The tuberculous pleural effusion
Pleural tuberculosis (TB) is a common entity with similar epidemiological characteristics to pulmonary TB. It represents a spectrum of disease that can variably self-resolve or progress to TB empyema with severe sequelae such as chronic fibrothorax or empyema necessitans. Coexistence of and progress...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2023-12-01
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| Series: | Breathe |
| Online Access: | http://breathe.ersjournals.com/content/19/4/230143.full |
| _version_ | 1797293783604264960 |
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| author | Emma McNally Clare Ross Laura E. Gleeson |
| author_facet | Emma McNally Clare Ross Laura E. Gleeson |
| author_sort | Emma McNally |
| collection | DOAJ |
| description | Pleural tuberculosis (TB) is a common entity with similar epidemiological characteristics to pulmonary TB. It represents a spectrum of disease that can variably self-resolve or progress to TB empyema with severe sequelae such as chronic fibrothorax or empyema necessitans. Coexistence of and progression to pulmonary TB is high. Diagnosis is challenging, as pleural TB is paucibacillary in most cases, but every effort should be made to obtain microbiological diagnosis, especially where drug resistance is suspected. Much attention has been focussed on adjunctive investigations to support diagnosis, but clinicians must be aware that apparent diagnostic accuracy is affected both by the underlying TB prevalence in the population, and by the diagnostic standard against which the specified investigation is being evaluated. Pharmacological treatment of pleural TB is similar to that of pulmonary TB, but penetration of the pleural space may be suboptimal in complicated effusions. Evidence for routine drainage is limited, but evacuation of the pleural space is indicated in complicated disease.
Educational aims
To demonstrate that pleural TB incorporates a wide spectrum of disease, ranging from self-resolving lymphocytic effusions to severe TB empyema with serious sequelae. To emphasise the high coexistence of pulmonary TB with pleural TB, and the importance of obtaining sputum for culture (induced if necessary) in all cases. To explore the significant diagnostic challenges posed by pleural TB, and consequently the frequent lack of information about drug sensitivity prior to initiating treatment. To highlight the influence of underlying TB prevalence in the population on the diagnostic accuracy of adjunctive investigations for the diagnosis of pleural TB. To discuss concerns around penetration of anti-TB medications into the pleural space and how this can influence decisions around treatment duration in practice. |
| first_indexed | 2024-03-07T21:20:51Z |
| format | Article |
| id | doaj.art-4d435776ff18438f864c30afdaf6d56f |
| institution | Directory Open Access Journal |
| issn | 1810-6838 2073-4735 |
| language | English |
| last_indexed | 2024-03-07T21:20:51Z |
| publishDate | 2023-12-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | Breathe |
| spelling | doaj.art-4d435776ff18438f864c30afdaf6d56f2024-02-27T11:58:24ZengEuropean Respiratory SocietyBreathe1810-68382073-47352023-12-0119410.1183/20734735.0143-20230143-2023The tuberculous pleural effusionEmma McNally0Clare Ross1Laura E. Gleeson2 Department of Respiratory Medicine, St James's Hospital, Dublin, Ireland Department of Respiratory Medicine, Imperial NHS Healthcare Trust, London, UK Department of Respiratory Medicine, St James's Hospital, Dublin, Ireland Pleural tuberculosis (TB) is a common entity with similar epidemiological characteristics to pulmonary TB. It represents a spectrum of disease that can variably self-resolve or progress to TB empyema with severe sequelae such as chronic fibrothorax or empyema necessitans. Coexistence of and progression to pulmonary TB is high. Diagnosis is challenging, as pleural TB is paucibacillary in most cases, but every effort should be made to obtain microbiological diagnosis, especially where drug resistance is suspected. Much attention has been focussed on adjunctive investigations to support diagnosis, but clinicians must be aware that apparent diagnostic accuracy is affected both by the underlying TB prevalence in the population, and by the diagnostic standard against which the specified investigation is being evaluated. Pharmacological treatment of pleural TB is similar to that of pulmonary TB, but penetration of the pleural space may be suboptimal in complicated effusions. Evidence for routine drainage is limited, but evacuation of the pleural space is indicated in complicated disease. Educational aims To demonstrate that pleural TB incorporates a wide spectrum of disease, ranging from self-resolving lymphocytic effusions to severe TB empyema with serious sequelae. To emphasise the high coexistence of pulmonary TB with pleural TB, and the importance of obtaining sputum for culture (induced if necessary) in all cases. To explore the significant diagnostic challenges posed by pleural TB, and consequently the frequent lack of information about drug sensitivity prior to initiating treatment. To highlight the influence of underlying TB prevalence in the population on the diagnostic accuracy of adjunctive investigations for the diagnosis of pleural TB. To discuss concerns around penetration of anti-TB medications into the pleural space and how this can influence decisions around treatment duration in practice.http://breathe.ersjournals.com/content/19/4/230143.full |
| spellingShingle | Emma McNally Clare Ross Laura E. Gleeson The tuberculous pleural effusion Breathe |
| title | The tuberculous pleural effusion |
| title_full | The tuberculous pleural effusion |
| title_fullStr | The tuberculous pleural effusion |
| title_full_unstemmed | The tuberculous pleural effusion |
| title_short | The tuberculous pleural effusion |
| title_sort | tuberculous pleural effusion |
| url | http://breathe.ersjournals.com/content/19/4/230143.full |
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