Aylin BABALIK, Şule KIZILTAŞ, Korkmaz ORUÇ, Gülgün ÇETİNTAŞ, Sinem ALTUNBEY, Haluk Celalettin ÇALIŞIR

The Profile of Pleural Tuberculosis Patients in Turkey

Abstract Background: Tuberculosis is the leading cause of exudative pleural effusion. The present study was designed to evaluate the patient profile in a 3-year cohort of pleural tuberculosis patients. Methods: A total of 174 patients with pleural tuberculosis (mean(SD) age was 36.1 (17.3) years, 64.9% were males) followed up in our clinic from 2004 to 2007 were included in this study. Data on diagnostic methods, pleural fluid findings and clinical features of patients were recorded based on retrospective evaluation of the medical records. Diagnostic thorasynthesis was performed in patients with pleural effusion. Concomitant analysis of pleural fluid and blood biochemistry (glucose, LDH, protein levels), ADA values and cytology of pleural fluid were performed. Tuberculosis patients were categorized and treated in accordance with WHO guidelines. Patients were invited to attend monthly visits for the cohort analysis after discharge. Results: The frequency of patients below and above 35 years of age was 51.1 and 48.9%, respectively. Parenchymal lesion was evident in 22.4% of patients while pleural fluid was detected in 50.6% of patients. Lymphocytic fluid was detected in 98%. Mean (SD) level for ADA in the pleural fluid was 76.9(41.2) U/L. Pleural biopsy revealed granulomatous infection in 53.8% and chronic pleuritis in 46.2% of patients. There was a significant relation of age over 35 years to presence of chronic infection in pleural biopsy (OR: 3.11 (1.33-7.23)) and co-morbid disorder (OR: 23.53 (5.33-103.93)). Pleural biopsy was performed in 38.2% of patients who were younger than 35 years while in 51.7% of patients who were older than 35 years. The frequency of granulomatous infection diagnosis was significantly higher in patients younger than 35 years when compared to older patients (54.8% vs. 45.2 %; p=0.02). Conclusion: In our study including homogenous distribution of patients in terms of being younger and older than 35 years of age, pleural biopsy was performed more commonly in older patient in order to eliminate possible underlying malignancy. However the diagnostic power of pleural biopsy was determined to be poor. Accordingly, after elimination of other causes of the exudate development, initiation of tuberculosis treatment based on ADA and cell count results seems reasonable

Anahtar Kelimeler:

pleural tuberculosis; patients profile; Turkey

The Profile of Pleural Tuberculosis Patients in Turkey

Keywords:

pleural tuberculosis; patients profile; Turkey,

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Light RW. Pleural Disease. 5 th ed. Lippincott Williams &Wilkins; 2007;211-24.
TB/HIVA Clinical Manual: WHO/HTM/TB/329:104. 2004.
Treatment of Tuberculosis guidelines. 4 th ed. WHO/HTM/TB/420. 2009.
Iseman MD: A Clinician’s Guide to Tuberculosis. Lippincott Williams&Wilkins. 2000;155
Treatment of Tuberculosis: Guidelines for National Programmes. 3 rd ed. World Health Organization-Geneva. 2003.
Tuberculosis: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control NICE clinical guideline 117 Developed by the National Collaborating Centre for Chronic Conditions and the Centre for Clinical Practice at NICE. March 2011. Centers for Disease Control and Prevention: Reported tuberculosis in the United State, 1997. CDC, Atlanta. 1998.
Valdés L, Alvarez D, Valle JM, Pose A, San José E. The etiology of pleural effusions in an area with high incidence of tuberculosis. Chest. 1996;109(1):158-62.
Al-Qorain A, Larbi EB, al-Muhanna F, Satti MB, Baloush A, Falha K. Pattern of pleural effusion in Eastern Province of Saudi Arabia: a prospective study. East Afr Med J. 1994;71(4):246-9.
Saks AM, Posner R. Tuberculosis in HIV positive patients in South Africa: a comparative radiological study with HIV negative patients. Clin Radiol. 1992;46(6):387-90.
Awil PO, Bowlin SJ, Daniel TM. Radiology of pulmonary turberculosis and human immunodeficiency virus infection in Gulu, Uganda. Eur Respir J. 1997;10(3):615-8.
Pozniak AL, MacLeod GA, Ndlovu D, Ross E, Mahari M, Weinberg. Clinical and chest radiographic features of tuberculosis associated with human immunodeficiency virus in Zimbabwe. Am J Respir Crit Care Med. 1995;152(5 Pt 1):1558-61.
Türkiye’de Verem Savaşı 2010 Raporu. T.C Sağlık Bakanlığı Verem Savaş Dairesi Başkanlığı, Ankara, 2010.
Asan E, Şenyiğit A, Topçu F, Kirbasi G, Coskunsel M, Ozekinci. Tüberküloz plörezili 108 olgunun analizi. Solunum Hastalıkları. 2000;11:282-8.
Öztop A, Ünsal İ, Özgü A, Akguner A, Ozguven S, Oguz VA, Cakmak R. Doksanbeş erişkin akciğer dışı tüberküloz olgusu. Solunum Hastalıkları. 2004;15:34-42.
Yurdakul AS, Çalışır HC, Taci N, Ogretensoy M. Tüberküloz plörezi olgularının özellikleri. Solunum Hastalıkları. 2003;13:30-6.
Valdés L, Alvarez D, San José E, Penela P, Valle JM, García-Pazos JM, Suárez J, Pose A. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med. 1998;158(18):2017-21. Ferrer JS, Muñoz XG, Orriols RM, Light RW, Morell FB. Evolution of idiopathic pleural effusion: a prospective, long-term follow-up study. Chest 1996;109(6):1508-13.
Lee YC, Rogers JT, Rodriguez RM, Miller KD, Light RW.Adenosine deaminase levels in nontuberculous lymphocytic pleural effusions. Chest. 2001;120(2):356-61.
Jiménez Castro D, Díaz Nuevo G, Pérez-Rodríguez E, Light RW. Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions. Eur Respir J. 2003;21(2):220-4.
Lazarus AA, McKay S, Gilbert R. Pleural tuberculosis. Dis Mon. 2007;53(1):16-21.
Ferrer J. Pleural tuberculosis. Eur Respir J. 1997;10(4):942-7.