PDF herunterladen
Semin Respir Crit Care Med 2001; 22(6): 637-646
DOI: 10.1055/s-2001-18800
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Tuberculous Pleural Effusion and Tuberculous Empyema

Jaume Ferrer
  • Servei de Pneumologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
05. Dezember 2001 (online)

    Lizenzen und Reprints

ABSTRACT

Tuberculous pleuritis has increased worldwide, especially in developing countries, as a consequence of human immunodeficiency virus co-infection. Tuberculous pleuritis is a delayed hypersensitivity reaction against mycobacterial antigens in the pleural space. Mycobacteria are detected in less than 50% of pleural samples, but the characteristic pleural involvement, granulomas with or without caseous necrosis, is evident in 56 to 80% of cases from samples obtained by percutaneous pleural biopsy. Of several pleural fluid parameters studied, adenosine deaminase and interferon gamma (IFN-γ) have the best diagnostic yield, while polymerase chain reaction remains a promising test. Treatment of patients with tuberculous pleuritis is discussed.

Tuberculous empyema is a rare form of tuberculous pleuritis. It consists of a purulent infection of the pleural cavity with detectable bacilli in pleural fluid. Diagnosis is easily established clinically and bacteriologically. Treatment is to adequately drain the pleural space and achieve lung reexpansion, in conjunction with antituberculous chemotherapy. The efficacy of different surgical techniques is discussed.

