Sidra Kiran, Kauser Jabeen, Muhammad Irfan.
Tuberculous pleural effusion: an update.
Pak J Chest Med Jan ;20(1):19-25.

Pleural Tuberculosis (PTB) is a common manifestation of extra pulmonary tuberculosis (EPTB) and is a frequent cause of pleural effusion in high burden countries. Tuberculous pleural effusion (TPE) occurs in up to 25% of tuberculosis (TB) patients. TPE usually presents with fever, cough and pleuritic chest pain. The pleural fluid is an exudate that usually has predominantly lymphocytes. Owing to the paucibacillary nature of the pleural fluid, the diagnosis of TPE is a challenge. The definitive diagnosis of TPE is currently made by demonstrating the presence of tubercle bacilli in specimens such as pleural fluid and/pleural biopsies, or by histological examination of pleural tissue for granulomas. Pleural fluid cultures are positive for Mycobacterium tuberculosis in less than 40% and smears are virtually always negative. The one way to establish the diagnosis of TPE in a patient with a lymphocytic pleural effusion is to generally demonstrate a pleural fluid adenosine deaminase level above 40 U/L. In the last few years, there have been significant technological advances in the field of diagnosis of TB and MDR TB. The most exciting among them are the nucleic acid amplification tests (NAATs) for the diagnosis of TB. The use of NAATS for diagnosis of TPE has currently very limited utility. The chemotherapy for TPE is the same as that for pulmonary tuberculosis.

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