Cytokine polarization in miliary and pleural tuberculosis

J Clin Immunol. 2002 Nov;22(6):345-52. doi: 10.1023/a:1020604331886.


Cytokines were measured in patients with pleural effusion and miliary tuberculosis (TB). Patients with pleural effusion had significantly higher interferon-gamma (IFN-gamma) levels (P < 0.001) in their pleural fluid as compared to that of peripheral blood of the same patients, thus exhibiting localization of predominantly Th1-type immunity in the pleural fluid. On the contrary, patients with miliary TB had higher IFN-gamma levels in the peripheral blood as compared to their bronchoalveolar lavage fluid. Moreover, the median IFN-gamma: IL-4 ratio in the peripheral blood of miliary TB patients was two-fold higher as compared to bronchoalveolar lavage fluid, suggesting that the cytokine profile at the disease site is skewed toward a Th2-like bias. Further, flow cytometry data revealed a significantly higher (P < 0.001) percentage of CD4+ pleural fluid lymphocytes expressing IFN-gamma, whereas in the miliary TB, a nine-fold higher percentage of lymphocytes in bronchoalveolar lavage fluid expressed IL-4 in comparison with their peripheral CD4 T cells. Our data indicate, respectively, a Th1-like and Th2-like response in tuberculous pleural effusion and miliary TB, suggesting that these clinical forms of extrapulmonary tuberculosis probably reflect the extreme ends of a Th1-Th2 spectrum of the disease.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bronchoalveolar Lavage Fluid / chemistry
  • Bronchoalveolar Lavage Fluid / cytology
  • CD4-Positive T-Lymphocytes / immunology
  • Cytokines / analysis*
  • Cytokines / blood
  • Female
  • Flow Cytometry
  • Humans
  • Male
  • Pleural Effusion / chemistry
  • Pleural Effusion / cytology
  • Tuberculosis, Miliary / blood
  • Tuberculosis, Miliary / immunology*
  • Tuberculosis, Pleural / blood
  • Tuberculosis, Pleural / immunology*


  • Cytokines