The main objective of the study was to determine the aetiology of exudative PE and its association with human immune virus ( HIV) infection in Mulago Hospital. Other objectives were to determine the relative prevalence/frequency of the various aetiologies of exudative PE, the HIV sero prevalence among these patients and to describe the clinical, laboratory, radiographic and demographic features of the various causes of exudative PE.METHODOLOGY: The study was done on the general medical wards in Mulago University teaching and national referral hospital.A descriptive cross-sectional study was carried out on patients 15-90 years inclusive, who were screened for exudative PE using Light’s criteria. Clinical examination, thoracocentesis, and pleural biopsy were done. Pleural fluid (PF) and tissue culture for M.tuberculosis were done using lowenstein jensen (LJ) media. HIV serology after pre and posttest counseling was obtained.
Of the 93 patients with exudative PE recruited, tuberculosis (TB) accounted for 66.7%. The other causes of the effusion were cancer (14%), empyema (3.1%), eosinophilic granuloma (1.1%), and connective tissue disoder (1.1%). The cause of the effusion remained unknown in 14% of the patients. Overall HIV prevalence among the patients recruited was 57%. Most patients with TB were in the age range 20-39 years (72.6%) while over 50% of the cancer patients were above 50 years. Micro bacteriological culture studies on PF was only positive for M.tuberculosis in HIV positive patients. On chest x-ray, most effusions in TB were of moderate size while in cancer of massive size.
Empirical treatment for TB in patients with exudative PE is a reasonable option particularly in patients in the age range 20 - 40 years with pleural fluid lymphocytosis. Cancer remains a common cause of exudative PE in patients over 50 years.CLINICAL IMPLICATION: Exudative PE pause a big problem in areas where there are no proper facilities for its investigation.
I.C. Charles, American Chest Foundation, grant monies.