Pleural fluid protein content, ldh activity and cholesterol level were measured to investigate their utility in differentiating the exudates from the transudates. Globally, pleural tb remains one of the most frequent causes of pleural exudates, particularly in tb. Tuberculous pleural effusion tpe is one of the most common forms of. It was concluded that ada measurement in the pleural fluid is an appropriate, fast diagnostic tool for the diagnosis of tuberculous pleural effusion, with higher. The modern diagnosis and management of pleural effusions. Pleural disease remains a commonly encountered clinical problem for both general physicians and chest specialists. In 93 tuberculous pleural effusions, there were sonographic appearances of an anechoic pattern in 12% 1193, a complex septated pattern in 47% 4493, and a complex. Tuberculosis pleural effusion tpe is common in clinical practice, and its diagnosis remains a challenge for clinicians. Pleural effusions are common, with an estimated 11.
To evaluate patients who have a paradoxical response development of new opacities to treatment for tuberculous pleural effusion not related to acquired immunodeficiency syndrome. A study was carried out among 20patients of tb pleural effusion, of which 3 could be followed for a period of 3months. Diagnosing tuberculous pleural effusion using clinical data and pleural fluid analysis. So far, no formal guidelines are available for diagnosis and treatment of tuberculous pleurisy. Glucose, lactate dehydrogenase ldh, proteins, white. In the usa, tuberculous pleurisy is fairly uncommon. In 20, 23% of reported tb cases were culturenegative in the united states.
One of the lowest rates is reported from spain with 10 % 5. The management of idiopathic pleural effusion remains controversial. Background tuberculous pleural effusion is the second most common form of extrapulmonary tuberculosis. Tuberculous pleurisy tp diagnosis remains difficult, with the sensitivity of xpert mtbrif xpert and mycobacterial culture culture only about 3050%. Differential diagnosis of lymphocytic pleural effusions between tuberculous tbe and malignant me effusion is usually difficult in daily practice. Unfortunately, many pf analyses lack enough sensitivity or specificity, which may ultimately lead to requesting. Tuberculous tb pleural effusion is a buildup of fluid in the space between the lining of the lung and the lung tissue pleural space after a severe, usually longterm infection with tuberculosis. The relationship between the geriatric population and. Tuberculous pleural effusion was diagnosed if the patient had m tuberculosis cultured from sputum, pleura, or pleural fluid. Objectives to determine the age at which tuberculous pleural effusions occur, the radiological and biochemical characteristics of the effusions, the sensitivities of the various diagnostic tests, and the utility of combining clinical, radiological, and analytic data in diagnosis methods we studied the case histories of 254 patients in whom tuberculous pleural effusions were diagnosed with. Dickinson, franklin lakes, nj, usa, or with manual culture methods that. Score for differentiating pleural tuberculosis from. However, effective clinical biomarkers were rarely explored. For this crosssectional study, 150 consecutive patients with pleural effusion.
A rational diagnostic workup, emphasizing the most common. Afb cultures are positive in less than 50% of tuberculous effusions, but are highly specific when positive. The diagnostic utility of pleural markers for tuberculosis. It aims to be evidence based together with some practical. In order to provide the evidencebased updated information. A study of patients less than 40 yearsold in an area with a high incidence of tuberculosis. The pleural space usually holds only a small amount of fluid.
Tuberculosis tb is an important cause of morbidity and mortality in the united states. But if too much fluid fills the space, it can make it hard or painful to breathe. It may be a consequence of infection extending from other sites after pneumonectomy, or it can occur when the contents of a bronchopleural fistula cavity are released into the pleural space. Diagnosing tuberculous pleural effusion using clinical data and. The diagnosis of a tuberculous pleural effusion tpe requires a positive culture from pleural fluid or pleural tissue or the presence of granulomas in the pleura. Depending on its cause, pleurisy can be associated with an accumulation of fluid in the space between the lungs and chest wall called a pleural effusion or it. Diagnosing tuberculous pleural effusion using clinical. The pleura are 2 layers of thin, smooth tissue that surround the lungs and line the chest. Cellfree mycobacterium tuberculosis dna test in pleural.
Tuberculous pleural effusion occurs in approximately 5% of patients with. Tuberculous pleurisy is categorized as extrapulmonary tb despite the intimate anatomical relationship between the pleural membranes and the lungs. According to the world health organization, there were an estimated 9. Pleural tuberculosis tb diagnosis often requires invasive procedures such as pleural biopsy. By predefined criteria, 31 of these effusions were classified as transudates and 31 as exudates. Scribd is the worlds largest social reading and publishing site. Novel tests for diagnosing tuberculous pleural effusion. Considering the totally different prognosis and clinical treatment of tpe and mpe, the accurate and noninvasive diagnosis are very critical for patients with pleural effusion to initiate efficient management and treatment.
