Tuberculous pleural effusion

• Causes, incidence, and risk factors

  As the number of patients with HIV and AIDS increases, this condition is occurring more often.

• Signs and tests

  Fluid can be removed with a needle (thorencentesis) from the pleural space. However, in most cases, the tuberculosis bacteria cannot be found in the fluid by examining it under a microscope or by trying to grow the bacteria in the laboratory from a sample of pleural fluid (culture).

  The best way to make the diagnosis is to remove a piece of the lining of the lung (pleural tissue) by biopsy. This is more likely to reveal the disease-causing organism through a culture or by examining it under a microscope.

  Special dyes are added to a sample to see the bacteria under the microscope. The organism takes up the dye, and then appears colored when viewed under a microscope.

• Treatment

  Treatment of tuberculous pleural effusion will always involve a combination of many drugs (usually four drugs). The medicines are continued until lab tests show which medicines work best.

  Medications that may be prescribed include:

  • Isoniazid (INH)
  • Rifampin
  • Pyrazinamide
  • Amikacin
  • Ethambutol
  • Ethionamide
  • Moxifloxacin
  • Para-aminosalicylic acid (PAS)
  • Streptomycin

  You must talk the medicines every day by mouth for 1 year or longer. Directly observed therapy, in which a health care provider watches the patient take the prescribed antituberculous drugs, is the most effective strategy for some patients. In this case, drugs may be given 2 or 3 times per week, as prescribed by a doctor.

  You may need to be admitted to a hospital for 2 to 4 weeks to avoid spreading the disease to others until you are no longer contagious.

  Your doctor or nurse is required by law to report your TB illness to the local health department. Your health care team will be sure that you receive the best care for your TB.

• Expectations (prognosis)

  The outlook is excellent if tuberculous pleural effusion is diagnosed early and treatment is begun quickly.

• Complications

  Tuberculous pleural effusion can cause permanent lung damage if not treated early.

  Medicines used to treat TB may cause side effects, including liver problems and:

  • Changes in vision
  • Orange- or brown-colored tears and urine
  • Rash
• Calling your health care provider

  Call your health care provider if:

  • You have been exposed to TB
  • You develop symptoms of TB
  • Your symptoms continue despite treatment
  • New symptoms develop
• Prevention

  TB is a preventable disease, even in those who have been exposed to an infected person. Skin testing (PPD) for TB is used in high risk populations or in people who may have been exposed to TB, such as health care workers.

  A positive skin test in a person with no symptoms of TB is a sign of a previous exposure to TB. Discuss preventive therapy with your doctor. People who have been exposed to TB should be skin tested immediately and have a follow-up test at a later date (usually 12 weeks), if the first test is negative.

  Prompt treatment is extremely important in controlling the spread of TB from those who have active TB disease to those who have never been infected with TB.

  Some countries with a high rate of TB give people a BCG vaccination to prevent TB. However, the effectiveness of this vaccine is controversial and it is not routinely used in the United States.

• References

  Iseman MD. Tuberculosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 345.

Review Date: 12/1/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.