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tuberculous pleural effusion
Laboratory:
- lymphocyte predominant pleural effusion
- adenosine deaminase in pleural fluid is highly specific for Mycobacterium tuberculosis
- value > 60-70 U/L highly specific for tuberculosis
- value < 40 U/L excludes tuberculosis
- pleural biopsy if adenosine deaminase > 40-60 U/L
- elevated interferon gamma in pleural fluid virtually diagnostic of tuberculous pleuritis in patients with lymphocytic exudates [3] (closest Loinc is interferon gamma in interferon gamma in body fluid)
- ref [4] questions sensitivity & specificity of
- adenosine deaminase in pleural fluid &
- interferon gamma in pleural fluid
Special laboratory:
- pleural biopsy
- confirm diagnosis of lymphocyte predominant pleural effusion with elevated pleural fluid adenosine deaminase
- granulomas or organisms on tissue specimens obtained via needle biopsy of the pleura or thoracoscopy [3]
- mycobacterial culture of pleural biopsy [4]
Management:
- empiric therapy for tuberculosis
- prognosis
- pleural effusion tends to spontaneously resolve over 2-4 months
- active tuberculosis develops in 65% of patients within 5 years
General
pleural effusion
tuberculosis
References
- Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18
American College of Physicians, Philadelphia 2012, 2015, 2018
- NEJM Knowledge+ Question of the Week. Dec 26, 2017
https://knowledgeplus.nejm.org/question-of-week/308/
- Light RW
Update on tuberculous pleural effusion.
Respirology. 2010 Apr;15(3):451-8
PMID: 20345583
- NEJM Knowledge+ Question of the Week. June 23, 2020
https://knowledgeplus.nejm.org/question-of-week/566/
- Zhou Q et al. Diagnostic accuracy of T-cell interferon-gamma release assays
in tuberculous pleurisy: a meta-analysis.
Respirology 2011 Feb 9; 16:473
PMID: 21299686
- Keng LT et al.
Evaluating pleural ADA, ADA2, IFN-gamma and IGRA for diagnosing
tuberculous pleurisy.
J Infect 2013 Jun 26; 67:294
PMID: 23796864