Background: Tuberculosis is the leading cause of exudative pleural effusion. The present study was designed to evaluate the patient profile in a 3-year cohort of pleural tuberculosis patients.
Methods: A total of 174 patients with pleural tuberculosis (mean(SD) age was 36.1 (17.3) years, 64.9% were males) followed up in our clinic from 2004 to 2007 were included in this study. Data on diagnostic methods, pleural fluid findings and clinical features of patients were recorded based on retrospective evaluation of the medical records. Diagnostic thorasynthesis was performed in patients with pleural effusion. Concomitant analysis of pleural fluid and blood biochemistry (glucose, LDH, protein levels), ADA values and cytology of pleural fluid were performed. Tuberculosis patients were categorized and treated in accordance with WHO guidelines. Patients were invited to attend monthly visits for the cohort analysis after discharge.
Results: The frequency of patients below and above 35 years of age was 51.1 and 48.9%, respectively. Parenchymal lesion was evident in 22.4% of patients while pleural fluid was detected in 50.6% of patients. Lymphocytic fluid was detected in 98%. Mean (SD) level for ADA in the pleural fluid was 76.9(41.2) U/L. Pleural biopsy revealed granulomatous infection in 53.8% and chronic pleuritis in 46.2% of patients. There was a significant relation of age over 35 years to presence of chronic infection in pleural biopsy (OR: 3.11 (1.33-7.23)) and co-morbid disorder (OR: 23.53 (5.33-103.93)). Pleural biopsy was performed in 38.2% of patients who were younger than 35 years while in 51.7% of patients who were older than 35 years. The frequency of granulomatous infection diagnosis was significantly higher in patients younger than 35 years when compared to older patients (54.8% vs. 45.2 %; p=0.02).
Conclusion: In our study including homogenous distribution of patients in terms of being younger and older than 35 years of age, pleural biopsy was performed more commonly in older patient in order to eliminate possible underlying malignancy. However the diagnostic power of pleural biopsy was determined to be poor. Accordingly, after elimination of other causes of the exudate development, initiation of tuberculosis treatment based on ADA and cell count results seems reasonable
pleural tuberculosis; patients profile; Turkey