Study objectives: To describe the age distribution,
clinical, laboratory, radiographic, and bacteriologic findings of
pediatric patients with tuberculous pleural effusion.
Design: A retrospective study.
methods: We have identified all cases of primary pulmonary
tuberculosis in children < 18 years, reported to the health
department. We have collected information from medical records
regarding demographics, clinical findings, bacteriologic results, and
evolution. Chest radiographs obtained at the time of initial evaluation
were reviewed independently by two groups of radiologists who were
blind to the clinical and epidemiologic data.
Between January 1983 and December 1996, 175 children <18 years were
diagnosed as having primary pulmonary tuberculosis. Among them, 39
patients (22.1%) showed pleural effusion on chest radiograph. The mean
age of patients with tuberculous pleural effusion was significantly
higher (13.52 ± 0.5 years vs 6.97 ± 0.42 years). The sensitivity
of the tuberculin test is 97.4% for an induration ≥ 5 mm. Pleural
fluid analysis shows a lymphocytic exudative effusion. Chest radiograph
review showed unilateral pleural effusion in all cases. Pleural
effusion was the sole radiographic manifestation in 41% of cases.
Parenchymal disease is associated in 23 cases (59%). Bacteriologic
confirmation of tuberculosis was achieved in 22 cases (56.4%).
Cultures of pleural fluid and biopsy material both yielded
Mycobacterium tuberculosis in 15 of 34 (44.1%) and 12 of
18 (66.6%), respectively, for samples under study. Pleural biopsy
specimens showed granulomatous inflammation in 18 of 23 cases (78.3%).
Antituberculous therapy for 6 to 9 months was effective in all cases.
Transient side effects occurred in 1 of 39 patients (2.9%).
Conclusions: Pleural effusion accounts for 22.1% of cases
of pediatric pulmonary tuberculosis. Parenchymal consolidation is the
most common associated radiographic finding. Bacteriologic confirmation
was achieved in 56.4% of cases. A short course of chemotherapy is
Abbreviations: ADA = adenosine deaminase activity;
LDH = lactate dehydrogenase; TB = tuberculosis;
TPE =tuberculous pleural effusion