Tuberculous Pleural Effusion: A study on 250 patients

The average prevalence of all forms of tuberculosis in India is estimated to be 5.05 per thousand, prevalence of smear-positive cases 2.27 per thousand and average annual incidence of smear-positive cases at 84 per 1,00,000 annually.¹⁰⁰⁴ Tuberculosis is a common cause of pleural effusion in India. Recent studies of populations with a high prevalence of tuberculosis report that tuberculous pleural effusion occurs in approximately 30% of patients with tuberculosis.³

To report our experience of 250 patients with tuberculous pleural effusion.

250 patients suffering from tuberculous pleural effusion were included in the study. Thorough history taking and physical examinations, radiological findings, hematological and serum biochemical profiles were recorded. Pleural aspiration and biopsy were also performed. At least two pieces of pleural tissue were taken and one piece of each sample of pleural tissue was cultured for mycobacteria and the rest was sent for histological examination. Macroscopic findings, cytological, microbiological and biochemical analysis of pleural fluid were analyzed.

Main symptoms noted were fever, cough and breathlessness, followed by chest pain. Blood count mainly revealed lymphocytosis. ADA and LDH were raised in almost all cases. 2 (0.8%) patients had bilateral pleural effusion and 43 (17.2%) patients had associated parenchymal lesion. All patients responded well to anti-tubercular treatment alongwith steroid and thoracentesis.

The definitive diagnosis of TB pleural effusions depends on the demonstration of M tuberculosis in sputum, pleural fluid, or pleural biopsy specimens. Supportive evidence includes demonstration of classical TB granulomas in the pleura and elevated adenosine deaminase (ADA), lactate dehydrogenase (LDH) and alkaline phosphates levels in pleural fluid. Pleural fluid analysis can be an important tool in patients of pleural effusion.