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1 Chief, Pulmonary Disease Service, Mount Sinai Hospital Services-City Hospital Center at Elmhurst; Associate Professor of Clinical Medicine, Mount Sinai School of Medicine of the City University of New York
2 Department of Medicine, Mount Sinai Hospital Services-City Hospital Center at Elmhurst, Elmhurst, New York; Mount Sinai School of Medicine of the City University of New York, New York City
The average age of patients with tuberculous pleurisy is increasing and the disease is now commonly seen in middle and old age. Abrupt onset occurs in two-thirds of cases and may resemble acute bacterial pneumonia. The temperature may not be elevated above normal in occasional patients when they are first examined. Initial intermediate strength tuberculin or tine tests are negative in almost one-third of patients but upon repeat of these tests or performance of second strength tests a positive reaction is invariably obtained. The pleural effusion is usually unilateral, most commonly less than one-half the volume of the hemithorax but may involve the entire hemithorax, and is associated with active pulmonary lesions in slightly more than one-third of the cases. Pleural fluid lymphocytosis of 95-100 percent is found in most cases but is a nonspecific finding. Serosanguinous fluid is rarely present. Pleural fluid protein is almost invariably above 3 gm/100 ml and LDH levels are usually elevated. The frequency of diminished pleural fluid glucose has been overemphasized in the previous literature. Less than one-fifth of patients have values below 50 mg/100 ml but none has had a level less than 30 mg/100 ml in our series of cases. Pleural biopsy histologic examination and pleural biopsy culture for tuberculous organisms are each positive in more than two-thirds of patients. Pleural fluid culture demonstrates tubercle bacilli less frequently than biopsy culture and sputum or gastric cultures are usually negative unless pulmonary lesions are present. Treatment for two years with isoniazid and ethambutol or with isoniazid and para-aminosalicylic acid produces excellent results and development of new pulmonary lesions, recurrence of pleural effusion, or a need for pleural decortication are very rare.
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