{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:02:03Z","timestamp":1760234523042,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"World Health Organization Country Office in Uzbekistan","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"German KfW Development Bank","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Tuberculosis (TB) pleural effusion (TPE) is the second most common manifestation of extrapulmonary TB (EPTB), which remains a great diagnostic challenge worldwide. In Uzbekistan, there has been no formal evaluation of the actual practices of diagnosing and treating TPE. Our cohort study therefore aimed to describe the frequency and types of different diagnostic procedures of TPE during 2017\u20132018 and assess the association of baseline characteristics and establish diagnostic methods with TB treatment outcomes. In total, 187 patients with presumptive TPE were assessed, and 149 had a confirmed diagnosis of TPE (other diagnoses included cancer n = 8, pneumonia n = 17, and 13 cases were unspecified). TB was bacteriologically confirmed in 22 (14.8%), cytologically confirmed in 64 (43.0%), and histologically confirmed in 16 (10.7%) patients. Hepatitis was the only co-morbidity significantly associated with unsuccessful treatment outcomes (RR 4.8; 95%CI: 1.44\u201315.98, p value 0.011). Multivariable regression analysis showed that drug-resistant TB was independently associated with unsuccessful TB treatment outcome. (RR 3.83; 95%CI: 1.05\u201314.02, p value 0.04). Multidisciplinary approaches are required to maximize the diagnostic accuracy of TPE and minimize the chances of misdiagnosis. TPE patients with co-infections and those with drug resistance should be more closely monitored to try and ensure successful TB treatment outcomes.<\/jats:p>","DOI":"10.3390\/ijerph18115769","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T11:07:02Z","timestamp":1622113622000},"page":"5769","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic Procedures, Diagnoses, and Treatment Outcomes of Patients with Presumptive Tuberculosis Pleural Effusion in Uzbekistan"],"prefix":"10.3390","volume":"18","author":[{"given":"Fazlkhan","family":"Abdugapparov","sequence":"first","affiliation":[{"name":"Department of Phthisiology and Pulmonology, Tashkent Medical Academy, Farabi 2, Tashkent 100109, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruzanna","family":"Grigoryan","sequence":"additional","affiliation":[{"name":"Tuberculosis Research and Prevention Center, NGO, Yerevan 0023, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nargiza","family":"Parpieva","sequence":"additional","affiliation":[{"name":"Republican Specialized Scientific Practical Medical Center of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, Sh. Alimov 1, Little Ring Road, Tashkent 100086, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherali","family":"Massavirov","sequence":"additional","affiliation":[{"name":"Department of Phthisiology and Pulmonology, Tashkent Medical Academy, Farabi 2, Tashkent 100109, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anvar","family":"Riskiyev","sequence":"additional","affiliation":[{"name":"Republican Specialized Scientific Practical Medical Center of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, Sh. Alimov 1, Little Ring Road, Tashkent 100086, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3998-5786","authenticated-orcid":false,"given":"Jamshid","family":"Gadoev","sequence":"additional","affiliation":[{"name":"World Health Organization Country Office in Uzbekistan, 16 Tarobiy Str., Tashkent 100100, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana","family":"Buziashvili","sequence":"additional","affiliation":[{"name":"Department of Scientific Research, National Center for Tuberculosis and Lung Diseases, 8 Adjara Str., 0101 Tbilisi, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0276-1204","authenticated-orcid":false,"given":"Nestani","family":"Tukvadze","sequence":"additional","affiliation":[{"name":"Department of Scientific Research, National Center for Tuberculosis and Lung Diseases, 8 Adjara Str., 0101 Tbilisi, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7904-9071","authenticated-orcid":false,"given":"Arax","family":"Hovhannesyan","sequence":"additional","affiliation":[{"name":"World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3080-8321","authenticated-orcid":false,"given":"Andrei","family":"Dadu","sequence":"additional","affiliation":[{"name":"World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,27]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2020). Global Tuberculosis Report 2020, World Health Organization. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/336069\/9789240013131-eng.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1136\/thx.2006.075754","article-title":"A systematic review of commercial serological antibody detection tests for the diagnosis of extrapulmonary tuberculosis","volume":"83","author":"Steingart","year":"2007","journal-title":"Postgrad. Med. J."},{"key":"ref_3","first-page":"981","article-title":"Tuberculous pleural effusions: Advances and controversies","volume":"7","author":"Vorster","year":"2015","journal-title":"J. Thorac. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1086\/605559","article-title":"Epidemiology of extrapulmonary tuberculosis in the United States, 1993\u20132006","volume":"49","author":"Peto","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1136\/thoraxjnl-2011-201363","article-title":"Revisiting tuberculous pleurisy: Pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area","volume":"67","author":"Ruan","year":"2012","journal-title":"Thorax"},{"key":"ref_6","unstructured":"Light, R.W. (2013). Pleural Diseases, Lippincott Williams & Wilkins. [6th ed.]."