Tuberculous pleural effusion in elderly patients
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Pneumon 1999;12(3):196-202
We reviewed the records of 120 cases of tuberculous pleural effusion seen during the period 1979-94. These cases constituted 24.3% of all diseases due to Mycobacterium Tuberculosis and 37% of all exudative pleural eflusions. The mean age of the patients was 44 years and 27.5% of them was over 60 years of age. Ten per cent of the total cases were accompanied by roentgenographic pulmonary parenchymal infiltrates. As for the elderly group we found in 79% of the cases the pleural effusion as the only roentgenographic abnormality. Eighteen per cent of the cases had M. Tuberculosis cultured in sputum while the 66% of this subgroup had no parenchymal infiltrates. Tuberculous pleural effusion was diagnosed if the patient had positive pleural biopsy and M. Tuberculosis cultured in pleural fluid or sputum. In the absence of a positive culture, the diagnosis was based upon an undiagnosed lymphocytic exudative pleural effusion, increased ADA in pleural fluid and pleural lysozyme /serum lysozyme ratio as well as clinical and roentgenographic abnormalities resolution following antimycobacterial chemotherapy. We conclude that the age of patients with pleural effusion appears to be increasing. Sputum cultures in addition to other specimens cultures increase the diagnostic yield even in cases without roentgenographic parenchymal infiltrates. Pneumon 1999, 12 (3): 196-202
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