Factors Affecting Morbidity in Chronic Tuberculous Empyema

Sönmezoğlu, Yaşar; Turna, Akif; Cevik, Ayse; Demir, Adalet; Sayar, Adnan; Dincer, Y; Bedirhan, Mehmet Ali; Gürses, Atilla

doi:10.1055/s-2007-965301

Cited by 16 publications

(12 citation statements)

References 10 publications

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“…Delayed recurrence are caused by many factors: (i) the initial pleura infection by Mycobacterium tuberculosis (before the operation) continues in pleural cavity and causes tuberculous empyema 13) ; (ii) the visceral pleura and lung tissue may be damaged during the operation, and the fiberboard not adequately stripped, especially the reflexed part; (iii) ineffective antituberculosis treatment after the operation, which may lead to drug-resistant tuberculosis. If the pleural effusion is not actively treated, it would cause pleural calcification and lead to serious impact on lung function (Supplemental Fig.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Video-Assisted Thoracic Surgical Decortication in 274 Patients with Tuberculous Empyema

Chen

Zhang

et al. 2015

ATCS

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Objective: The present work aimed to retrospectively assess the outcomes associated with decortication by video-assisted thoracic surgery (VATS) in patients with tuberculous empyema. Methods: Patients (n = 274) who underwent decortication by VATS for surgical management of pleural empyema between January 2000 to 2010 were included. Pre-, intra-, and postoperative characteristics were observed for all patients, which were followed up for 12 months to evaluate surgical outcomes such as postoperative complications and disease recurrence. Results: No patients required conversion to thoracotomy, and no death or postoperative bleeding was reported. The mean operation time was 104.5 ± 20.4 min, with 271.5 ± 41.3 ml intraoperative blood loss and median length of hospital stay of 7.2 ± 3 .4 days. Of the 274 patients, 262 were followed up for 12 months; 26 (9.9%) patients showed complications, including incomplete lung re-expansion (11 patients) and persistent air leak (6 patients). While early disease recurrence was observed in 3 (1.1%) patients after surgery, late recurrence was reported for 6 (2.3%) individuals. Interestingly, the complication rate was much higher in patients with chronic empyema (15/34, 44.1%) than in subjects with acute empyema (11/228, 4.8%). Conclusions: Decortication by VATS decreases postsurgical complications, and results in decreased disease recurrence. This study demonstrated improved outcomes by decortication by VATS, even in patients with stage III tuberculous empyema.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Video-Assisted Thoracic Surgical Decortication in 274 Patients with Tuberculous Empyema

Chen

Zhang

et al. 2015

ATCS

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“…It is important to note that TB empyema is both uncommon and a distinct entity from TB pleural effusion. It is the result of chronic active infection of the pleura, with the influx of neutrophils and subsequent development of a purulent effusion (which may have loculations), and eventually extensive thickening and calcification of the pleura . Occasionally, the infection extends through the parietal pleura into the chest wall, known as empyema necessitans , which may drain onto the skin through fistulae .…”

Section: Clinical Featuresmentioning

confidence: 99%

“…It is the result of chronic active infection of the pleura, with the influx of neutrophils and subsequent development of a purulent effusion (which may have loculations), and eventually extensive thickening and calcification of the pleura. 25 Occasionally, the infection extends through the parietal pleura into the chest wall, known as empyema necessitans, which may drain onto the skin through fistulae. 26 TB empyema is thought to arise through various mechanisms including progression of TB pleural effusion, direct spread of infection from a ruptured thoracic lymph node or a subdiaphragmatic focus, haematogenous spread from a distant focus, post-pneumonectomy and, in the historical context, following therapeutic pneumothorax, Lucite ball plombage or oleothorax.…”

Section: Tb Empyemamentioning

confidence: 99%

Tuberculous pleural effusion

2019

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Tuberculous effusion is a common disease entity with a spectrum of presentations from a largely benign effusion, which resolves completely, to a complicated effusion with loculations, pleural thickening and even frank empyema, all of which may have a lasting effect on lung function. The pathogenesis is a combination of true pleural infection and an effusive hypersensitivity reaction, compartmentalized within the pleural space. Diagnostic thoracentesis with thorough pleural fluid analysis including biomarkers such as adenosine deaminase and gamma interferon achieves high accuracy in the correct clinical context. Definitive diagnosis may require invasive procedures to demonstrate histological evidence of caseating granulomas or microbiological evidence of the organism on smear or culture. Drug resistance is an emerging problem that requires vigilance and extra effort to acquire a complete drug sensitivity profile for each tuberculous effusion treated. Nucleic acid amplification tests such as Xpert MTB/RIF can be invaluable in this instance; however, the yield is low in pleural fluid. Treatment consists of standard anti‐tuberculous therapy or a guideline‐based individualized regimen in the case of drug resistance. There is low‐quality evidence that suggests possible benefit from corticosteroids; however, they are not currently recommended due to concomitant increased risk of adverse effects. Small studies report some short‐ and long‐term benefit from interventions such as therapeutic thoracentesis, intrapleural fibrinolytics and surgery but many questions remain to be answered.

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“…Until recently, effusions related to TB were largely thought to be an immunological phenomenon; however, current diagnostic techniques frequently enable the isolation of TB from the effusion and pleura, suggesting that effusions are commonly the result of paucibacillary mycobacterial infections of the pleural space 6. TB pleural effusions often spontaneously resolve, leaving a thickened pleura7; however, up approximately two-third of patients will go on to develop active TB 8. Given this, there is a window of opportunity to diagnose these patients while they have features consistent with pleural TB, and as such a high index of suspicion is needed.…”

Section: Discussionmentioning

confidence: 99%

Pleural tuberculosis: a key differential diagnosis for pleural thickening, even without obvious risk factors for tuberculosis in a low incidence setting

Philip¹,

Kon

Roddie

et al. 2018

BMJ Case Reports

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We report the case of a 64-year-old woman, presenting with pleuritic chest pain and weight loss. She had a previous history of breast malignancy and no clear risk factors for tuberculosis (TB). Initial investigations showed a right-sided pleural effusion and pleural thickening suggestive of malignancy, which would have been in keeping with the clinical presentation. Initial pleural biopsy showed features suggestive of possible TB infection, though no growth on cultures. A repeat biopsy was negative on initial microscopy, but was culture positive for Mycobacterium tuberculosis, also identifying isoniazid resistance. This case highlights that TB remains an important differential even in the absence of classical risk factors, and illustrates the diagnostic challenges it poses. It also highlights the value of culture positivity in identification of drug resistance and facilitation of appropriate treatment.

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Factors Affecting Morbidity in Chronic Tuberculous Empyema

Abstract: Our findings indicate that open drainage leads to better results compared to those of Eloesser flap in patients with chronic tuberculous empyema. Patients who underwent pneumonectomy were expected to have higher complication rates and the procedure must therefore be avoided when possible.

Cited by 16 publications

References 10 publications

Outcomes of Video-Assisted Thoracic Surgical Decortication in 274 Patients with Tuberculous Empyema

Outcomes of Video-Assisted Thoracic Surgical Decortication in 274 Patients with Tuberculous Empyema

Tuberculous pleural effusion

Pleural tuberculosis: a key differential diagnosis for pleural thickening, even without obvious risk factors for tuberculosis in a low incidence setting

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