Revisiting tuberculous pleurisy: pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area
- Sheng-Yuan Ruan1,
- Yu-Chung Chuang1,
- Jann-Yuan Wang1,
- Jou-Wei Lin2,
- Jung-Yien Chien3,
- Chun-Ta Huang1,
- Yao-Wen Kuo2,
- Li-Na Lee1,
- Chong-Jen J Yu1
- 1Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- 2Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
- 3Department of Health, Chest Hospital, Tainan, Taiwan
- Correspondence to Dr Jann-Yuan Wang, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei 10002, Taiwan; jywang{at}ntu.edu.tw
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Contributors SYR, YCC, JYW: study concept and design, analysis of data and drafting of manuscript. JWL: statistical analysis and interpretation of data. JYC, CTH, YWK: interpretation of data and review of manuscript. LNL, CJY: review of manuscript.
- Received 12 November 2011
- Accepted 3 March 2012
- Published Online First 21 March 2012
Abstract
Background Tuberculous pleurisy is traditionally indicated by extreme lymphocytosis in pleural fluid and low yield of effusion culture. However, there is considerable inconsistency among previous study results. In addition, these data should be updated due to early effusion studies and advances in culture methods.
Methods From January 2004 to June 2009, patients with tuberculous pleurisy were retrospectively identified from the mycobacteriology laboratories and the pathology and tuberculosis registration databases of two hospitals in Taiwan where tuberculosis is endemic. Pleural fluid characteristics and yields of mycobacterial cultures using liquid media were evaluated.
Results A total of 382 patients with tuberculous pleurisy were identified. The median lymphocyte percentage of total cells in pleural fluids was 84% (IQR 64–95%) and 17% of cases had a lymphocyte percentage of <50%. The lymphocyte percentage was negatively associated with the probability of a positive effusion culture (OR 0.97; 95% CI 0.96 to 0.99). The diagnostic yields were 63% for effusion culture, 48% for sputum culture, 79% for the combination of effusion and sputum cultures, and 74% for histological examination of pleural biopsy specimens.
Conclusion The degree of lymphocyte predominance in tuberculous pleurisy was lower than was previously thought. The lymphocyte percentage in pleural fluid was negatively associated with the probability of a positive effusion culture. With the implementation of a liquid culture method, the sensitivity of effusion culture was much higher than has been previously reported, and the combination of effusion and sputum cultures provided a good diagnostic yield.
- Diagnosis
- Mycobacterium
- pleural effusion
- pleuritis
- tuberculosis
- ARDS
- assisted ventilation
- clinical epidemiology
- respiratory infection
- bronchoscopy
- COPD mechanisms
- atypical mycobacterial infection
- COPD epidemiology
- lung cancer
- lung cancer chemotherapy
- non-small cell lung cancer
- pneumonia
Footnotes
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Funding The study was partly supported by National Taiwan University Hospital Yun-Lin Branch grant NTUHYL98.X007 and the Institute for Biotechnology and Medicine Industry of Taiwan.
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Competing interests None.
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Ethics approval The Research Ethics Committee of the National Taiwan University Hospital.
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Provenance and peer review Not commissioned; externally peer reviewed.
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Data sharing statement We would like to share the original data of our study. Dr J Y Wang is the corresponding author and has full access to all study data.
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