Tuberculous pleural effusion

Jane A. Shaw; Andreas H. Diacon; Coenraad F.N. Koegelenberg

doi:10.1111/resp.13673

journal article Aug 16, 2019

Tuberculous pleural effusion

Jane A. Shaw Andreas H. Diacon Coenraad F.N. Koegelenberg

Respirology Vol. 24 No. 10 pp. 962-971 · Wiley

View at Publisher Save 10.1111/resp.13673

Abstract

ABSTRACTTuberculous effusion is a common disease entity with a spectrum of presentations from a largely benign effusion, which resolves completely, to a complicated effusion with loculations, pleural thickening and even frank empyema, all of which may have a lasting effect on lung function. The pathogenesis is a combination of true pleural infection and an effusive hypersensitivity reaction, compartmentalized within the pleural space. Diagnostic thoracentesis with thorough pleural fluid analysis including biomarkers such as adenosine deaminase and gamma interferon achieves high accuracy in the correct clinical context. Definitive diagnosis may require invasive procedures to demonstrate histological evidence of caseating granulomas or microbiological evidence of the organism on smear or culture. Drug resistance is an emerging problem that requires vigilance and extra effort to acquire a complete drug sensitivity profile for each tuberculous effusion treated. Nucleic acid amplification tests such as Xpert MTB/RIF can be invaluable in this instance; however, the yield is low in pleural fluid. Treatment consists of standard anti‐tuberculous therapy or a guideline‐based individualized regimen in the case of drug resistance. There is low‐quality evidence that suggests possible benefit from corticosteroids; however, they are not currently recommended due to concomitant increased risk of adverse effects. Small studies report some short‐ and long‐term benefit from interventions such as therapeutic thoracentesis, intrapleural fibrinolytics and surgery but many questions remain to be answered.

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Details

Published: Aug 16, 2019
Vol/Issue: 24(10)
Pages: 962-971
License: View

Authors

J

Jane A. Shaw

Division of Pulmonology, Department of Medicine Tygerberg Academic Hospital and Stellenbosch University Cape Town South Africa

A

Andreas H. Diacon

Division of Pulmonology, Department of Medicine Tygerberg Academic Hospital and Stellenbosch University Cape Town South Africa

C

Coenraad F.N. Koegelenberg

Division of Pulmonology, Department of Medicine Tygerberg Academic Hospital and Stellenbosch University Cape Town South Africa

Cite This Article

Jane A. Shaw, Andreas H. Diacon, Coenraad F.N. Koegelenberg (2019). Tuberculous pleural effusion. Respirology, 24(10), 962-971. https://doi.org/10.1111/resp.13673

Tuberculous pleural effusion

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