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Fundaments of Pleural Tuberculosis Effusions Related to Clinical Practice FREE TO VIEW

Doina Todea; Loredana Elena Rosca; Andreea Codruta Coman
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University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoc, Romania, Cluj-Napoca, Romania

Chest. 2014;146(4_MeetingAbstracts):913A. doi:10.1378/chest.1993428
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SESSION TITLE: Respiratory Infections Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Pleural tuberculosis accounts for less than 1% of all exudative effusions in developed countries, occurring in only 3-5% of tuberculous patients, but in developing countries it is responsible for 30-80% of all pleural effusions encountered and may complicate tuberculosis. Due to this considerations it is considered a matter o publich health.

METHODS: The aim of this study was to assess the diagnosis aspects of pleural tuberculosis. We analyzed retrospectively 81 patients (60 males and 21 females), aged between 18-73 years, with tuberculous pleural effusion from a total of 471 patients with tuberculosis admitted in our clinic in 2013.

RESULTS: The frequent symptoms were chest pain in 55/81 cases and dry cough in 26/81 cases. Most frequent radiological aspects were unilateral pleural effusion in moderate quantity 71/81 cases, but also were observed 10 cases of bilateral pleural effusions. Concomitant parenchymal lesions were revealed in 17/81 cases by chest radiography or thoracic computed tomography. Thoracentesis and sputum collection were applied in all cases. The pleural fluid was examined by biochemical, cytological and bacteriological tests. Pleural fluid cytology showed most frequent lymphocytic predominance and no atypical cells. Ordinary culture and Gram stain showed no organisms. Pleural needle biopsy (PNB) was applied in 32/81 cases. Parietal pleural samples were assessed by histology and culture. Both for pleural fluid and biopsies samples were used liquid culture systems (MB/Bact). Pleural biopsy histology shown caseating epitelioid granulomas in 17 cases (53.12%) and biopsy cultures was positive in 15 (46.88%) cases. The pleural fluid cultures (MB/Bact) were positive in 20 cases. All patients were treated with antituberculous treatment. In 76/81 (93.82%) cases clinical and radiological favorable evolution was seen, confirmed at periodical controls, 5 patients developing empiema. All patients with positive results by MbBact system had a histological evidence of caseous epitheliod granuloma.

CONCLUSIONS: Bioptic technique is superior in evaluation of tuberculosis effusions and combination between histology and culture lead to higher diagnosis yield.

CLINICAL IMPLICATIONS: Due to the fact that nowadays tuberculous pleuritis remains a major contributor to global morbidity and mortality, early combinate diagnosis and also the proper treatment will improve the global health status.

DISCLOSURE: The following authors have nothing to disclose: Doina Todea, Loredana Elena Rosca, Andreea Codruta Coman

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