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Tuberculous Pleural Effusion

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Practical Manual of Pleural Pathology

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Abstract

Tuberculous pleural effusion accounts for about 25% of cases of extra-pulmonary tuberculosis. The clinical picture is usually characterised by an acute or sub-acute onset with fever, cough and chest pain. The clinical picture of tuberculous pleurisy is not indicative and is similar to that of acute infectious pleurisy of other aetiology. The effusion is generally a unilateral lymphocytic exudate, with a low glucose level. Blood laboratory tests in tuberculous pleurisy are not indicative. Pleural fluid cytology almost always reveals lymphocytosis, and it is important to perform the differential count of the cells of the pleural fluid, since in 90% of cases, lymphocytosis is present, and this can be a useful guide to the exact diagnosis.

The culture test on pleural fluid is positive in approximately 30% of cases. In many situations, only the pleural biopsy enables us to obtain the correct diagnosis.

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References

  1. Murray JF, Nadel JA. Textbook of respiratory medicine. 2nd ed. Philadelphia, PA: W.B. Saunders; 1994. p. 1094–160.

    Google Scholar 

  2. Casalini AG. Il ruolo della toracoscopia nella patologia pleurica tubercolare. In: Casalini AG, editor. Pneumologia Interventistica. Milan: Springer; 2007.

    Chapter  Google Scholar 

  3. Qiu L, Teeter LD, Liu Z, Ma X, Musser JM, Graviss EA. Diagnostic associations between pleural and pulmonary tuberculosis. J Infect. 2006;53(6):377–86. https://doi.org/10.1016/j.jinf.2005.12.023. Epub 2006 Feb 7. PMID: 16466663.

    Article  PubMed  Google Scholar 

  4. Kim HJ, Lee HJ, Kwon SY, Yoon HI, Chung HS, Lee CT, Han SK, Shim YS, Yim JJ. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest. 2006;129(5):1253–8. https://doi.org/10.1378/chest.129.5.1253. PMID: 16685016.

    Article  PubMed  Google Scholar 

  5. Porcel JM, Vives M. Differentiating tuberculous from malignant pleural effusions: a scoring model. Med Sci Monit. 2003;9(5):CR175-80. PMID: 12761453.

    PubMed  Google Scholar 

  6. Valdés L, Alvarez D, San José E, Penela P, Valle JM, García-Pazos JM, Suárez J, Pose A. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med. 1998;158(18):2017–21. https://doi.org/10.1001/archinte.158.18.2017. PMID: 9778201.

    Article  PubMed  Google Scholar 

  7. Hooper C, Lee YC, Maskell N, BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(Suppl. 2):ii4–17. https://doi.org/10.1136/thx.2010.136978. PMID: 20696692.

    Article  PubMed  Google Scholar 

  8. Antony VB, Godbey SW, Kunkel SL, Hott JW, Hartman DL, Burdick MD, Strieter RM. Recruitment of inflammatory cells to the pleural space. Chemotactic cytokines, IL-8, and monocyte chemotactic peptide-1 in human pleural fluids. J Immunol. 1993;151(12):7216–23. PMID: 8258721.

    Article  CAS  PubMed  Google Scholar 

  9. Valdés L, San José ME, Pose A, Gude F, González-Barcala FJ, Alvarez-Dobaño JM, Sahn SA. Diagnosing tuberculous pleural effusion using clinical data and pleural fluid analysis A study of patients less than 40 years-old in an area with a high incidence of tuberculosis. Respir Med. 2010;104(8):1211–7. https://doi.org/10.1016/j.rmed.2010.02.025. Epub 2010 Mar 26. PMID: 20347287.

    Article  PubMed  Google Scholar 

  10. Jeon D. Tuberculous pleurisy: an update. Tuberc Respir Dis (Seoul). 2014;76(4):153–9. https://doi.org/10.4046/trd.2014.76.4.153. Epub 2014 Apr 25. PMID: 24851127; PMCID: PMC4021261.

    Article  PubMed  Google Scholar 

  11. Bielsa S, Palma R, Pardina M, Esquerda A, Light RW, Porcel JM. Comparison of polymorphonuclear- and lymphocyte-rich tuberculous pleural effusions. Int J Tuberc Lung Dis. 2013;17(1):85–9. https://doi.org/10.5588/ijtld.12.0236. Epub 2012 Nov 15. PMID: 23164256.

    Article  CAS  PubMed  Google Scholar 

  12. Casalini AG, Mori PA, Majori M, Anghinolfi M, Silini EM, Gnetti L, Motta F, Larini S, Montecchini S, Pisi R, Calderaro A. Pleural tuberculosis: medical thoracoscopy greatly increases the diagnostic accuracy. ERJ Open Res. 2018;4(1):00046–2017. https://doi.org/10.1183/23120541.00046-2017. PMID: 29318136; PMCID: PMC5754561.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ruan SY, Chuang YC, Wang JY, Lin JW, Chien JY, Huang CT, Kuo YW, Lee LN, Yu CJ. Revisiting tuberculous pleurisy: pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area. Thorax. 2012;67(9):822–7. https://doi.org/10.1136/thoraxjnl-2011-201363. Epub 2012 Mar 21. PMID: 22436167; PMCID: PMC3426072.

