Discussion Author: P. Gabriel Peterson
Tuberculous pleuritis refers to the presentation of Tuberculosis as a pleural effusion. The effusion is exudative and usually a result of a hypersensitivity reaction. It is often difficult to diagnose from thoracentesis alone, with a positive AFB culture less than 25% of the time. Conversely, a pleural biopsy provides a culture positive result greater than 60-80% of the time. Other lab tests can be used to increase the sensitivity and specificity of thoracentesis results (Adenosine deaminase, INF-gamma, lymphocytic predominance, etc.).
The importance in diagnosing TB pleuritis results from the fact that most of the effusions will resolve spontaneously without treatment, yet greater than 65% of patients will go on to develop pulmonary or extrapulmonary TB within 5 years.
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