C. Richter et al., DIAGNOSIS OF TUBERCULOSIS IN PATIENTS WITH PLEURAL EFFUSION IN AN AREA OF HIV-INFECTION AND LIMITED DIAGNOSTIC FACILITIES, Tropical and geographical medicine, 46(5), 1994, pp. 293-297
In a prospective study of 118 patients with pleural effusion, tubercul
osis (TB) was diagnosed in 112. In 84 patients the diagnosis of TB was
made by detection of acid fast bacilli by stain (auramine, Ziehl-Neel
sen) or by culture of mycobacteria (Lowenstein-Jensen medium) in pleur
al fluid or pleural tissue (obtained by closed biopsy) or by the prese
nce of caseating granulomas in histological sections. In 28 patients t
he diagnosis of TB was considered probable, based on good response to
anti-tuberculous therapy. The highest diagnostic yield was obtained by
histology (85%), followed by culture of pleural biopsy (37%) and pleu
ral fluid culture (36%). Pulmonary tuberculosis was found in 8 patient
s and dissemination of TB to other sites in 25 patients of whom 20 wer
e HIV positive. By logistic regression analysis we identified 2 indepe
ndent diagnostic markers for TB pleuritis: pleural fluid protein >50 g
/l (Odds ratio 12.1, 95% confidence interval (CI): 1.1-128.3) and aden
osine deaminase of >10 U/l (Odds ratio 11.08, 95% CI: 1.3-96.4). We co
nclude that conventional facilities of a referral hospital are suffici
ent to diagnose tuberculous pleuritis as well as disseminated tubercul
osis irrespective of HIV infection. However, for regions with overstre
tched health services and high prevalences of tuberculous pleurisy in
patients with pleural effusion eve suggest a simplified diagnostic app
roach based on exclusion of other causes of pleural effusion by simple
means and use of these diagnostic markers.