Tuberculous pleural effusion.
extra-pulmonary
pleural biopsy
pleural effusion
tuberculosis
tuberculosis empyema
Journal
Respirology (Carlton, Vic.)
ISSN: 1440-1843
Titre abrégé: Respirology
Pays: Australia
ID NLM: 9616368
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
16
05
2019
revised:
05
07
2019
accepted:
23
07
2019
pubmed:
17
8
2019
medline:
1
7
2020
entrez:
17
8
2019
Statut:
ppublish
Résumé
Tuberculous effusion is a common disease entity with a spectrum of presentations from a largely benign effusion, which resolves completely, to a complicated effusion with loculations, pleural thickening and even frank empyema, all of which may have a lasting effect on lung function. The pathogenesis is a combination of true pleural infection and an effusive hypersensitivity reaction, compartmentalized within the pleural space. Diagnostic thoracentesis with thorough pleural fluid analysis including biomarkers such as adenosine deaminase and gamma interferon achieves high accuracy in the correct clinical context. Definitive diagnosis may require invasive procedures to demonstrate histological evidence of caseating granulomas or microbiological evidence of the organism on smear or culture. Drug resistance is an emerging problem that requires vigilance and extra effort to acquire a complete drug sensitivity profile for each tuberculous effusion treated. Nucleic acid amplification tests such as Xpert MTB/RIF can be invaluable in this instance; however, the yield is low in pleural fluid. Treatment consists of standard anti-tuberculous therapy or a guideline-based individualized regimen in the case of drug resistance. There is low-quality evidence that suggests possible benefit from corticosteroids; however, they are not currently recommended due to concomitant increased risk of adverse effects. Small studies report some short- and long-term benefit from interventions such as therapeutic thoracentesis, intrapleural fibrinolytics and surgery but many questions remain to be answered.
Substances chimiques
Antitubercular Agents
0
Interferon-gamma
82115-62-6
Adenosine Deaminase
EC 3.5.4.4
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
962-971Informations de copyright
© 2019 Asian Pacific Society of Respirology.
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