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Pleural Tuberculosis in the United States^*

Incidence and Drug Resistance

^* From the University of Mississippi Medical Center (Drs. Baumann, Nolan, and Petrini), Jackson, MS; Oxford University (Dr. Lee), Oxford, UK; Vanderbilt University (Dr. Light), Nashville, TN; and the Centers for Disease Control and Prevention (Dr. Schneider), Atlanta, GA.

Correspondence to: Michael H. Baumann, MD, MS, FCCP, Professor of Medicine, 2500 North State St, Division of Pulmonary and Critical Care Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4505; e-mail: mbaumann{at}medicine.umsmed.edu

Abstract

Background: Pleural tuberculosis (TB) should be considered in any patient with a lymphocytic pleural effusion. The diagnostic approach is under debate. Knowledge of pleural TB epidemiology would be beneficial. To help clarify pleural TB epidemiology, we analyzed US national TB surveillance data for 1993 to 2003.

Methods: We compared pleural TB to pulmonary TB (where each was reported as the major site of TB disease, and no additional sites of disease were reported). Applicable statistical tests were performed; p < 0.05 was considered to be significant.

Results: From 1993 through 2003, 7,549 cases of pleural TB and 156,779 cases of pulmonary TB were reported (in 2003: pleural TB, 536 cases; pulmonary TB, 10,551 cases). The annual proportion of pleural TB was relatively stable (median rate, 3.6%; range, 3.3 to 4.0%) compared to that for pulmonary TB, which steadily decreased (average annual decrease, 0.9%; p < 0.01). Pleural TB occurred significantly more often than pulmonary TB among persons 65 years old (30.4% vs 23.3%, respectively; p < 0.01), and it occurred significantly less often among children < 15 years old (1.8% vs 6.1%, respectively; p < 0.01) and persons 45 to 64 years old (22.9% vs 27.9%, respectively; p < 0.01). Pleural TB patients (63.4%) were born slightly more often in the United States than were pulmonary TB patients (60.9%; p < 0.01). Drug-resistance patterns of pleural TB broadly reflected those of pulmonary TB. However, isolates from pleural TB patients were less often resistant to at least isoniazid (6.0% vs 7.8%, respectively; p < 0.01) and to at least one first-line TB drug (9.9% vs 11.9%, respectively; p < 0.01) compared with pulmonary TB patients.

Conclusions: Knowledge of pleural TB demographic, clinical, and drug-resistance patterns may assist clinicians in making diagnostic and therapeutic decisions.

Key Words: pleura • resistance • tuberculosis