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Case 2
History
Lives in reserve
No Contact with TB
No travel ,pets
PMH ve
PSH : MVA Rt arm atrophy 1991
Blood Tx after MVA
No IV drugs
Examination
Investigation
CBC N
Creat , BUN , Lytes N
LFT & Liver enzymes N
CXR
Investigation
Management
4 Anti TB Rx + Pyridoxine
Improved afebrile ,no SOB
Chest tube was removed
Discharged Home
TB Pleural Effusion
5% of all diseases attributed to TB
Results from delayed hypersensitivity reaction
to TB antigen
Different from tuberculous empyema which is
purulent fluid abundant in TB organism with
thickened calcified pleura
Different presentation in Non HIV Vs HIV
Presentation
60 Pt study
* In HIV
Younger Patient , more Wt Loss &
extrapulmonary involvement
Frye et al
Chest Aug 1997
Imaging
*In Non HIV
Imaging
In HIV
963 HIV Vs 1000 Non HIV
Unilateral effusion
Lung infiltrate Lower Lobes
Adenopathy 5-18%
Miliary Pattern 7-10%
Less cavitations 33%
Tshibwabwa-Tumba et al
Clin Radiol 1997 Nov
Microbiology
Sputum culture +ve 20-50%
involvement of lung parenchyma
Pleural Fluid culture +ve 40-50 %
Pleural Bx culture +ve 60-80 %
Higher yield in HIV patients in all specimens
ADA
216 Patients 100 TB , 86 Malignancy
19 empyema , 6 transudate
15 miscellaneous , 8 unknown
High ADA in TB 110 & in Empyema 191
No difference Between HIV +ve & -ve TB Pt
Cut off 60 u/l PPV & NPV 95%
Riantawan P et al
Chest 1999 Jul
ADA
106 lymphocytic effusion {Non TB}
ADA measured once in all
& second time 6weeks later in 26 cases
45 Post CABG , 27 Malignant
10 Miscellaneous , 24 Transudative
With cut off 40 u/l only 3 patients +ve
2 Lymphoma & 1 complicated parapneumonic
High NPV & reproducible
Gary Lee et al
Chest Aug 2001
Treatment
Similar to Pulmonary TB
Steroid ? Effect small study 40 pt
faster resolution of Fever & SOB & effusion
But no effect on pleural thickening
Drainage Small study 60 pt
Initial improvement in SOB in first week
No effect later on symptoms
or pleural thickening