{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:37:17Z","timestamp":1787031437227,"version":"build-2736575974"},"reference-count":87,"publisher":"Societatea Romana de Morfologie","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rom J Morphol Embryol"],"published-print":{"date-parts":[[2025,2,20]]},"abstract":"<jats:p>Aim: Tuberculosis (TB) came back in the top of causes for infectious disease-related deaths and its pleural involvement is still in the top two extrapulmonary sites. The authors continued their studies on TB pleural effusions (Pl-Effs) with the assessment of biological and cytological variable of pleural fluid (PF), introducing in the investigation algorithm and testing a new tool, the computer-assisted evaluation of cell populations on PF smears. Patients, Materials and Methods: A series of 85 patients with TB pleurisy (PLTB) were selected from a larger group of 322 patients with different types of Pl-Effs. The algorithm of investigation included. clinical variables, biological assays of PF, gross aspects including imagistic variables and PF cytology on May-Gr\u00fcnwald\u2013Giemsa (MGG)-stained smears. All the data obtained were entered into and processed using Microsoft Excel module of the 2019 Microsoft Office Professional software along with the 2014 XLSTAT add-in program for MS Excel. The PF cellularity was assessed qualitatively by a cytologist and quantitatively with in-house software. Continuous variables were compared using Pearson\u2019s correlation test, while categorical variables were compared using \u03c72 (chi-squared) test. Results: Our analysis showed that patients were usually males, aged between 25 and 44 years with Pl-Eff discovered at clinical imagistic examination, almost always one-sided and free in the pleural cavity. Its extension was either moderate or reduced. The PF had a serous citrine appearance in most of the cases, and biological characteristics pleaded for an exudate [high levels of proteins and lactate dehydrogenase (LDH)], with elevated adenosine deaminase (ADA) values and rich in lymphocytes (Ly). The attempt to identify the pathogen in PF was not of much help. Apart from Ly, neutrophils [polymorphonuclear neutrophils (PMNs)] were a rare presence and their amount had only a trend of direct correlation with Ly. The same situation was encountered in the case of mesothelial cells (MCs). The comparison between the qualitative and the quantitative, computer-assisted evaluations of cytological smears showed that the results of the two methods overlapped in less than one third of the cases, although the sensitivity and specificity values as well as the two calculated predictive values of the qualitative method were encouraging. Conclusions: The assessment of biological variables and cell populations of the PF are basic tools in the diagnosis of pleural TB. The assessment of PF cell population could be improved by the use of computer-assisted quantitative analysis of the PF smears, which is simple to design, easy to introduce and handle and reliable.<\/jats:p>","DOI":"10.47162\/rjme.65.4.17","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T05:37:15Z","timestamp":1740634635000},"page":"693-712","source":"Crossref","is-referenced-by-count":1,"title":["Biological and cytological-morphological assessment of tuberculous pleural effusions"],"prefix":"10.47162","volume":"65","author":[{"name":"Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Pathology, Bagdasar\u2013Arseni Emergency Clinical Hospital, Bucharest, Romania","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iancu Emil","family":"Ple\u015fea","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena Leocadia","family":"Ple\u015fea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Bacteriology, Virology and Parasitology, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u0103zvan Mihail","family":"Ple\u015fea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Cell and Molecular