Pleural tuberculosis

Abstract

Pleural effusions in tuberculosis are commonly seen in young adults as an immunological phenomenon occurring soon after primary infection. However, the epidemiology and demographics of tuberculous pleurisy are changing due to the impact of HIV co-infection and the increasing number of pleural effusions seen as part of re-activation disease. Pleural biopsy for histology and culture is the mainstay of diagnosis with closed needle biopsy adequate in the majority of cases. Techniques such as PCR of biopsy specimens and the role of pleural fluid ADA are still being evaluated as a diagnostic aid. Tuberculous empyema is less commonly seen in the western world and the diagnostic yield from pleural fluid here is greater than in “primary” effusions. Treatment with appropriate antituberculous chemotherapy is generally successful though there is currently insufficient evidence to recommend the routine use of corticosteroids in this condition.

Diagnostic Value of Pleural Effusion Mononuclear Cells Count and Adenosine Deaminase for Tuberculous Pleurisy Patients in China: A Case-Control Study

“…In this study, the two study groups were different in age and chronic diseases, such as diabetes, arrhythmia, coronary heart disease, chronic gastritis. One study indicated that pleural tuberculosis was most commonly seen in adolescents and young adults (28), which was similar with this study. Another study found out that, compared with tuberculosis patients who had diabetes, the incidence of pleurisy is reduced in the tuberculosis patients who do not have diabetes (29).…”

Pleural Tuberculosis: A Febrile Presentation Without Respiratory Symptoms

“…It is hypothesized that TB can be the culprit of up to 80% of pleural effusions in these locations [ 8 ]. The epidemiology and traditional demographics of TB haVe been shifting with more data showing increased presence with HIV co-infection and those that are immunosuppressed [ 9 ]. PT is the most common extrapulmonary form in adults [ 10 ].…”

JAID/JSC Guidelines for the Treatment of Respiratory Infectious Diseases: The Japanese Association for Infectious Diseases/Japanese Society of Chemotherapy – The JAID/JSC Guide to Clinical Management of Infectious Disease/Guideline-preparing Committee Respiratory Infectious Disease WG

“…When pus is obtained on thoracentesis, a definitive diagnosis of pyothorax is made. When the protein level in nonpurulent pleural effusion is high, tuberculous pleuritis should be differentiated [244].…”