Epidemiology and diagnosis of pleural tuberculosis in a low incidence country with high rate of immigrant population: A retrospective study

• Main Authors: Antonio Macías, Adrián Sánchez-Montalvá, Fernando Salvador, Ana Villar, Teresa Tórtola, Nuria Saborit, Israel Molina
• Format: Article
• Language: English
• Published: Elsevier 2019-01-01
• Series: International Journal of Infectious Diseases
• Online Access: http://www.sciencedirect.com/science/article/pii/S120197121834551X

Background: The confirmatory diagnosis of pleural tuberculosis (pTB) remains challenging. The aim of this study was to describe the clinical and epidemiological characteristics of pTB patients and assess the yield of different diagnostic procedures in a low burden country with a high rate of immigrant population. Methods: All adult patients with pTB between 2007 and 2014 were studied retrospectively. Results: One hundred and three out of 843 patients with tuberculosis had pTB. Fifty-three (54.1%) were male, and the median age was 45 years (range 18–87 years). Fifty-two (50.49%) patients were immigrants. A confirmed diagnosis was reached in 16 patients (15.5%) by microbiological studies of pleural effusion. Lung involvement was demonstrated by sputum smear microscopy in 13/49 (26.5%), sputum GeneXpert MTB/RIF test in 13/20 (65%), and sputum culture in 16/37 (43.2%). High-resolution computed tomography (CT) showed lung involvement in 47.7% of the patients. The cure rate was 91.3% at the 1-year follow-up. Three patients died, all of them within the first month after diagnosis. Conclusions: The detection of lung involvement increased by two-fold when lung CT was used; this correlated with the likelihood of finding a positive microbiological result on sputum sample testing. Pleural microbiological studies had a low diagnostic yield, and sputum could have a complementary role. Keywords: Pleural tuberculosis, Immigrant population, Tuberculosis diagnostic tools