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Chest Infections |

Usefulness of Diagnosis Tools in Tuberculous Pleural Effusions. Where Is Nowadays Reality?

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


Chest. 2015;148(4_MeetingAbstracts):134A. doi:10.1378/chest.2274021
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Abstract

SESSION TITLE: Chest Infections Posters: Tuberculosis

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Pleural tuberculosis is the main cause of pleural effusion, being the most common form of extrapulmonary tuberculosis. According to low sensitivity of diagnosis tools, tuberculous pleural effusions remains a real diagnosis and therapeutically challenge. The aim of this study was to assess the diagnosis aspects of pleural tuberculosis.

METHODS: We conducted a retrospective study in order to evaluate the clinical, imagistical, bacteriological and histopathological aspects of 72 patients (47 males and 25 females), aged between 19-78 years, with tuberculous pleural effusion from a total of 583 patients with tuberculosis admitted in Clinical Hospital of Pneumology ʺLeon-Danielloʺ Romania, in 2011.

RESULTS: The most common symptoms were chest pain in 41/72 cases and dry cough in 25/72 cases. Most frequent radiological and imagistically aspects were unilateral pleural effusion in moderate quantity 53/72 cases. 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 27/72 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 51% of cases and biopsy cultures was positive in 49% of cases. The pleural fluid cultures (MB/Bact) were positive in 18 cases (25%). All patients was submitted to antituberculous treatment. In 67/72 (93.05%) cases clinical and radiological favorable evolution was seen, confirmed at periodical controls, 4 patients developing empiema. All patients with positive results by MbBact system had a histological evidence of caseous epitheliod granuloma. Bioptic technique is superior in evaluation of tuberculosis effusions (p<0.001) and combination between histology and culture lead to higher diagnosis yield (p<0.00001).

CONCLUSIONS: Association of this two diagnosis tools (histology and culture) will increase the diagnosis sensibility of tuberculous pleural effusions in clinical practice.

CLINICAL IMPLICATIONS: As clinicians, we need to direct our attention to a most carefull monitoring of patients with tuberculous pleural effusion and to improve the diagnostic tools, in order to have an early diagnosis and correct treatment.

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

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