Biology, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mircea-Sebastian","family":"\u015eerb\u0103nescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Olaru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Imagistics, Faculty of Medical Assistance, T\u00e2rgu Jiu Subsidiary, Titu Maiorescu University, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drago\u015f","family":"Nicolosu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Pulmonology, Victor Babe\u015f Clinical Hospital of Infectious Diseases and Pneumophthisiology, Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gheorghe Gindrovel","family":"Dumitra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Family Medicine, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin Titus","family":"Grigorean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Lucia","family":"Toma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Pulmonology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"26736","published-online":{"date-parts":[[2025,2,13]]},"reference":[{"key":"ref0","unstructured":"\"[1] Global Tuberculosis Programme (GTB). Global Tuberculosis Report 2024. World Health Organization (WHO), Geneva, Switzerland, License: CC BY-NC-SA 3.0 IGO, 2024."},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"[2] Kang W, Yu J, Du J, Yang S, Chen H, Liu J, Ma J, Li M, Qin J, Shu W, Zong P, Zhang Y, Dong Y, Yang Z, Mei Z, Deng Q, Wang P, Han W, Wu M, Chen L, Zhao X, Tan L, Li F, Zheng C, Liu H, Li X, A E, Du Y, Liu F, Cui W, Wang Q, Chen X, Han J, Xie Q, Feng Y, Liu W, Tang P, Zhang J, Zheng J, Chen D, Yao X, Ren T, Li Y, Li Y, Wu L, Song Q, Yang M, Zhang J, Liu Y, Guo S, Yan K, Shen X, Lei D, Zhang Y, Yan X, Li L, Tang S. The epidemiology of extrapulmonary tuberculosis in China: a large-scale multi-center observational study. PLoS One, 2020, 15(8):e0237753. https:\/\/doi.org\/10.1371\/journal.pone.0237753","DOI":"10.1371\/journal.pone.0237753"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"[3] Kim S, de Los Reyes V AA, Jung E. Country-specific intervention strategies for top three TB burden countries using mathematical model. PLoS One, 2020, 15(4):e0230964. https:\/\/doi.org\/10.1371\/journal.pone.0230964","DOI":"10.1371\/journal.pone.0230964"},{"key":"ref3","unstructured":"[4] Vorster MJ, Allwood BW, Diacon AH, Koegelenberg CFN. Tuberculous pleural effusions: advances and controversies. J Thorac Dis, 2015, 7(6):981-989. https:\/\/doi.org\/10.3978\/j.issn.2072-1439.2015.02.18"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"[5] Golli AL, Ni\u0163u MF, Turcu F, Popescu M, Ciobanu-Mitrache L, Olteanu M. Tuberculosis remains a public health problem in Romania. Int J Tuberc Lung Dis, 2019, 23(2):226-231. https:\/\/doi.org\/10.5588\/ijtld.18.0270","DOI":"10.5588\/ijtld.18.0270"},{"key":"ref5","unstructured":"[6] World Health Organization (WHO). Definitions and reporting framework for tuberculosis - 2013 revision: updated December 2014 and January 2020. WHO, Geneva, Switzerland, 2013."},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"[7] te Beek LAM, van der Werf MJ, Richter C, Borgdorff MW. Extrapulmonary tuberculosis by nationality, The Netherlands, 1993-2001. Emerg Infect Dis, 2006, 12(9):1375-1382. https:\/\/doi.org\/10.3201\/eid1209.050553","DOI":"10.3201\/eid1209.050553"},{"key":"ref7","unstructured":"[8] Global Tuberculosis Programme (GTB). Global Tuberculosis Report 2018. World Health Organization (WHO), Geneva, Switzerland, WHO Ref. No. HO\/CDS\/TB\/2018.20, 2018."},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"[9] Rolo M, Gonz\u00e1lez-Blanco B, Reyes CA, Rosillo N, L\u00f3pez-Roa P. Epidemiology and factors associated with extra-pulmonary tuberculosis in a low-prevalence area. J Clin Tuberc Other Mycobact Dis, 2023, 32:100377. https:\/\/doi.org\/10.1016\/j.jctube.2023.100377","DOI":"10.1016\/j.jctube.2023.100377"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"[10] Sharma SK, Mohan A, Kohli M. Extrapulmonary tuberculosis. Expert Rev Respir Med, 2021, 15(7):931-948. https:\/\/doi.org\/10.1080\/17476348.2021.1927718","DOI":"10.1080\/17476348.2021.1927718"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"[11] Gomes