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doi:10.1378/chest.06-2063
(Chest. 2007; 131:880-889)
© 2007 American College of Chest Physicians
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Diagnosis and Treatment of Tuberculous Pleural Effusion in 2006*

Arun Gopi, MBBS; Sethu M. Madhavan, MD; Surendra K. Sharma, MD, PhD and Steven A. Sahn, MD, FCCP

* From the Division of Pulmonary and Critical Care Medicine (Drs. Gopi, Madhavan, and Sharma), Department of Medicine, All India Institute of Medical Sciences, New Delhi, India; and Division of Pulmonary, Critical Care, Allergy and Sleep Medicine (Dr. Sahn), Medical University of South Carolina, Charleston, SC.

Correspondence to: Steven A. Sahn, MD, FCCP, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Jonathan Lucas St, Suite 812-CSB, PO Box 250360, Charleston, SC 29426; e-mail: sahnsa{at}musc.edu

Abstract

Tuberculous (TB) pleural effusion occurs in approximately 5% of patients with Mycobacterium tuberculosis infection. The HIV pandemic has been associated with a doubling of the incidence of extrapulmonary TB, which has resulted in increased recognition of TB pleural effusions even in developed nations. Recent studies have provided insights into the immunopathogenesis of pleural TB, including memory T-cell homing and chemokine activation. The definitive diagnosis of TB pleural effusions depends on the demonstration of acid-fast bacilli in the sputum, pleural fluid, or pleural biopsy specimens. The diagnosis can be established in a majority of patients from the clinical features, pleural fluid examination, including cytology, biochemistry, and bacteriology, and pleural biopsy. Measurement of adenosine deaminase and interferon-{gamma} in the pleural fluid and polymerase chain reaction for M tuberculosis has gained wide acceptance in the diagnosis of TB pleural effusions. Although promising, these tests require further evaluation before their routine use can be recommended. The treatment of TB pleural effusions in patients with HIV/AIDS is essentially similar to that in HIV-negative patients. At present, evidence regarding the use of corticosteroids in the treatment of TB pleural effusion is not clear-cut.

Key Words: adenosine deaminase • diagnosis • corticosteroids • interferon-{gamma} • pathogenesis • polymerase chain reaction • treatment • tuberculous pleural effusions






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Copyright © 2007 by the American College of Chest Physicians.