Erdoğan KUNTER, Hakan ÇERMİK, Hakan MUTLU, Faruk ÇİFTÇİ, Ahmet İLVAN, Ersin DEMİRER

Infectiousness of pleural tuberculosis without radiological evidence for parenchymal involvement

Amaç: Plevral tüberküloza her zaman radyolojik olarak belirgin parankim hastalığı (PH) eşlik etmemekte ve klinik pratikte, radyolojik olarak PH belirtisi olmayan hastalar genellikle bulaştırıcı olarak değerlendirilmemektedir. Çalışma planı: Çalışmaya plevral tüberküloz tanısı kanıtlanmış 77 hasta (3 kadın, 74 erkek; ort. yaş 23±6; dağılım 18-52) alındı. Balgam yayması (BY) veya mide lavajı yayması (MLY) ile asit-alkole dirençli basil yönünden pozitif bulunan ve/veya balgam kültürü (BK) veya mide lavajı kültüründe M. tuberculosis saptanan hastalar muhtemel bulaştırıcı kabul edildi.Bulgular: Balgam veya gastrik lavaj sonuçları bir arada değerlendirildiğinde, altı hastada (%7.8) yayma, 21 hastada (%27.3) kültürde pozitifliğe rastlandı. Toplamda 27 hastada (%27.3) basil-pozitif pulmoner tüberküloz saptandı. Göğüs radyografisinde 29 hastada (%37.7) PH izlendi. Elli beş hastada yüksek çözünürlüklü bilgisayarlı tomografi (BT) çekildi ve 48 hastada (%87.3) PH saptandı. Göğüs radyografisinde PH saptanan hastaların beşinde (%17.2) yayma, 13’ünde (%44.8) kültür pozitifliği bulundu. Radyografide PH saptanmayan 48 hastanın balgam veya mide lavajı örneklerinde ise; birinde (%2.1) yayma, sekizinde (%16.7) kültür pozitifliği bulundu. Yüksek çözünürlüklü BT ile PH saptanan 48 olguda, bir hastada (%2.1) yayma, 12 hastada (%25) kültür pozitif bulundu; PH saptanmayan yedi hastanın ikisinin (%28.5) kültürleri pozitif bulunurken, yayma örnekleri tüm hastalarda negatif idi. Parankim hastalığının belirlenmesinde yüksek çözünürlüklü BT daha duyarlı olmakla birlikte, bulaştırıcılık oranı göğüs radyografisinde PH saptanan grupta anlamlı derecede daha yüksekti (p=0.007).Sonuç: Plevral tüberkülozlu hastalarda radyolojik olarak parankimal tutulum saptanmasa bile bulaştırıcılık olabileceği sonucuna varıldı.

Radyolojik olarak parankim tutulumu olmayan plevral tüberkülozun bulaştırıcılığı

Background: Pleural tuberculosis is not always associated with radiologically evident parenchymal disease (PD) and, in clinical practice, patients without radiological evidence for PD are usually deemed noninfectious. Methods: The study included 77 patients (3 females, 74 males; mean age 23±6 years; range 18 to 52 years) with a definite diagnosis of pleural tuberculosis. Patients with a positive sputum smear or gastric lavage smear for acidfast bacilli and/or positive sputum culture or gastric lavage culture for M. tuberculosis were considered possibly infectious.Results: When sputum and gastric lavage results were taken together, smear positivity was found in six (7.8%) and culture positivity was found in 21 cases (27.3%). Overall, 21 patients (27.3%) had bacillus-positive pulmonary tuberculosis. Chest X-ray revealed PD in 29 patients (37.7%). Highresolution computed tomography (HRCT) was performed in 55 patients and PD was found in 48 patients (87.3%). Of the patients with PD on chest radiograms, five (17.2%) had positive smears and 13 (44.8%) had positive cultures of sputum or gastric lavage. Of 48 patients without PD on chest radiograms, one (2.1%) had smear positivity and eight (16.7%) had culture positivity. Sputum or gastric lavage samples showed one smear positivity (2.1%) and 12 culture positivity (25%) among 48 patients who were found to have PD by HRCT. Of seven cases in which HRCT did not show PD, two (28.5%) had positive cultures and none had positive smears. Although HRCT was more sensitive to detect PD, infectiousness rate was significantly higher in patients who had PD on chest radiograms (p=0.007).Conclusion: We suggest that pleural tuberculosis cases may be infectious despite lack of radiological evidence for parenchymal involvement

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