    Article  PubMed  Google Scholar 

  14. Conde MB, Loivos AC, Rezende VM, Soares SL, Mello FC, Reingold AL, Daley CL, Kritski AL. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med. 2003;167(5):723–5. https://doi.org/10.1164/rccm.2111019. PMID: 12598215.

    Article  PubMed  Google Scholar 

  15. Stead WW, Eichenholz A, Stauss HK. Operative and pathologic findings in twenty-four patients with syndrome of idiopathic pleurisy with effusion, presumably tuberculous. Am Rev Tuberc. 1955;71(4):473–502. https://doi.org/10.1164/artpd.1955.71.4.473. PMID: 14361964.

    Article  CAS  PubMed  Google Scholar 

  16. Majori M, Mori PA, Anghinolfi M, Pisi R, Gnetti L, Motta F, Calderaro A, Casalini AG. Tubercolosi pleurica multir-esistente in gravidanza: challenge diagnostico e terapeutico. Mutidrug-resistent tuberculous pleural effusion in pregnant woman: diagnostic and therapeutic challenge. Rassegna di Patologia dell’Apparato Respiratorio. 2014;29:282–4.

    Google Scholar 

  17. Chaudhry K, Tafti D, Siccardi MA. Anembryonic pregnancy. StatPearls. Treasure Island, FL: StatPearls Publishing; 2021. PMID: 29763113.

    Google Scholar 

  18. Anevlavis S, Varga C, Nam TH, Man RWC, Demetriou A, Jain N, Lanfranco A, Froudarakis ME. Is there any role for thoracoscopy in the diagnosis of benign pleural effusions. Clin Respir J. 2019;13(2):73–81. https://doi.org/10.1111/crj.12983. PMID: 30578625.

    Article  PubMed  Google Scholar 

  19. Engel ME, Matchaba PT, Volmink J. Corticosteroids for tuberculous pleurisy. Cochrane Database Syst Rev. 2007;(4):CD001876. https://doi.org/10.1002/14651858.CD001876.pub2. Update in: Cochrane Database Syst Rev. 2017;3: CD001876. PMID: 17943759.

  20. Berger HW, Mejia E. Tuberculous pleurisy. Chest. 1973;63(1):88–92. https://doi.org/10.1378/chest.63.1.88. PMID: 4630686.

  21. Epstein DM, Kline LR, Albelda SM, Miller WT. Tuberculous pleural effusions. Chest. 1987;91(1):106–9. https://doi.org/10.1378/chest.91.1.106. PMID: 3792061.

  22. Seibert AF, Haynes J Jr, Middleton R, Bass JB Jr. Tuberculous pleural effusion. Twenty-year experience. Chest. 1991;99(4):883–6. https://doi.org/10.1378/chest.99.4.883. PMID: 1901261.

  23. Haro M, Ruiz-Manzano J, Gallego M, Abad J, Manterola JM, Morera J. Tuberculosis pleural: análisis de 105 casos [Pleural tuberculosis: analysis of 105 cases]. Enferm Infecc Microbiol Clin. 1996;14(5):285–9. Spanish. PMID: 8744366.

    Google Scholar 

  24. Kirsch CM, Kroe DM, Azzi RL, Jensen WA, Kagawa FT, Wehner JH. The optimal number of pleural biopsy specimens for a diagnosis of tuberculous pleurisy. Chest. 1997;112(3):702–6. https://doi.org/10.1378/chest.112.3.702. PMID: 9315802.

  25. Diacon AH, Van de Wal BW, Wyser C, Smedema JP, Bezuidenhout J, Bolliger CT, Walzl G. Diagnostic tools in tuberculous pleurisy: a direct comparative study. Eur Respir J. 2003;22(4):589–91. https://doi.org/10.1183/09031936.03.00017103a. PMID: 14582908.

  26. Sakuraba M, Masuda K, Hebisawa A, Sagara Y, Komatsu H. Thoracoscopic pleural biopsy for tuberculous pleurisy under local anesthesia. Ann Thorac Cardiovasc Surg. 2006;12(4):245–8. PMID: 16977293.

    Google Scholar 

  27. Hansen M, Faurschou P, Clementsen P. Medical thoracoscopy, results and complications in 146 patients: a retrospective study. Respir Med. 1998;92(2):228–32. https://doi.org/10.1016/s0954-6111(98)90100-7. PMID: 9616517.

  28. Thomas, M., Ibrahim, W.H., Raza, T. et al. Medical thoracoscopy for exudative pleural effusion: an eight-year experience from a country with a young population. BMC Pulm Med. 2017;17:151. https://doi.org/10.1186/s12890-017-0499-y.

  29. Wang Z, Xu LL, Wu YB, Wang XJ, Yang Y, Zhang J, Tong ZH, Shi HZ. Diagnostic value and safety of medical thoracoscopy in tuberculous pleural effusion. Respir Med. 2015;109(9):1188–92. https://doi.org/10.1016/j.rmed.2015.06.008. Epub 2015 Jul 3. PMID: 26166016.

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  1. Parma, Italy

    Angelo G. Casalini

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    Angelo G. Casalini

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Casalini, A.G. (2023). Tuberculous Pleural Effusion. In: Casalini, A.G. (eds) Practical Manual of Pleural Pathology. Springer, Cham. https://doi.org/10.1007/978-3-031-20312-1_13

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  • DOI: https://doi.org/10.1007/978-3-031-20312-1_13

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