Table 2.: Clinical Characteristics and Pleural Fluid Analysis in Unusual Infections of the Pleura

Organisms R. conorii[3] C. burnetii [11] C. burnetii [12] F. tularensis[20] F. tularensis[21] F. tularensis[21] B. anthracis[35] B. anthracis[26]

Age (years) 30 41 45 37 66 52 61 94

Gender Male Male Male Female Male Male Female Female

Location Greece Northern Ireland Spain United States Finland Finland United States United States

Occupation Farmer Bricklayer Pharmaceuti-cal factory worker; spent weekends in the countryside Landscaping Gardener Retired farmer Central supply room hospital worker5 N/A

Medical history Healthy Healthy Healthy Healthy Healthy Tuberculosis 20 years ago Hypertension COPD, hypertension, chronic renal disease

Clinical presentation Headache, fever, chills, myalgia, dry cough, left pleuritic chest pain Cough, left sided pleuritic chest pain, anorexia, weight loss Acute fever, headaches, cough, asthenia, myalgia, arthralgia, weight loss, pleuritic pain Fever, chills, pleuritic chest pain, myalgias, headache, night sweats, dry cough Shortness of breath, chest pain, low-grade fever, abdominal pain Fever, dyspnea Weakness, chest heaviness, dyspnea, malaise, cough, chills Fever, fatigue, myalgias, cough, shortness of breath

Characterization of pleural effusion$$$ Exudate Exudate Transudate Exudate Exudate Exudate Exudate Exudate

Radiographic manifestations Left-sided pleural effusion Left-sided pleural effusion Bilateral pleural effusions Left-sided pleural effusion with ipsilateral hilar adenopa-thy Right- sided pleural effusion Right lower lobe infiltrate and ipsilateral pleural effusion Widened mediastinum, arge bilateral effusions, soft tissue edema Widened mediastinum, bilateral effusions

Pleural fluid analysis
Color N/A Straw Sanguineous Sanguineous Serosanguineous Serosanguineous Serosanguineous
pH 7.1 7.45 N/A N/A N/A N/A 7.12
TP (g/dL) 5.6 5.5 5.2 5.0 4.7 4.2 3.4
LDH (U/L) 560 N/A 1080 573 584 1264 611
Glucose  (mg/dL) 54 N/A 55 88.2 92 147 259.2
Total nucleated cell count (per µL) 1200 2,500 952 1,850 3000 N/A
Neutrophils (%) 73 49 N/A N/A N/A N/A
Lymph. (%) 27 48 90.5 71 N/A N/A
Eosinophils (%) 70

Serum antibodies 1:12481 1:1,2803 1:6404 1:6404
IgM 1:512 1:1922
IgG 1:1024 1:2048

Pleural fluid culture N/A N/A N/A F. tularensis F. tularensis N/A B. anthracis6 B. anthracis6

N/A: not available; Lymph.: lymphocytes; IFA: indirect immunofluorescent antibody; TP: Total protein; LDH: Lactate dehydrogenase; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; Alk. Phos: Alkaline phosphatase; IFA: indirect immunofluorescent antibody.
1. Antibodies against phase II form, did not specify whether IgM or IgG.
2. Antibodies were against phase II form, consistent with acute Q fever infection.
3. Initial titer was negative.
4. Initial titer was 1:160.
5. Her space at work was shared with a mail sorting room.
6. B. anthracis identified by PCR.
$$$ According to Light’s criteria and available information.