Evaluation of suspected tuberculous pleurisy: clinical and diagnostic findings in HIV-1-positive and HIV-negative adults in Uganda

SETTING: National Tuberculosis Treatment Centre, Mulago Hospital, Kampala, Uganda. OBJECTIVES: To compare clinical and radiographic presentation, and diagnost ic methods, in adults with tuberculous pleurisy who are negative and positi ve for the human immunodeficiency virus (HI-V). DESIGN: Adults with suspected pleural tuberculosis were screened by clinica l examination, thoracocentesis and closed pleural biopsy. Biopsy material w as cultured on Middlebrook 7H-10 solid medium and in BACTEC 12B radiometric vials. Pleural fluid was cultured using Lowenstein-Jensen slants, BACTEC a nd Kirchner liquid medium. RESULTS: Of 156 individuals enrolled, 142 had tuberculosis, of whom 80% wer e HIV-positive. Among those with tuberculosis, H-TV-positive patients had a more severe and longer illness. The size of effusions was similar in HIV-p ositive and HIV-negative patients. A higher proportion of HIV-positive pati ents had parenchymal infiltrates but this difference was not statistically significant. Pleural fluid lymphocytosis was present in all HAI negative an d 97% of the HIV-positive patients. HIV-positive patients had lower pleural fluid lymphocyte counts. Pleural fluid cultures were more often positive i n HIV-positive patients. BACTEC and Kirchner liquid media gave higher yield s than solid media. CONCLUSION: HIV-positive patients with tuberculous pleurisy had a more seve re illness than HIV-negative patients. Mycobacterial cultures from HIV-posi tive patients were more often positive, suggesting more mycobacterial exten sion from the lungs into the pleural space. Liquid culture media were super ior to solid media with regard to diagnostic yield and time until diagnosis .