T, Reis-Santos B, Bertolde A, Johnson JL, Riley LW, Maciel EL. Epidemiology of extrapulmonary tuberculosis in Brazil: a hierarchical model. BMC Infect Dis, 2014, 14:9. https:\/\/doi.org\/10.1186\/1471-2334-14-9","DOI":"10.1186\/1471-2334-14-9"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"[12] Ade S, Harries AD, Tr\u00e9bucq A, Ade G, Agodokpessi G, Adjonou C, Azon S, Anagonou S. National profile and treatment outcomes of patients with extrapulmonary tuberculosis in B\u00e9nin. PLoS One, 2014, 9(4):e95603. https:\/\/doi.org\/10.1371\/journal.pone.0095603","DOI":"10.1371\/journal.pone.0095603"},{"issue":"12","key":"ref12","doi-asserted-by":"publisher","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","unstructured":"[13] Sandgren A, Hollo V, van der Werf MJ. Extrapulmonary tuberculosis in the European Union and European Economic Area, 2002 to 2011. Euro Surveill, 2013, 18(12):20431.","journal-title":"Euro Surveill"},{"issue":"12","key":"ref13","doi-asserted-by":"publisher","first-page":"20432","DOI":"10.2807\/ese.18.12.20432-en","article-title":"Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011","volume":"18","author":"Solovic","year":"2013","unstructured":"[14] Solovic I, Jonsson J, Korzeniewska-Kose\u0142a M, Chiotan DI, Pace-Asciak A, Slump E, Rumetshofer R, Abubakar I, Kos S, Svetina-Sorli P, Haas W, Bauer T, Sandgren A, van der Werf MJ. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011. Euro Surveill, 2013, 18(12):20432.","journal-title":"Euro Surveill"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"[15] Pang Y, An J, Shu W, Huo F, Chu N, Gao M, Qin S, Huang H, Chen X, Xu S. Epidemiology of extrapulmonary tuberculosis among inpatients, China, 2008-2017. Emerg Infect Dis, 2019, 25(3):457-464. https:\/\/doi.org\/10.3201\/eid2503.180572","DOI":"10.3201\/eid2503.180572"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"[16] Kruijshaar ME, Abubakar I. Increase in extrapulmonary tuberculosis in England and Wales 1999-2006. Thorax, 2009, 64(12):1090-1095. https:\/\/doi.org\/10.1136\/thx.2009.118133","DOI":"10.1136\/thx.2009.118133"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"[17] Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis, 2009, 49(9):1350-1357. https:\/\/doi.org\/10.1086\/605559","DOI":"10.1086\/605559"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"[18] Lo Cascio CM, Kaul V, Dhooria S, Agrawal A, Chaddha U. Diagnosis of tuberculous pleural effusions: a review. Respir Med, 2021, 188:106607. https:\/\/doi.org\/10.1016\/j.rmed.2021.106607","DOI":"10.1016\/j.rmed.2021.106607"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"[19] Li C, Liu C, Sun B, Zhang W, Wang Y, Sun J, Ma F, Chen Y. Performance of Xpert\u00ae MTB\/RIF in diagnosing tuberculous pleuritis using thoracoscopic pleural biopsy. BMC Infect Dis, 2020, 20(1):840. https:\/\/doi.org\/10.1186\/s12879-020-05578-3","DOI":"10.1186\/s12879-020-05578-3"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"[20] Shaw JA, Diacon AH, Koegelenberg CFN. Tuberculous pleural effusion. Respirology, 2019, 24(10):962-971. https:\/\/doi.org\/10.1111\/resp.13673","DOI":"10.1111\/resp.13673"},{"key":"ref20","unstructured":"[21] Centers for Disease Control and Prevention (CDC). Reported Tuberculosis in the United States, 2017. CDC, Atlanta, GA, USA, 2018."},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"[22] Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, Keane J, Lewinsohn DA, Loeffler AM, Mazurek GH, O'Brien RJ, Pai M, Richeldi L, Salfinger M, Shinnick TM, Sterling TR, Warshauer DM, Woods GL. Official American Thoracic Society\/Infectious Diseases Society of America\/Centers for Disease Control and Prevention Clinical Practice Guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis, 2017, 64(2):111-115. https:\/\/doi.org\/10.1093\/cid\/ciw778","DOI":"10.1093\/cid\/ciw778"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"[23] Zhai K, Lu Y, Shi HZ. Tuberculous pleural effusion. J Thorac Dis, 2016, 8(7):E486-E494. https:\/\/doi.org\/10.21037\/jtd.2016.05.87","DOI":"10.21037\/jtd.2016.05.87"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"[24] Jeon D. Tuberculous pleurisy: an update. Tuberc Respir Dis (Seoul), 2014, 76(4):153-159. https:\/\/doi.org\/10.4046\/trd.2014.76.4.153","DOI":"10.4046\/trd.2014.76.4.153"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"[25] Porcel JM, Esquerda A, Vives M, Bielsa S. Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses. Arch Bronconeumol, 2014, 50(5):161-165. https:\/\/doi.org\/10.1016\/j.arbres.2013.11.007","DOI":"10.1016\/j.arbres.2013.11.007"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"[26] Light RW. Update on tuberculous pleural effusion. Respirology, 2010, 15(3):451-458. https:\/\/doi.org\/10.1111\/j.1440-1843.2010.01723.x","DOI":"10.1111\/j.1440-1843.2010.01723.x"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"[27] Baumann MH, Nolan R, Petrini M, Lee YCG, Light RW, Schneider E. Pleural tuberculosis in the United States: incidence and drug resistance. Chest, 2007, 131(4):1125-1132. https:\/\/doi.org\/10.1378\/chest.06-2352","DOI":"10.1378\/chest.06-2352"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"[28] Andreu J, C\u00e1ceres J, Pallisa E, Martinez-Rodriguez M. Radiological manifestations of pulmonary tuberculosis. Eur J Radiol, 2004, 51(2):139-149. https:\/\/doi.org\/10.1016\/j.ejrad.2004.03.009","DOI":"10.1016\/j.ejrad.2004.03.009"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"[29] Seibert AF, Haynes J Jr, Middleton R, Bass JB Jr. Tuberculous pleural effusion. Twenty-year experience. Chest, 1991, 99(4):883-886. https:\/\/doi.org\/10.1378\/chest.99.4.883","DOI":"10.1378\/chest.99.4.883"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"[30] Zheng WQ, Hu ZD. Pleural fluid biochemical analysis: the past, present and future. Clin Chem Lab Med, 2022, 61(5):921-934. https:\/\/doi.org\/10.1515\/cclm-2022-0844","DOI":"10.1515\/cclm-2022-0844"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"[31] Porcel JM, Azzopardi M, Koegelenberg CF, Maldonado F, Rahman NM, Lee YCG. The diagnosis of pleural effusions. Expert Rev Respir Med, 2015, 9(6):801-815. https:\/\/doi.org\/10.1586\/17476348.2015.1098535","DOI":"10.1586\/17476348.2015.1098535"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"[32] von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT, Chung PK, Rautenbach C, Wasserman E, Bernasconi M, Friedrich SO, Diacon AH. The yield of different pleural fluid volumes for Mycobacterium tuberculosis culture. Thorax, 2013, 68(3):290-291. https:\/\/doi.org\/10.1136\/thoraxjnl-2012-202338","DOI":"10.1136\/thoraxjnl-2012-202338"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"[33] Zeng T, Ling B, Hu X, Wang S, Qiao W, Gao L, Shen Y, Li D. The value of adenosine deaminase 2 in the detection of tuberculous pleural effusion: a meta-analysis and systematic review. Can Respir J, 2022, 2022:7078652. https:\/\/doi.org\/10.1155\/2022\/7078652","DOI":"10.1155\/2022\/7078652"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"[34] Garcia-Zamalloa A, Vicente D, Arnay R, Arrospide A, Taboada J, Castilla-Rodr\u00edguez I, Aguirre U, M\u00fagica N, Aldama L, Aguinagalde B, Jimenez M, Biku\u00f1a E, Basauri MB, Alonso M, Perez-Trallero E; with the Gipuzkoa Pleura Group Consortium. 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, 2021, 16(11):e0259203. https:\/\/doi.org\/10.1371\/journal.pone.0259203","DOI":"10.1371\/journal.pone.0259203"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"[35] Li Y, Tian S, Huang Y, Dong W. Driverless artificial intelligence framework for the identification of malignant pleural effusion. Transl Oncol, 2021, 14(1):100896. https:\/\/doi.org\/10.1016\/j.tranon.2020.100896","DOI":"10.1016\/j.tranon.2020.100896"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"[36] Chen Z, Chen K, Lou Y, Zhu J, Mao W, Song Z. Machine learning applied to near-infrared spectra for clinical pleural effusion classification. Sci Rep, 2021, 