tuberculous pleural effusion
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Laboratory
- lymphocyte predominant pleural effusion
- adenosine deaminase in pleural fluid is highly specific for Mycobacterium tuberculosis
- value > 60-70 U/L highly specific for tuberculosis
- value < 40 U/L excludes tuberculosis
- pleural biopsy if adenosine deaminase > 40-60 U/L
- elevated interferon gamma in pleural fluid virtually diagnostic of tuberculous pleuritis in patients with lymphocytic exudates[3] (closest Loinc is interferon gamma in interferon gamma in body fluid)
- ref[4] questions sensitivity & specificity of
Diagnostic procedures
- pleural biopsy
- confirm diagnosis of lymphocyte predominant pleural effusion with elevated pleural fluid adenosine deaminase
- granulomas or organisms on tissue specimens obtained via needle biopsy of the pleura or thoracoscopy[3]
- mycobacterial culture of pleural biopsy[4]
Management
- empiric therapy for tuberculosis
- prognosis
- pleural effusion tends to spontaneously resolve over 2-4 months
- active tuberculosis develops in 65% of patients within 5 years
More general terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18 American College of Physicians, Philadelphia 2012, 2015, 2018
- ↑ NEJM Knowledge+ Question of the Week. Dec 26, 2017 https://knowledgeplus.nejm.org/question-of-week/308/
- ↑ 3.0 3.1 3.2 Light RW Update on tuberculous pleural effusion. Respirology. 2010 Apr;15(3):451-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20345583
- ↑ 4.0 4.1 4.2 NEJM Knowledge+ Question of the Week. June 23, 2020 https://knowledgeplus.nejm.org/question-of-week/566/
Zhou Q et al. Diagnostic accuracy of T-cell interferon-gamma release assays in tuberculous pleurisy: a meta-analysis. Respirology 2011 Feb 9; 16:473 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21299686
Keng LT et al. Evaluating pleural ADA, ADA2, IFN-gamma and IGRA for diagnosing tuberculous pleurisy. J Infect 2013 Jun 26; 67:294 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23796864