PDF(Pubmed)
Abstract：
Background Tuberculous effusions are common. Classically, they are described as bacteria poor and lymphocyte rich. Our experience, however, has been more varied. We compiled this rare group of bacteria-positive tuberculous fluids to document their cytologic spectrum and to look for possible predictors of bacillary positivity. Methods Fifty-one cases of bacillary positive fluids were identified and their clinicopathological details were noted. Per case, the smear background was assigned as either clear, caseous, suppurative, granular proteinaceous or frankly hemorrhagic. Fine, punched-out vacuoles in the smear background were also noted. The bacillary load in each case was classified from scanty to 3+. Eventually, the clinicopathologic variables were tabulated for frequency and studied for any association with bacillary presence. Results Only 19 of the 51 patients had a history of tuberculosis. Retropositive patients comprised a small proportion (9.8%) and did not always indicate strong (3+) bacillary positivity. The granular proteinaceous background was the most frequent (35%) pattern. Only a suppurative background was associated with strong bacillary positivity. Fine vacuoles were seen almost always with caseous and granular proteinaceous backgrounds but without statistical significance. Conclusion Tuberculous effusions can have diverse smear backgrounds, not necessarily one rich in caseous material. When tuberculosis is known or clinically suspected, non-classical findings such as abundant neutrophils or suppurative background should not dissuade one from requisitioning mycobacterial stains. In fact, acid-fast stains should probably routinely accompany Giemsa slides of clinically idiopathic effusions in endemic areas since it is still the cheapest and fastest method for a conclusive diagnosis.
摘要：
背景：结核性积液很常见。经典的,它们被描述为细菌贫乏和淋巴细胞丰富。我们的经验,然而,变得更加多样化。我们汇编了这组罕见的细菌阳性结核性液体，以记录其细胞学谱并寻找可能的细菌阳性预测因子。方法对51例细菌阳性液体进行鉴定，并记录其临床病理细节。每个案例，涂片背景被指定为清晰的，干酪,化脓性,颗粒状的蛋白质或坦率地出血性。很好，还注意到涂片背景中穿孔的空泡。每种情况下的细菌负荷从少量分类为3。最终,对临床病理变量的频率进行了列表,并研究了与细菌存在的任何关联.结果51例患者中只有19例有结核病史。逆转录阳性患者所占比例很小（9.8％），并不总是显示强（3）杆菌阳性。颗粒蛋白质背景是最常见的(35%)模式。只有化脓背景与强杆菌阳性相关。几乎总是在干酪样和颗粒状蛋白质背景下看到细液泡，但没有统计学意义。结论结核性积液具有不同的涂片背景,不一定富含干酪质。当已知或临床怀疑肺结核时，非经典的发现，如丰富的中性粒细胞或化脓性背景，不应该阻止一个从需要分枝杆菌染色。事实上,在流行地区，临床特发性积液的Giemsa载玻片通常应伴有耐酸染色，因为它仍然是决定性诊断的最便宜，最快的方法。
