Pleural Tuberculosis

Pleural tuberculosis (TB) is the second most common extra-pulmonary form of TB, following tuberculous lymphadenitis. Pleural TB is most likely to occur due to the rupture of a subpleural caseous focus within the lung or, sometimes, due to the spread of infection from a lymph node into the pleural space. In pleural TB, it has been found that the delayed type of hypersensitivity (DTH) is responsible for the development of pleural effusion. Clinical manifestations mainly include pleuritic chest pain, nonproductive cough, anorexia, weight loss, night sweats, and in severe cases, dyspnea. Manifestations of pleural TB among HIV individuals depend on the CD4 count. A chest radiograph is the initial mode of investigation and is confirmed by USG thorax. Pleural fluid analysis helps in diagnosing and ruling out other causes of pleural TB. Levels of ADA and interferon gamma are helpful in establishing the diagnosis of pleural TB. Pleural biopsy culture, in combination with histopathological and molecular methods, can diagnose up to 95% of pleural TB. Anti-tuberculous drugs are the mainstay of therapy and the duration of treatment is 6 months. The role of corticosteroids is limited to certain situations only. Residual pleural fibrosis is the most common complication, while TB empyema is a severe form of complication.