11(1):9411. https:\/\/doi.org\/10.1038\/s41598-021-87736-4","DOI":"10.1038\/s41598-021-87736-4"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"[37] Ren Z, Hu Y, Xu L. Identifying tuberculous pleural effusion using artificial intelligence machine learning algorithms. Respir Res, 2019, 20(1):220. https:\/\/doi.org\/10.1186\/s12931-019-1197-5","DOI":"10.1186\/s12931-019-1197-5"},{"key":"ref37","unstructured":"[38] Nicolosu D, Ple\u015fea IE, Demetrian AD, Ple\u015fea RM, Popescu EL, Str\u00e2mbu IR, T\u0103taru T. The clinical-morphological profile of tuberculous pleurisies - our experience in relation to literature data. Rom J Morphol Embryol, 2019, 60(2):555-565."},{"key":"ref38","unstructured":"[39] Ojo O. Pleural fluid interpretation. Geeky Medics, Laboratory Test Interpretation, Nov 16, 2018."},{"key":"ref39","unstructured":"[40] Cadogan M. Pleural fluid analysis. Life in the Fastlane, Feb 23, 2023."},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"[41] Mercer RM, Corcoran JP, Porcel JM, Rahman NM, Psallidas I. Interpreting pleural fluid results. Clin Med (Lond), 2019, 19(3):213-217. https:\/\/doi.org\/10.7861\/clinmedicine.19-3-213","DOI":"10.7861\/clinmedicine.19-3-213"},{"key":"ref41","unstructured":"[42] Boka K. Pleural effusion workup. Medscape, Drugs & Diseases, Pulmonology, Jun 26, 2024."},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"[43] Romero-Candeira S, Fern\u00e1ndez C, Mart\u00edn C, S\u00e1nchez-Paya J, Hern\u00e1ndez L. Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure. Am J Med, 2001, 110(9):681-686. https:\/\/doi.org\/10.1016\/s0002-9343(01)00726-4","DOI":"10.1016\/S0002-9343(01)00726-4"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"[44] Na MJ. Diagnostic tools of pleural effusion. Tuberc Respir Dis (Seoul), 2014, 76(5):199-210. https:\/\/doi.org\/10.4046\/trd.2014.76.5.199","DOI":"10.4046\/trd.2014.76.5.199"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"[45] Diacon AH, Van de Wal BW, Wyser C, Smedema JP, Bezuidenhout J, Bolliger CT, Walzl G. Diagnostic tools in tuberculous pleurisy: a direct comparative study. Eur Respir J, 2003, 22(4):589-591. https:\/\/doi.org\/10.1183\/09031936.03.00017103a","DOI":"10.1183\/09031936.03.00017103a"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"[46] Vald\u00e9s L, San Jos\u00e9 ME, Pose A, Gude F, Gonz\u00e1lez-Barcala FJ, \u00c1lvarez-Doba\u00f1o JM, Sahn SA. Diagnosing tuberculous pleural effusion using clinical data and pleural fluid analysis. A study of patients less than 40 years-old in an area with a high incidence of tuberculosis. Respir Med, 2010, 104(8):1211-1217. https:\/\/doi.org\/10.1016\/j.rmed.2010.02.025","DOI":"10.1016\/j.rmed.2010.02.025"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"[47] Gupta BK, Bharat V, Bandyopadhyay D. Role of adenosine deaminase estimation in differentiation of tuberculous and non-tuberculous exudative pleural effusions. J Clin Med Res, 2010, 2(2):79-84. https:\/\/doi.org\/10.4021\/jocmr2010.03.280w","DOI":"10.4021\/jocmr2010.03.280w"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"[48] Antonangelo L, Vargas FS, Seiscento M, Bombarda S, Teixera L, Sales RK. Clinical and laboratory parameters in the differential diagnosis of pleural effusion secondary to tuberculosis or cancer. Clinics (Sao Paulo), 2007, 62(5):585-590. https:\/\/doi.org\/10.1590\/s1807-59322007000500009","DOI":"10.1590\/S1807-59322007000500009"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"[49] Liao M, Yang Q, Zhang J, Zhang M, Deng Q, Liu H, Graner MW, Kornfeld H, Zhou B, Chen X. Gamma interferon immunospot assay of pleural effusion mononuclear cells for diagnosis of tuberculous pleurisy. Clin Vaccine Immunol, 2014, 21(3):347-353. https:\/\/doi.org\/10.1128\/CVI.00680-13","DOI":"10.1128\/CVI.00680-13"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"[50] Wang XJ, Yang Y, Wang Z, Xu LL, Wu YB, Zhang J, Tong ZH, Shi HZ. Efficacy and safety of diagnostic thoracoscopy in undiagnosed pleural effusions. Respiration, 2015, 90(3):251-255. https:\/\/doi.org\/10.1159\/000435962","DOI":"10.1159\/000435962"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"[51] Dhooria