ABSTRACT
Epidemiology of pleural tuberculosis 331 Pathophysiology of pleural tuberculosis 333 Clinical presentation of pleural tuberculosis 334 Diagnosis of pleural tuberculosis 335
Radiology of pleural tuberculosis 335 Pleural fluid biochemical analysis and cell counts335 Microbiological tests 335
Nucleic acid amplification tests 335 Histopathology 336 Biomarkers 336 Treatment of pleural tuberculosis336
Conclusion 339 References 339
● Pleural TB is the second most common form of extra-pulmonary TB. ● In TB endemic countries, pleural TB is one of the most common causes of unilateral pleural eusions. ● e number of TB bacilli in the pleural uid in TB pleuritis is typically very low. ● Symptoms are heterogeneous and do not dierentiate TB pleuritis from other illnesses. ● Pleural eusions due to TB are usually unilateral associated with some parenchymal abnormalities. ● e pleural uid analysis typically is lymphocyte predominant with low mesothelial cells and is exudative with
elevated total protein, elevated LDH, and low glucose. ● AFB smear and culture yield of the pleural uid is low. ● e sensitivity of nucleic acid amplication testing on the pleural uid is also limited. ● Adenosine deaminase and unstimulated interferon-gamma are useful biomarkers for the evaluation of pleural TB
with good sensitivity although somewhat limited specicity. ● e gold standard for the diagnosis of pleural TB is a pleural biopsy with tissue AFB smear, AFB culture, and
pathology examination to evaluate for caseating granulomas. ● Antimicrobial treatment for pleural TB is the same standard regimen as recommended for pulmonary TB. ● Unless a TB empyema is present, surgical drainage of a TB pleural eusion is not needed.
