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Tuberculous pleural effusion in elderly patients
K. Dimakou, P. Latsi, M. Tïubis, A. Rasidakis, D. Orfanidou, E. Zagana, P.
Bakakos, I. Iordanoglou
SUMMARY: We reviewed the records of 120 cases of tuberculous pleural
effusion seen during the period 1979-94. These cases constituted 24.3% of all
diseases due to Mycobacterium Tuberculosis and 37% of all exudative pleural
eflusions. The mean age of the patients was 44 years and 27.5% of them was over
60 years of age. Ten per cent of the total cases were accompanied by roentgenographic
pulmonary parenchymal infiltrates. As for the elderly group we found in 79%
of the cases the pleural effusion as the only roentgenographic abnormality.
Eighteen per cent of the cases had M. Tuberculosis cultured in sputum while
the 66% of this subgroup had no parenchymal infiltrates. Tuberculous pleural
effusion was diagnosed if the patient had positive pleural biopsy and M. Tuberculosis
cultured in pleural fluid or sputum. In the absence of a positive culture, the
diagnosis was based upon an undiagnosed lymphocytic exudative pleural effusion,
increased ADA in pleural fluid and pleural lysozyme/serum lysozyme ratio as
well as clinical and roentgenographic abnormalities resolution following antimycobacterial
chemotherapy. We conclude that the age of patients with pleural effusion appears
to be increasing. Sputum cultures in addition to other specimens cultures increase
the diagnostic yield even in cases without roentgenographic parenchymal infiltrates.
Pneumon 1999, 12(3):196-202
Key words: Ôuberculosis, Pleural effusion, Elderly.
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