023.100479. Acesso em: 28 ago. 2025.
MOHAPATRA, A. et al. Diagnostic accuracy of Lipoarabinomannan detection by lateral flow assay in pleural tuberculosis. BMC Infect Dis, v. 24, n. 1, p. 178, 9 fev. 2024. Disponível em: https://doi.org/10.1186/s12879-024-09088-4. Acesso em: 28 ago. 2025.
MOHAPATRA, A. et al. Laboratory diagnosis of pleural tuberculosis: an unsolved enigma. Indian J Med Microbiol, v. 54, p. e100817, mar./abr. 2025. Disponível em: https://doi.org/10.1016/j.ijmmb.2025.100817. Acesso em: 28 ago. 2025.
NA, F. et al. Performance of adenosine deaminase in detecting paediatric pleural tuberculosis: a systematic review and meta-analysis. Ann Med, v. 54, n. 1, p. 3129-3135, dez. 2022. Disponível em: https://doi.org/10.1080/07853890.2022.2140452. Acesso em: 28 ago. 2025.
NEVES, D.; MORISSON, P. Novos métodos no diagnóstico da tuberculose pleural. New diagnostic tools for pleural tuberculosis. In: 2007. Disponível em: <https://www.semanticscholar.org/paper/Novos-m%C3%A9todos-no-diagn%C3%B3stico-da-tuberculose-New-for-Neves-Morisson/3eb9839dd065c50bc59ffb006ec0bfa764c204ea>. Acesso em: 28 ago. 2025
NEVES, Denise Duprat et al. Rendimento de variáveis clínicas, radiológicas e laboratoriais para o diagnóstico da tuberculose pleural. Jornal Brasileiro de Pneumologia, v. 30, n. 4, p. 319–326, ago. 2004.
NIERO, Rinaldo. Emprego do método bacteriológico nos programas de controle da tuberculose. Revista de Saúde Pública, v. 11, n. 3, p. 416–426, set. 1977.
PAIVA, Luis Felipe Pedroso et al. Tuberculose Pleural em paciente com Síndrome da Imunodeficiência Adquirida. Caminhos da Clínica, n. 3, 8 maio 2024.
PEÑAFIEL YANCHA, Doris Estefanía. Métodos de imagen y patrones radiológicos en pacientes con tuberculosis diagnosticados de Covid-19: actualidad: revisión bibliográfica. Ciencia Latina Revista Científica Multidisciplinar, México, v. 7, n. 2, p. 5382-5394, mar./abr. 2023. Disponível em: https://doi.org/10.37811/cl_rcm.v7i2.5727. Acesso em: 28 ago. 2025.
PEÑAFIEL YANCHA, Doris Estefanía. Métodos de imagen y patrones radiológicos en pacientes con tuberculosis diagnosticados de Covid-19: actualidad: revisión bibliográfica. Ciencia Latina Revista Científica Multidisciplinar, México, v. 7, n. 2, p. 5382-5394, mar./abr. 2023. Disponível em: https://doi.org/10.37811/cl_rcm.v7i2.5727. Acesso em: 28 ago. 2025.
PINHEIRO, Raissa Maria Albuquerque et al. Perfil epidemiológico da tuberculose em idosos em Belém-PA entre 2017-2021. Research, Society and Development, v. 12, n. 8, p. e13912838723–e13912838723, 26 ago. 2023.
RIBEIRO, Suzane et al. Disseminated Tuberculosis in an Immunocompetent Patient: The Answer is in the Liver. GE Portuguese Journal of Gastroenterology, v. 23, n. 4, p. 208–213, 3 dez. 2015.
RODRIGUES, N. S.; FREITAS, M. G. T. de; ARAÚJO, P. V. O. PNEUMONIA TUBERCULOIDE COMO DIAGNÓSTICO DIFERENCIAL EM PACIENTE COM CONSOLIDAÇÃO PULMONAR E DERRAME PLEURAL. REVISTA FOCO, [S. l.], v. 17, n. 11, p. e6429, 2024. DOI: 10.54751/revistafoco.v17n11-202. Disponível em: https://ojs.focopublicacoes.com.br/foco/article/view/6429. Acesso em: 28 ago. 2025.
ROSSO, Franciele. Contribuição da detecção de DNA de Mycobacterium tuberculosis em diferentes amostras para o diagnóstico de tuberculose pleural. In: 2008. Disponível em: <https://www.semanticscholar.org/paper/Contribui%C3%A7%C3%A3o-da-detec%C3%A7%C3%A3o-de-DNA-de-Mycobacterium-em-Rosso/e51d138903dab92c321734ee70bfe882f7b465a7>. Acesso em: 28 ago. 2025
SANTOS, A. P. et al. Hyporexia and cellular/biochemical characteristics of pleural fluid as predictive variables on a model for pleural tuberculosis diagnosis. J Bras Pneumol, v. 48, n. 2, p. e20210245, 13 dez. 2021. Disponível em: https://doi.org/10.36416/1806-3756/e20210245. Acesso em: 28 ago. 2025.
SHARMA, P. et al. Development and assessment of a novel magnetic nanoparticle antibody-conjugate and aptamer-based assay (MNp-Ab-Ap assay) for the rapid diagnosis of pleural tuberculosis. Nanotheranostics, v. 9, n. 1, p. 20-30, 1 jan. 2025. Disponível em: https://doi.org/10.7150/ntno.95332. Acesso em: 28 ago. 2025.
