Current Respiratory Medicine Reviews - Online First

Primary pleural hydatidosis is a rare manifestation of cystic echinococcosis, a zoonotic parasitic disease caused by Echinococcus granulosus. While the liver and lungs are the most common sites of infection, pleural involvement is uncommon and often overlooked. This review aims to provide a comprehensive overview of primary pleural hydatid cysts by analyzing their epidemiological patterns, clinical presentations, diagnostic approaches, treatment strategies, and patient outcomes.

A systematic literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar, without time restrictions, employing MeSH terms related to pleural and extrapulmonary hydatidosis. Forty-four articles published between 1964 and 2024 were included, yielding data on 36 patients.

A total of 36 cases of primary pleural hydatid cysts were identified from 34 published reports. Patients’ ages ranged from 10 to 79 years (median, 24 years), with a male predominance (58.3%). The most frequently reported symptoms were chest pain (58%), dyspnea (50%), cough (47%), and fever (31%), while thoracic masses and asymptomatic presentations were less common (11% each). Right-sided pleural involvement was observed in 64% of cases. Hydatid serology was positive in 13 patients, negative in 5, and unreported in 18. Pleural fluid analysis was performed in 4 cases, all of which were positive for Echinococcus granulosus or hydatid-specific IgG. Imaging primarily included chest X-ray (83%), computed tomography (92%), and ultrasound (14%). Treatment strategies included surgery alone (47%), surgery with postoperative albendazole (39%), combined pre- and postoperative albendazole with surgery (11%), and albendazole monotherapy (3%). The most favorable outcomes were observed with combined pre- and post-operative albendazole and surgery (100%), followed by surgery with post-operative albendazole (71%).

Primary pleural hydatid cysts are exceptionally rare, with only a few cases reported worldwide. Their pathogenesis remains unclear, although hematogenous dissemination may explain isolated pleural involvement without hepatic or pulmonary disease. Clinical manifestations are often nonspecific, and diagnosis relies primarily on imaging, particularly computed tomography, which aids both detection and surgical planning. Serological tests may support diagnosis but have limited specificity. Surgery remains the treatment of choice, while adjuvant albendazole therapy helps reduce the risk of recurrence.

Given the rarity and non-specific presentation of primary pleural hydatid disease, a high index of clinical suspicion is necessary. Early diagnosis and combined surgical and medical treatment generally result in good prognoses. Further studies are warranted to refine diagnostic and therapeutic protocols.

Interstitial Lung Diseases (ILDs) involve chronic inflammation and fibrosis. Neutrophil-to-Lymphocyte Ratio (NLR) and Systemic Immune-inflammation Index (SII) are potential systemic inflammation markers. This retrospective case-control study evaluated NLR and SII in Idiopathic Pulmonary Fibrosis (IPF) and Connective-Tissue-Disease-associated ILD (CTD-ILD).

Medical records from a Bengaluru tertiary-care centre were reviewed (November 2022–November 2023). 120 ILD patients (60 IPF, 60 CTD-ILD) were compared with 120 healthy controls. Patients with COPD, asthma, infections, malignancies, or haematological disorders were excluded. NLR and SII were calculated from routine blood counts at diagnosis. ANOVA was used for statistical analysis (p < 0.05).

Both markers were significantly elevated in ILD patients versus controls. Mean NLR: IPF 6.38 ± 2.1, CTD-ILD 4.53 ± 1.8, controls 1.93 ± 0.9 (p < 0.0001). Mean SII: IPF 1,425.2 ± 510.4, CTD-ILD 1,417.7 ± 478.6, controls 551.4 ± 210.3 (p < 0.0001). No significant difference existed between IPF and CTD-ILD groups (p > 0.05).

Elevated NLR and SII reflect heightened systemic inflammation in ILD, supporting their utility as accessible biomarkers. Similar values between IPF and CTD-ILD suggest limited discriminatory power for subtyping but validate their role in assessing inflammatory burden.

NLR and SII are significantly elevated in ILD patients, validating their clinical utility as markers of inflammation. Further prospective studies should establish prognostic value and optimal integration into clinical assessment.

This study aimed to assess the efficacy of inhaled topical capsaicin versus placebo in reducing cough frequency and cough sensitivity scores in patients with chronic cough. To address this objective, a systematic review and meta-analysis of randomized controlled trials (RCTs) were performed.

Web of Science, Embase, PubMed, Cochrane Library, CNKI, Weipu, and Wanfang were searched for RCTs evaluating capsaicin for the treatment of chronic cough. Studies were screened, their quality assessed, and data extracted; those that failed to meet the inclusion criteria were excluded. A systematic review and meta-analysis were then performed on the eligible studies.

This meta-analysis was prospectively registered in PROSPERO. A total of five high-quality RCTs were included. Compared to the control group, there was a statistically significant reduction in cough frequency (Z=18.52, p < 0.00001, 95% CI: 2.09-2.59). Additionally, the difference in cough sensitivity scores was also statistically significant (Z=18.88, p < 0.00001, 95% CI: 1.33-1.65).

While the results of this meta-analysis suggest that capsaicin may have a beneficial effect on chronic cough, the findings are limited by the small number of trials and the relatively small sample sizes included in the analysis.

Capsaicin represents a novel therapeutic strategy for chronic cough, suggesting it a non-traditional antitussive treatment. Further well-designed, large-scale randomized controlled trials are needed to confirm its efficacy, elucidate its long-term mechanisms, and support the development of standardized clinical guidelines.