Study of the Clinnical Characteristics and Outcomes of Exudative Pleural Effusion: Improving Clinical Decision Making in Resource Limited Setting

Abstract

Introduction: In the background of resource limited setting like Nepal, we set out to identify if specific clinical characteristics and basic lab parameters would guide differentiation of Tuberculous from other causes of exudative pleural effusion.Methodology: Retrospective study of 109 consecutive patients with exudative pleural effusion.Results: Compared to Tubercular pleural effusions (41.3%), increased age, increased duration of symptom and increased pack years statistically favoured a diagnosis of Malignant pleural effusion(21.1%), whereas presence of fever, cough and increased pleural ADA levels favoured Tubercular pleural effusions. With regards to Parapneumonic effusions (26.6%), a shorter duration of symptom, smaller effusions, higher pleural Neutrophils, lower pleural lymphocyte neutrophil ratio and lower ADA favoured the diagnosis as compared to Tubercular pleural effusions.Conclusions: The appreciation of important clinical and pleural biochemical differences between Tubercular and other major causes of exudative pleural effusions aids in improved clinical decision making with minimal resources in resource limited settings like ours.SAARC J TUBER LUNG DIS HIV/AIDS, 2017; XIV(1), page: 33-39

Study of diagnostic utility of Xpert MTB/Rif test on pleural fluid in the evaluation of patients presenting with Pleural Tuberculosis in Nepal

“…However, as only 17% (9/51) cases were diagnosed as pleural TB using these criteria, the generalization of such findings would be incorrect given that the prevalence of pleural TB in all exudative samples was 41.3% at the same center. [ 8 ] Further, since cases were only included after screening for clinico-radiologic suspicion of pleural TB, we would have expected a higher prevalence of the disease with such screening. In a study where Xpert MTB/Rif was done on thoracoscopic pleural biopsy, the sensitivity of Xpert was 69.0% against the CRS data and that against MGIT 960 culture was (56.6%).…”