S, Singh N, Aggarwal AN, Gupta D, Agarwal R. A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions. Respir Care, 2014, 59(5):756-764. https:\/\/doi.org\/10.4187\/respcare.02738","DOI":"10.4187\/respcare.02738"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"[52] Prabhu VG, Narasimhan R. The role of pleuroscopy in undiagnosed exudative pleural effusion. Lung India, 2012, 29(2):128-130. https:\/\/doi.org\/10.4103\/0970-2113.95304","DOI":"10.4103\/0970-2113.95304"},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"[53] Wilsher ML, Veale AG. Medical thoracoscopy in the diagnosis of unexplained pleural effusion. Respirology, 1998, 3(2):77-80. https:\/\/doi.org\/10.1111\/j.1440-1843.1998.tb00100.x","DOI":"10.1111\/j.1440-1843.1998.tb00100.x"},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"[54] Munavvar M, Khan MAI, Edwards J, Waqaruddin Z, Mills J. The autoclavable semirigid thoracoscope: the way forward in pleural disease? Eur Respir J, 2007, 29(3):571-574. https:\/\/doi.org\/10.1183\/09031936.00101706","DOI":"10.1183\/09031936.00101706"},{"key":"ref54","doi-asserted-by":"publisher","unstructured":"[55] Ferrer J, Rold\u00e1n J, Teixidor J, Pallisa E, Gich I, Morell F. Predictors of pleural malignancy in patients with pleural effusion undergoing thoracoscopy. Chest, 2005, 127(3):1017-1022. https:\/\/doi.org\/10.1378\/chest.127.3.1017","DOI":"10.1378\/chest.127.3.1017"},{"key":"ref55","doi-asserted-by":"publisher","unstructured":"[56] Blanc FX, Atassi K, Bignon J, Housset B. Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study. Chest, 2002, 121(5):1677-1683. https:\/\/doi.org\/10.1378\/chest.121.5.1677","DOI":"10.1378\/chest.121.5.1677"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"[57] Hansen M, Faurschou P, Clementsen P. Medical thoracoscopy, results and complications in 146 patients: a retrospective study. Respir Med, 1998, 92(2):228-232. https:\/\/doi.org\/10.1016\/s0954-6111(98)90100-7","DOI":"10.1016\/S0954-6111(98)90100-7"},{"key":"ref57","doi-asserted-by":"publisher","unstructured":"[58] DePew ZS, Wigle D, Mullon JJ, Nichols FC, Deschamps C, Maldonado F. Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative. Chest, 2014, 146(2):398-405. https:\/\/doi.org\/10.1378\/chest.13-2113","DOI":"10.1378\/chest.13-2113"},{"key":"ref58","doi-asserted-by":"publisher","unstructured":"[59] Ahmed MM, AbdElhalim HA, Shoukri AM, Abdelatty ME. Role of GeneXpert in diagnosing tuberculous pleural effusion compared with thoracoscopic pleural biopsy. Egypt J Chest Dis Tuberc, 2020, 69(2):380-385. https:\/\/doi.org\/10.4103\/ejcdt.ejcdt_97_19","DOI":"10.4103\/ejcdt.ejcdt_97_19"},{"key":"ref59","doi-asserted-by":"publisher","unstructured":"[60] Wang Z, Xu LL, Wu YB, Wang XJ, Yang Y, Zhang J, Tong ZH, Shi HZ. Diagnostic value and safety of medical thoracoscopy in tuberculous pleural effusion. Respir Med, 2015, 109(9):1188-1192. https:\/\/doi.org\/10.1016\/j.rmed.2015.06.008","DOI":"10.1016\/j.rmed.2015.06.008"},{"key":"ref60","doi-asserted-by":"publisher","unstructured":"[61] Choi H, Chon HR, Kim K, Kim S, Oh KJ, Jeong SH, Jung WJ, Shin B, Jhun BW, Lee H, Park HY, Koh WJ. Clinical and laboratory differences between lymphocyte- and neutrophil-predominant pleural tuberculosis. PLoS One, 2016, 11(10):e0165428. https:\/\/doi.org\/10.1371\/journal.pone.0165428","DOI":"10.1371\/journal.pone.0165428"},{"key":"ref61","doi-asserted-by":"publisher","unstructured":"[62] Vald\u00e9s L, Alvarez D, San Jos\u00e9 E, Penela P, Valle JM, Garc\u00eda-Pazos JM, Su\u00e1rez J, Pose A. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med, 1998, 158(18):2017-2021. https:\/\/doi.org\/10.1001\/archinte.158.18.2017","DOI":"10.1001\/archinte.158.18.2017"},{"key":"ref62","doi-asserted-by":"publisher","unstructured":"[63] Yang X, Zhang J, Liang Q, Pan L, Duan H, Yang Y, Li H, Guo C, Sun Q, Jia H, Du B, Wei R, Xing A, Zhang Z, Chen X. 