HIV Pleural effusion

Pleural effusion in HIV -an approach diagnosis : 

Pleural effusion in HIV -an approach diagnosis Dr Jody Mbuilu* M.D.(UniLu-2004), Dip.Med (UK), Cert. HIV (FPD-Pretoria) *Reviewer in Cardiovascular Journal of Africa

Plan : 

Plan Introduction Initial approach The transudate The exudate Conclusion 8/3/2010 2 HIV- Pleural effusion

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8/3/2010 HIV- Pleural effusion 3

Introduction : 

Introduction The burden of HIV in south Africa is apparent in day to day clinic practice with an estimate Mortalite of 26 % of all cause of death Prevalence of 29,5% among pregnant woman The occurrence of Pleural effusion in HIV patient is common: 55/222 patients (27%) Joseph J.,HIV in hospitalised patients Ann Int Med 1993 Other studies 10- 40 % 8/3/2010 4 HIV- Pleural effusion

Initial approach : 

Initial approach Light’s criteria, study published in 1972, pleural fluid may be classified as exudate if one or more of the following criteria are met: Protein- Pleural fluid /serum > 0,5 LDH fluid/serum > 0,6 LDH more than 2/3 of upper limit for serum 2 criteria are more specific of exudate 8/3/2010 5 HIV- Pleural effusion

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8/3/2010 6 HIV- Pleural effusion

The transudate : 

The transudate Cardiac disease (CMP 24 %) Aggressive course of liver disease HIV Nephropathy 10% Hypo- albuminaemia All having a prognostic value 8/3/2010 HIV- Pleural effusion 7

The exudate : 

The exudate Parapneumonic effusion Most common cause of ex-pleural effusion 50% CXR show evidence of pneumonia Causes includes: S pneumonidae, S aureus, H influenzae and P auruginosa Pneumocystis jirovechi seldom cause 4 % 8/3/2010 HIV- Pleural effusion 8

The exudate : 

The exudate Empyema Frequency of 1% of pleural effusion in HIV patients Characteristic Loculated pleural effusion Fluid < pH 7.2 Fluid < glucose 3.3 Positive gram stain bacteria Pus in pleural space 8/3/2010 HIV- Pleural effusion 9

The exudate : 

The exudate Tuberculous pleural effusion 2nd cause after bacterial pneumonia Gold standard – mycobacteria AFB/ culture – positive – 33- 91%, pleural biopsy 44-69% Fluid Adenosine deaminase (ADA) > 55 + lymphocyte/neutro ratio 0.75 --- Se 88%, Sp 95% Trial treatment is recommended by guidelines 8/3/2010 HIV- Pleural effusion 10

The exudate : 

The exudate Other infection: Mycobacterium avium, CMV, Aspergillus species, Cryptococcus neoformans, Nocardia species, Leishmania donovani, Toxoplasmosis gondii and septic emboli 8/3/2010 HIV- Pleural effusion 11

The exudate : 

The exudate Malignancies - Kaposi’s sarcoma 47-75% of patient with cutaneous KS have pleural involvement, 60% pleural effusion Bilateral, massive and bloody Pleural effusion + LN pH the mostly greater than 7.44 Mononuclear cells LDH 111-330 IU/l Glucose > 3.3 mmol/l Open lung biopsy- 75 % HHV-8 DNA in BAL Se100%, Sp98.9% 8/3/2010 HIV- Pleural effusion 12

The exudate : 

The exudate Lymphoma NHL frequent complication in HIV 1- 14% of pulmonary involvement 68% of thoracic NHL + pleural effusion Close lung biopsy gold standard diagnosis 8/3/2010 HIV- Pleural effusion 13

The exudate : 

The exudate 8/3/2010 HIV- Pleural effusion 14

Conclusion : 

Conclusion Pneumonia and tuberculosis account for the majority of pleural effusion in HIV population Others causes must be keep in mind… Clinical examination --- co-morbidity, CXR, cytology, microscopy, culture, biochemestry, biopsy, BAL 8/3/2010 HIV- Pleural effusion 15

Thank you : 

8/3/2010 HIV- Pleural effusion 16 Thank you SA Fam Pract 2009;51(4):280-2.