Tuberculous pleurisy with effusion

To assess the clinical features of Taiwanese patients with tuberculous pleu risy and their response to treatment, we analyzed die records of patients t reated for this condition from December 1990 through November 1995, at a re gional 100-bed referral center for tuberculosis care. Diagnosis of tubercul ous pleurisy uas based on histologic evidence of caseating granulomatous in flammation in the pleural biopsy specimen, or evidence of mycobacteria In p leural fluid. Patients were also stratified on the basis of parenchymal inv olvement. Ninety-seven patients (79 men, 18 women) with a mean age of 47.5 (range, 15-90) years were included in the analysis. The two major symptoms were cough (69%) and shortness of breath (57%). Chest, roentgenographs show ed that the pleural effusion uas unilateral in 58 (91%) patients, and small to moderate in amount in 74 (76%). Laboratory analysis of the pleural flui d showed moderate levels of glucose (4.6 mmol/L), with no significant diffe rence between patients with and without parenchymal involvement The levels of lactate dehydrogenase and triglycerides were significantly higher in pat ients with parenchymal involvement (172 vs 240.5 IU and 0.36 vs 0.45 mmol/L , respectively). In 85 of 93 patients (91%) with available data, lymphocyte s were predominant in the differential count. All patients had received sho rt-course chemotherapy For at least 6 months. After excluding the defaulter s and patients receiving subsequent management in other hospitals, the over all rate of successful treatment mas 97% (72/74). There as no significant d ifference in the treatment outcome between patients with parenchymal involv ement and those without. None of the successfully treated patients had. a r elapse within a mean followup period of 31.7 +/- 18.4 months. We conclude t hat current patients with tuberculosis pleurisy in Taiwan are not young, an d short-course chemotherapy with isoniazid, ethambutol, rifampicin, and pyr azinamide is an effective treatment, The presence of parenchymal tuberculou s lesions does not appear to influence the treatment outcome.