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, 2021, 21(1):4. https:\/\/doi.org\/10.1186\/s12879-020-05676-2","DOI":"10.1186\/s12879-020-05676-2"},{"key":"ref63","unstructured":"[64] Dhingra VK, Rajpal S, Aggarwal N, Aggarwal JK. Treatment of tuberculous pleural effusion patients and their satisfaction with DOTS - 1\u00bd year follow up. Indian J Tuberc, 2004, 51(4):209-212."},{"key":"ref64","unstructured":"[65] Aho K, Brander E, P\u00e4ti\u00e4l\u00e4 J. Studies for primary drug resistance in tuberculosis pleurisy. Scand J Respir Dis Suppl, 1968, 63:111-114."},{"key":"ref65","doi-asserted-by":"publisher","unstructured":"[66] Epstein DM, Kline LR, Albelda SM, Miller WT. Tuberculous pleural effusions. Chest, 1987, 91(1):106-109. https:\/\/doi.org\/1378\/chest.91.1.106","DOI":"10.1378\/chest.91.1.106"},{"key":"ref66","doi-asserted-by":"publisher","unstructured":"[67] Ruan SY, Chuang YC, Wang JY, Lin JW, Chien JY, Huang CT, Kuo YW, Lee LN, Yu CJ. Revisiting tuberculous pleurisy: pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area. Thorax, 2012, 67(9):822-827. https:\/\/doi.org\/10.1136\/thoraxjnl-2011-201363","DOI":"10.1136\/thoraxjnl-2011-201363"},{"key":"ref67","doi-asserted-by":"publisher","unstructured":"[68] Ilgazli A, Boyaci H, Basyigit I, Yildiz F. Extrapulmonary tuberculosis: clinical and epidemiologic spectrum of 636 cases. Arch Med Res, 2004, 35(5):435-441. https:\/\/doi.org\/10.1016\/j.arcmed.2004.05.008","DOI":"10.1016\/j.arcmed.2004.05.008"},{"key":"ref68","doi-asserted-by":"publisher","unstructured":"[69] Bielsa S, Acosta C, Pardina M, Civit C, Porcel JM. Tuberculous pleural effusion: clinical characteristics of 320 patients [Derrame pleural tuberculoso: caracter\u00edsticas cl\u00ednicas de 320 pacientes]. Arch Bronconeumol (Engl Ed), 2019, 55(1):17-22. https:\/\/doi.org\/10.1016\/j.arbres.2018.04.014","DOI":"10.1016\/j.arbres.2018.04.014"},{"key":"ref69","unstructured":"[70] Xiong Y, Gao X, Zhu H, Ding C, Wang J. Role of medical thoracoscopy in the treatment of tuberculous pleural effusion. J Thorac Dis, 2016, 8(1):52-60. https:\/\/doi.org\/10.3978\/j.issn.2072-1439.2016.01.34"},{"key":"ref70","doi-asserted-by":"publisher","unstructured":"[71] Dinu\u0163 AP, Zaharia DC, Dumitrache-Rujinski S, Toma CL, Bogdan MA. Clinical features and biochemical pleural fluid analysis - valuable tools for the diagnosis of tuberculous pleurisy. Arch Balk Med Union, 2020, 55(4):608-615. https:\/\/doi.org\/10.31688\/ABMU.2020.55.4.07","DOI":"10.31688\/ABMU.2020.55.4.07"},{"key":"ref71","doi-asserted-by":"publisher","unstructured":"[72] Reddy SL, Varaprasad K, Narahari N, Bhaskar K, Varma GR, Paramjyothi GK. Clinical and etiological profile of an exudative pleural effusion in a tertiary care center. Indian J Respir Care, 2019, 8(1):22. https:\/\/doi.org\/10.4103\/ijrc.ijrc_8_18","DOI":"10.4103\/ijrc.ijrc_8_18"},{"key":"ref72","doi-asserted-by":"publisher","unstructured":"[73] Shu CC, Wang JT, Wang JY, Lee LN, Yu CJ. In-hospital outcome of patients with culture-confirmed tuberculous pleurisy: clinical impact of pulmonary involvement. BMC Infect Dis, 2011, 11:46. https:\/\/doi.org\/10.1186\/1471-2334-11-46","DOI":"10.1186\/1471-2334-11-46"},{"key":"ref73","doi-asserted-by":"publisher","unstructured":"[74] Porcel JM. Tuberculous pleural effusion. Lung, 2009, 187(5):263-270. https:\/\/doi.org\/10.1007\/s00408-009-9165-3","DOI":"10.1007\/s00408-009-9165-3"},{"key":"ref74","doi-asserted-by":"publisher","unstructured":"[75] Agrawal S. Study of adenosine deaminase activity as a biochemical marker of cell mediated immunity in tuberculous meningitis, tuberculous pleural effusion and tuberculous ascites. J Med, 2012, 13(1):32-37. https:\/\/doi.org\/10.3329\/jom.v13i1.9065","DOI":"10.3329\/jom.v13i1.9065"},{"key":"ref75","unstructured":"[76] \u00c7irak AK, Tekg\u00fcl S, Bila\u00e7ero\u011flu S, K\u00f6m\u00fcrc\u00fco\u011flu B, U\u00e7ar MA, Yalniz E. Diagnostic values of pleural fluid and serum C-reactive protein, adenosine deaminase, and lactate dehydrogenase levels and pleural fluid\/serum ratios in the differentiation of malignant from benign pleural effusions. \u0130zmir G\u00f6\u011f\u00fcs Hastanesi Dergisi, 2012, 26(2):75-82."