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1183\/09031936.00147507","article-title":"Novel tests for diagnosing tuberculous pleural effusion: What works and what does not?","volume":"31","author":"Trajman","year":"2008","journal-title":"Eur. Respir. J."},{"key":"ref_8","unstructured":"World Health Organization (WHO) (2017). Guidelines for Treatment of Drug-Susceptible Tuberculosis and Patient Care, 2017, World Health Organization."},{"key":"ref_9","unstructured":"World Health Organization (2020). WHO Consolidated Guidelines on Tuberculosis. Module 3: Diagnosis-Rapid Diagnostics for Tuberculosis Detection, World Health Organization."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"20431","DOI":"10.2807\/ese.18.12.20431-en","article-title":"Extrapulmonary tuberculosis in the European Union and European Economic Area, 2002 to 2011","volume":"18","author":"Sandgren","year":"2013","journal-title":"Euro Surveill."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5152\/ttd.2014.001","article-title":"Tuberculous pleural effusion","volume":"16","author":"Light","year":"2015","journal-title":"Turk Toraks Derg."},{"key":"ref_12","unstructured":"United Nations Development Programme (2020, December 16). About Uzbekistan. Available online: https:\/\/www.uz.undp.org\/content\/uzbekistan\/en\/home\/countryinfo\/."},{"key":"ref_13","unstructured":"World Health Organization (2020). Definitions and Reporting Framework for Tuberculosis-2013 Revision (Updated Dec 2014 and Jan 2020) (WHO\/HTM\/TB\/2013.2), World Health Organization."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Liang, Q., Pang, Y., Yang, Y., Li, H., Guo, C., Yang, X., and Chen, X. (2019). An improved algorithm for rapid diagnosis of pleural tuberculosis from pleural effusion by combined testing with GeneXpert MTB\/RIF and an anti-LAM antibody-based assay. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4166-1"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.2217\/fmb-2017-0028","article-title":"Challenges in pleural tuberculosis diagnosis: Existing reference standards and nucleic acid tests","volume":"12","author":"Tyagi","year":"2017","journal-title":"Future Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"282","DOI":"10.21037\/atm.2016.07.23","article-title":"Advances in the diagnosis of tuberculous pleuritis","volume":"4","author":"Porcel","year":"2016","journal-title":"Ann. Transl. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"787","DOI":"10.5588\/ijtld.12.0892","article-title":"Can tuberculous pleural effusions be diagnosed by pleural fluid analysis alone?","volume":"17","author":"Sahn","year":"2013","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S0953-6205(03)00018-9","article-title":"Tuberculous pleural effusions","volume":"14","author":"Pose","year":"2003","journal-title":"Eur. J. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3636","DOI":"10.1128\/JCM.02182-15","article-title":"Performance of xpert MTB\/RIF assay in diagnosis of pleural tuberculosis by use of pleural fluid samples","volume":"53","author":"Rufai","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_20","first-page":"26","article-title":"Rapid diagnosis of pleural tuberculosis by Xpert MTB\/RIF assay using pleural biopsy and pleural fluid specimens","volume":"20","author":"Du","year":"2015","journal-title":"J. Res. Med. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"373","DOI":"10.21037\/atm.2019.07.17","article-title":"Differential diagnosis between lymphoma-associated malignant pleural effusion and tuberculous pleural effusion","volume":"7","author":"Kim","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.amjms.2017.04.006","article-title":"Predictive Factors and Treatment Outcomes of Tuberculous Pleural Effusion in Patients With Cancer and Pleural Effusion","volume":"354","author":"Lee","year":"2017","journal-title":"Am. J. Med. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s00408-008-9085-7","article-title":"Differential diagnosis of tuberculous and malignant pleural effusions: What is the role of adenosine deaminase?","volume":"186","author":"Kuruc","year":"2008","journal-title":"Lung"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.ijid.2018.10.005","article-title":"Epidemiology and diagnosis of pleural tuberculosis in a low incidence country with high rate of immigrant population: A retrospective study","volume":"78","author":"Salvador","year":"2019","journal-title":"Int. J. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.5588\/ijtld.12.0233","article-title":"Outcomes of category III DOTS treatment in immunocompetent patients with tuberculosis pleural effusion","volume":"16","author":"Sharma","year":"2012","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"347","DOI":"10.4103\/ijmy.ijmy_140_18","article-title":"Associated factors with unsuccessful tuberculosis treatment outcomes among tuberculosis\/HIV coinfected patients with drug-resistant tuberculosis","volume":"7","author":"Azeez","year":"2018","journal-title":"Int. J. Mycobacteriol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Chen, L., Bao, D., Gu, L., Gu, Y., Zhou, L., Gao, Z., and Huang, Y. (2018). Co-infection with hepatitis B virus among tuberculosis patients is associated with poor outcomes during anti-tuberculosis treatment. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-018-3192-8"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1586\/17476348.2015.1098535","article-title":"The diagnosis of pleural effusions","volume":"9","author":"Porcel","year":"2015","journal-title":"Expert Rev. Respir. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/11\/5769\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:09:13Z","timestamp":1760162953000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/11\/5769"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,27]]},"references-count":28,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["ijerph18115769"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18115769","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2021,5,27]]}}}