The hiv pandemic has been associated with a doubling of the incidence of extrapulmonary tb. Tuberculous pleural effusion occurs in approximately 5% of patients with mycobacterium tuberculosis tb infection 1 and accounts for 4% of all tb cases in the united states. Because the longterm evolution of this entity is not well known, two different approaches, aggressive and conservative, have been proposed. Our aim was to develop a score to differentiate tbe from me effusions. Tuberculous pleural effusion zhai journal of thoracic. Tuberculous pleural effusion uf health, university of. Our understanding of the pathogenesis of the disease has evolved and what was once thought to be an effusion as a result of a pure delayed hypersensitivity reaction is now believed to be the consequence of direct infection of the pleural space with a cascade of events including an. Au gopi a, madhavan sm, sharma sk, sahn sa so chest. A study of loculated tuberculous pleural effusions treated with. Tuberculous pleuritis is a common manifestation of extrapulmonary tuberculosis tb and is the most common cause of pleural effusion in many countries. Tuberculosis pleural effusion tpe and malignant pleural effusion mpe are very common clinical complications. Pleurisy means inflammation of the pleura, the membrane that lines the lungs within the chest cavity. A diagnosis of pleural effusion may be suggested by characteristic symptoms e.
Tuberculosis pleural effusions and a case of empyema necessitatis. Ziehlneelsen staining, pe mycobacterium tuberculosis culture, and biopsy are the gold standards for tpe diagnosis. The aims of the study were to assess the patient compliance with the management methods for tuberculous pleural effusion, the end. Cureus sputum smear and culturenegative tuberculosis.
A pleural effusion describes an excess of fluid in the pleural cavity, usually resulting from an imbalance in the normal rate of pleural fluid production or absorption, or both. Evaluation of realtime pcr of patient pleural effusion. Diagnosis and treatment of tuberculous pleural effusion in 2006. In this prospective study of 70 patients with pleural effusion, the underlying disease could be identified in 62 cases. Tuberculous pleural effusion tbpe is the most common form of. Am example of the impact of a high hivendemic environment on the incidence of tuberculous pleurisy is also given in a series from ruanda, where tb accounted for as much as 86 % of all diagnosed pleural effusions 4. Due to the unpredictable or nonspecific nature of its clinical presentations, tb can be a diagnostic challenge for physicians. Tuberculous pleural effusion is synonymous with the term tuberculous pleurisy.
Diagnostic dilemma in tuberculous pleural effusion sciencedirect. The mcnemar test was used to compare concordance among the tests. We aimed to assess the diagnostic performance of a cellfree mycobacterium tuberculosis dna test cftb in pleural effusion for tp. Most tb pleural effusions are exudates with high adenosine deaminase ada, lymphocyte. A cohort of 8 consecutive patients with pleural effusion was prospectively studied from may 2014 through june 2017. Tuberculous pleural effusion is the second most common form of extrapulmonary tuberculosis after lymphatic involvement and is the most common cause of pleural effusion in areas where tuberculosis is endemic. Pleural fluid adenosine deaminase detection for the diagnosis of pleural tuberculosis compared using the students ttest. Tuberculous tb pleural effusion occurs in approximately 5% of patients with mycobacterium tuberculosis infection. With this model, 216 of the 218 effusions were classified correctly sensitivity 99. Development of a clinical prediction rule for the diagnosis of pleural. Pleural fluid adenosine deaminase detection for the. We assessed 26 cases of tuberculous pleural effusion admitted in bangabandhu sheikh mujib medical university. The characteristic profile of a tuberculous pleural effusion is an exudate with a lymphocyte predominance associated with an ada level 40 ul. A pleural effusion represents the disruption of the normal mechanisms of formation and drainage of fluid from the pleural space.
Evaluation of the patient with pleural effusion cmaj. Identification of differentially expressed mirnas in. We conducted a 10year study of the evolution of idiopathic pleural effusion. Tuberculous pleurisy an overview sciencedirect topics. Tuberculosis accounts for millions of active disease cases and deaths in both developed and developing countries.
1189 1190 72 354 1061 375 988 1246 244 325 516 1154 403 125 220 466 1209 1555 428 1094 1550 321 1012 1344 487 82 408 649 1320 1552 1394 832 649 354 1206 1061 626 1020 307 1261 536 1416 601 1011