},{"key":"ref76","doi-asserted-by":"publisher","unstructured":"[77] Jim\u00e9nez Castro D, D\u00edaz Nuevo G, P\u00e9rez-Rodr\u00edguez E, Light RW. Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions. Eur Respir J, 2003, 21(2):220-224. https:\/\/doi.org\/110.1183\/09031936.03.00051603","DOI":"10.1183\/09031936.03.00051603"},{"key":"ref77","doi-asserted-by":"publisher","unstructured":"[78] Lee YC, Rogers JT, Rodriguez RM, Miller KD, Light RW. Adenosine deaminase levels in nontuberculous lymphocytic pleural effusions. Chest, 2001, 120(2):356-361. https:\/\/doi.org\/10.1378\/chest.120.2.356","DOI":"10.1378\/chest.120.2.356"},{"key":"ref78","doi-asserted-by":"publisher","unstructured":"[79] Porcel JM. Advances in the diagnosis of tuberculous pleuritis. Ann Transl Med, 2016, 4(15):282. https:\/\/doi.org\/10.21037\/atm.2016.07.23","DOI":"10.21037\/atm.2016.07.23"},{"key":"ref79","doi-asserted-by":"publisher","unstructured":"[80] Villena Garrido V, Cases Viedma E, Fern\u00e1ndez Villar A, de Pablo Gafas A, P\u00e9rez Rodr\u00edguez E, Porcel P\u00e9rez JM, Rodr\u00edguez Panadero F, Ruiz Mart\u00ednez C, Salvatierra Vel\u00e1zquez A, Vald\u00e9s Cuadrado L. Recommendations of diagnosis and treatment of pleural effusion. Update. Arch Bronconeumol, 2014, 50(6):235-249. https:\/\/doi.org\/10.1016\/j.arbres.2014.01.016","DOI":"10.1016\/j.arbres.2014.01.016"},{"key":"ref80","doi-asserted-by":"publisher","unstructured":"[81] Zari\u0107 B, Kuruc V, Milovan\u010dev A, Markovic M, \u0160ar\u010dev T, \u010canak V, Pavlovi\u0107 S. Differential diagnosis of tuberculous and malignant pleural effusions: what is the role of adenosine deaminase? Lung, 2008, 186(4):233-240. https:\/\/doi.org\/10.1007\/s00408-008-9085-7","DOI":"10.1007\/s00408-008-9085-7"},{"key":"ref81","unstructured":"[82] Bansal P, Kansal HM, Goyal S, Bansal P. Tuberculous pleural effusion: a study on 250 patients. J Med Sci Res, 2010, 1(2):46-49."},{"key":"ref82","doi-asserted-by":"publisher","unstructured":"[83] Pasricha P, Suri JC, Goel A, Chauhan S. Clinical and roentgenological profiles and etiological correlations of encysted pleural effusions. Respiration, 1990, 57(1):40-44. https:\/\/doi.org\/10.1159\/000195817","DOI":"10.1159\/000195817"},{"key":"ref83","doi-asserted-by":"publisher","unstructured":"[84] Ferreiro L, San Jos\u00e9 E, Vald\u00e9s L. Tuberculous pleural effusion. Arch Bronconeumol, 2014, 50(10):435-443. https:\/\/doi.org\/10.1016\/j.arbres.2013.07.006","DOI":"10.1016\/j.arbres.2013.07.006"},{"key":"ref84","doi-asserted-by":"publisher","unstructured":"[85] Antony VB, Sahn SA, Antony AC, Repine JE. Bacillus Calmette-Gu\u00e9rin-stimulated neutrophils release chemotaxins for monocytes in rabbit pleural spaces and in vitro. J Clin Invest, 1985, 76(4):1514-1521. https:\/\/doi.org\/10.1172\/JCI112131","DOI":"10.1172\/JCI112131"},{"key":"ref85","unstructured":"[86] Hurwitz S, Leiman G, Shapiro C. Mesothelial cells in pleural fluid: TB or not TB? S Afr Med J, 1980, 57(23):937-939."},{"key":"ref86","doi-asserted-by":"publisher","unstructured":"[87] Light RW, Erozan YS, Ball WC Jr. Cells in pleural fluid. Their value in differential diagnosis. Arch Intern Med, 1973, 132(6):854-860. https:\/\/doi.org\/10.1001\/archinte.1973.03650120060011\"","DOI":"10.1001\/archinte.1973.03650120060011"}],"container-title":["Romanian Journal of Morphology and Embryology"],"original-title":[],"deposited":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T05:53:27Z","timestamp":1740635607000},"score":1,"resource":{"primary":{"URL":"https:\/\/rjme.ro\/archive\/65\/4\/17\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,13]]},"references-count":87,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2,13]]},"published-print":{"date-parts":[[2025,2,20]]}},"URL":"https:\/\/doi.org\/10.47162\/rjme.65.4.17","relation":{},"ISSN":["1220-0522","2066-8279"],"issn-type":[{"value":"1220-0522","type":"print"},{"value":"2066-8279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,13]]}}}