SHARMA, P. et al. Evaluation of Mycobacterium tuberculosis derived cell-free DNA using pleural fluid and paired plasma samples for the diagnosis of pleural tuberculosis. Tuberculosis (Edinb), v. 142, p. e102369, set. 2023. Disponível em: https://doi.org/10.1016/j.tube.2023.102369. Acesso em: 28 ago. 2025.
SHARMA, S. et al. Xpert MTB/RIF Ultra as a diagnostic tool for pleural tuberculosis: a study at Indian tertiary care centre. Lett Appl Microbiol, v. 77, n. 11, p. ovae102, 6 nov. 2024. Disponível em: https://doi.org/10.1093/lambio/ovae102. Acesso em: 28 ago. 2025.
SHAW, J. A.; KOEGELENBERG, C. F. N. Pleural Tuberculosis. Clin Chest Med, v. 42, n. 4, p. 649-666, dez. 2021. Disponível em: https://doi.org/10.1016/j.ccm.2021.08.002. Acesso em: 28 ago. 2025.
SILVA, Denise Rossato et al. Diagnosis of tuberculosis: a consensus statement from the Brazilian Thoracic Association. Jornal Brasileiro de Pneumologia, v. 47, n. 2, p. e20210054, 2021.
SONI, A. et al. Detection of MPT-64 protein in pleural tuberculosis cases by magnetic bead-gold nanoparticle-PCR amplified immunoassay. Future Microbiol, v. 20, n. 2, p. 107-115, fev. 2025. Disponível em: https://doi.org/10.1080/17460913.2024.2432179. Acesso em: 28 ago. 2025.
SONI, A. et al. Diagnosis of pleural tuberculosis by multi-targeted loop-mediated isothermal amplification assay based on SYBR Green I reaction: comparison with GeneXpert® MTB/RIF assay. Expert Rev Respir Med, v. 17, n. 11, p. 1079-1089, jul./dez. 2023. Disponível em: https://doi.org/10.1080/17476348.2023.2292738. Acesso em: 28 ago. 2025.
SONI, A.; GULIANI, A.; NEHRA, K.; MEHTA, P. K. Insight into diagnosis of pleural tuberculosis with special focus on nucleic acid amplification tests. Expert Rev Respir Med, v. 16, n. 8, p. 887-906, ago. 2022. Disponível em: https://doi.org/10.1080/17476348.2022.2093189. Acesso em: 28 ago. 2025.
SUMALANI, K. K.; AKHTER, N.; CHAWLA, D.; RIZVI, N. A. Visual Diagnosis of Pleural Tuberculosis and its Association with Tissue Biopsy, Culture and Xpert Assay. Pneumologie, v. 76, n. 2, p. 92-97, fev. 2022. Disponível em: https://doi.org/10.1055/a-1666-5851. Acesso em: 28 ago. 2025.
SUN, W. et al. Diagnostic yield of Xpert MTB/RIF on contrast-enhanced ultrasound-guided pleural biopsy specimens for pleural tuberculosis. Int J Infect Dis, v. 108, p. 89-95, jul. 2021. Disponível em: https://doi.org/10.1016/j.ijid.2021.05.023. Acesso em: 28 ago. 2025.
TANDON, R.; AGARWAL, A.; NIRALA, P.; SINHA, A. Evaluation of radiological sequelae after treatment completion in new cases of pulmonary and pleural tuberculosis. Int J Mycobacteriol, v. 10, n. 4, p. 398-404, out./dez. 2021. Disponível em: https://doi.org/10.4103/ijmy.ijmy_192_21. Acesso em: 28 ago. 2025.
VIEIRA, J. L.; FOSCHIERA, L.; FERREIRA, I. C. S.; CHAKR, V. C. B. G. Performance of the quantification of adenosine deaminase and determination of the lactate dehydrogenase/adenosine deaminase ratio for the diagnosis of pleural tuberculosis in children and adolescents. J Bras Pneumol, v. 47, n. 2, p. e20200558, 17 maio 2021. Disponível em: https://doi.org/10.36416/1806-3756/e20200558. Acesso em: 28 ago. 2025.
YANG, X. et al. Use of T-SPOT.TB for the diagnosis of unconventional pleural tuberculosis is superior to ADA in high prevalence areas: a prospective analysis of 601 cases. BMC Infect Dis, v. 21, n. 1, p. 4, 4 jan. 2021. Disponível em: https://doi.org/10.1186/s12879-020-05676-2. Acesso em: 28 ago. 2025.
ZHOU, M.; REN, S. F.; GONG, H. Z.; WANG, M. S. Risk factors associated with surgical intervention in childhood pleural tuberculosis. Sci Rep, v. 11, n. 1, p. 3084, 4 fev. 2021. Disponível em: https://doi.org/10.1038/s41598-021-82936-4. Acesso em: 28 ago. 2025.
ZUBAIR, S. M.; ALI, M. G.; IRFAN, M. Post tuberculosis radiological sequelae in patients treated for pulmonary and pleural tuberculosis at a tertiary center in Pakistan. Monaldi Arch Chest Dis, v. 92, n. 1, 2 ago. 2021. Disponível em: https://doi.org/10.4081/monaldi.2021.1814. Acesso em: 28 ago. 2025.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Ana Karolina Ferreira Pereira , Luiza Gabriela Alves Gomes, Joyce Helena Leão Queiroz, Luiz Filipe Matos da Silva, Igor Tadeu de Castro Nascimento, Beatriz Tavares Monteverde da Costa , Rama Valente Lourenço , Fernanda Myllena Sousa Campos, Ana Paula barata do Vale, Gabriel Maia Franco, Jefferson Lazarini de Aquino