KEYWORD

Tuberculous pleuritis - tuberculous empyema - diagnosis - treatment

REFERENCES

  • 1 Raviglione M C, Snider D E, Kochi A. Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic.  JAMA . 1995;  273(3) 220-226
    CrossrefPubMedGoogle Scholar
  • 2 WHO. Global tuberculosis control 2000 . 
    Google Scholar
  • 3 Aktogu S, Yorgancioglu A, Çirak K, Köse T, Dereli S M. Clinical spectrum of pulmonary and pleural tuberculosis: a report of 5480 cases.  Eur Respir J . 1996;  9 2031-2035
    CrossrefPubMedGoogle Scholar
  • 4 Batungwanayo J, Taelman H, Allen S, Bogaerts J, Kagame A, Van de Perre P. Pleural effusion, tuberculosis and HIV-1 infection in Kigali, Rwanda.  AIDS . 1993;  7 73-79
    PubMedGoogle Scholar
  • 5 Grupo de trabajo de la P M I T. La tuberculosis en España: resultados del Proyecto Multicéntrico de Investigación sobre Tuberculosis (PMIT).  Med Clin (Barc) . 2000;  114 530-537
    PubMedGoogle Scholar
  • 6 Mehta J B, Dutt A, Harvill L, Mathews K M. Epidemiology of extrapulmonary tuberculosis.  Chest . 1991;  99 1134-1138
    PubMedGoogle Scholar
  • 7 Seibert A F, Haynes J, Middleton R, Bass J B. Tuberculous pleural effusion: twenty-year experience.  Chest . 1991;  99 883-886
    PubMedGoogle Scholar
  • 8 Frye M D, Pozsik C J, Sahn S A. Tuberculous pleurisy is more common in AIDS than in non-AIDS patients with tuberculosis.  Chest . 1997;  112 393-397
    PubMedGoogle Scholar
  • 9 Merino J M, Carpintero I, Alvarez T, Rodrigo J, Sánchez J, Coello J M. Tuberculous pleural effusion in children.  Chest . 1999;  115 26-30
    CrossrefPubMedGoogle Scholar
  • 10 Valdés L, Alvarez D, Valle J M, Pose A, San José E. The etiology of pleural effusions in an area with high incidence of tuberculosis.  Chest . 1996;  109 158-162
    CrossrefPubMedGoogle Scholar
  • 11 Richter C, Perenboom R, Mtoni I. Clinical features of HIV-seropositive and HIV-seronegative patients with tuberculous pleural effusion in Dar es Salaam, Tanzania.  Chest . 1994;  106 1471-1476
    CrossrefPubMedGoogle Scholar
  • 12 Marel M, Zrustová M, Stasny B, Light R W. The incidence of pleural effusion in a well-defined region: epidemiologic study in Central Bohemia.  Chest . 1993;  104 1486-1489
    CrossrefPubMedGoogle Scholar
  • 13 Saks A M, Posner R. Tuberculosis in HIV-positive patients in South Africa: a comparative radiological study with HIV-negative patients.  Clin Radiol . 1992;  46 387-390
    CrossrefPubMedGoogle Scholar
  • 14 Mlika-Cabanne N, Brauner M, Kamanfu G. Radiographic abnormalities in tuberculosis and risk of coexisting human immunodeficiency virus infection: methods and preliminary results from Bujumbura, Burundi.  Am J Respir Crit Care Med . 1995;  152 794-799
    PubMedGoogle Scholar
  • 15 Mlika-Cabanne N, Brauner M, Mugusi F. Radiographic abnormalities in tuberculosis and risk of coexisting human immunodeficiency virus infection: results from Dar-es-Salaam, Tanzania, and scoring system.  Am J Respir Crit Care Med . 1995;  152 786-793
    PubMedGoogle Scholar
  • 16 Pozniak A L, MacLeod G A, Ndlovu D, Ross E, Mahari M, Weinberg J. Clinical and chest radiographic features of tuberculosis associated with human immunodeficiency virus in Zimbabwe.  Am J Respir Crit Care Med . 1995;  152 1558-1561
    PubMedGoogle Scholar
  • 17 Caylà J A, Jansà J M, Artazcoz L, Plasència A, and the AIDS-TB Group. Predictors of AIDS in a cohort of HIV-infected patients with pulmonary or pleural tuberculosis.  Tubercle and Lung Disease . 1993;  74 113-120
    CrossrefPubMedGoogle Scholar
  • 18 Keiper M D, Beumont M, Elshami A, Langlotz C P, Miller W T. CD4 T lymphocyte count and the radiographic presentation of pulmonary tuberculosis: a study of the relationship between these factors in patients with human immunodeficiency virus infection.  Chest . 1995;  107 74-80
    CrossrefPubMedGoogle Scholar
  • 19 Stead W W, Eichenholz A, Stauss H-K. Operative and pathologic findings in twenty-four patients with syndrome of idiopathic pleurisy with effusion, presumably tuberculous.  Am Rev Tuberc Pulm Dis . 1955;  71 473-502
    PubMedGoogle Scholar
  • 20 Cazzadori A, Di Perri G, Marocco S, Carlotto A, Adami T, Concia E. Tuberculous pleurisy after percutaneous needle biopsy of a pulmonary nodule.  Respir Med . 1994;  88 477-478
    PubMedGoogle Scholar
  • 21 Antoniskis D, Amin K, Barnes P F. Pleuritis as a manifestation of reactivation tuberculosis.  Am J Med . 1990;  89 447-450
    CrossrefPubMedGoogle Scholar
  • 22 Gupta R C, Dixit R, Purohit S D, Saxena A. Devolopment of pleural effusion in patients during anti-tuberculous chemotherapy: analysis of twenty-nine cases with review of literature.  Indian J Chest Dis Allied Sci . 2000;  42 161-166
    PubMedGoogle Scholar
  • 23 Widström O, Nilsson B S. Pleurisy induced by intrapleural BCG in immunized guinea pigs.  Eur J Respir Dis . 1982;  63 425-434
    PubMedGoogle Scholar
  • 24 Leibowitz S, Kennedy L, Lessof M H. The tuberculin reaction in the pleural cavity and its suppression by antilymphocyte serum.  Br J exp Path . 1973;  54 152-162
    PubMedGoogle Scholar
  • 25 Schlesinger L S, Bellinger-Kawahara C G, Payne N R, Horwitz M A. Phagocytosis of Mycobacterium tuberculosis is mediated by human monocyte complement receptors and complement component C3.  J Immunol . 1990;  144 2771-2780
    PubMedGoogle Scholar
  • 26 Boom W H, Wallis R S, Chervenak K A. Human Mycobacterium tuberculosis-reactive CD4+ T-cell clones: heterogeneity in antigen recognition, cytokine production, and cytotoxicity for mononuclear phagocytes.  Infect Immun . 1991;  59 2737-2743
    PubMedGoogle Scholar
  • 27 Morgan D A, Ruscetti F W, Gallo R. Selective in vitro growth of T lymphocytes from normal human bone marrows.  Science . 1976;  193 1007-1008
    PubMedGoogle Scholar
  • 28 Kurasawa T, Shimokata K. Cooperation between accessory cells and T lymphocytes in patients with tuberculous pleurisy.  Chest . 1991;  100 1046-1052
    PubMedGoogle Scholar
  • 29 Barnes P F, Fong S J, Brennan P J, Twomey P E, Mazumder A, Modlin R L. Local production of tumor necrosis factor and interferon gamma in tuberculous pleuritis.  J Immunol . 1990;  145 149-154
    PubMedGoogle Scholar
  • 30 Barnes P F, Modlin A, Bikle D D, Adams J S. Transpleural gradient of 1,25-dihydroxyvitamin D in tuberculous pleuritis.  J Clin Invest . 1989;  83 1527-1532
    PubMedGoogle Scholar
  • 31 Maeda J, Ueki N, Ohkawa T. Local production and localization of transforming growth factor-beta in tuberculous pleurisy.  Clin Exp Immunol . 1993;  92 32-38
    PubMedGoogle Scholar
  • 32 Jonjic N, Peri G, Bernasconi S. Expression of adhesion molecules and chemotactic cytokines in cultured human mesothelial cells.  J Exp Med . 1992;  176 1165-1174
    CrossrefPubMedGoogle Scholar
  • 33 Mohammed K A, Nasreen N, Ward M J, Mubarak K K, Rodriguez-Panadero F, Antony V B. Mycobacterium-mediated chemokine expression in pleural mesothelial cells: role of C-C chemokines in tuberculous pleurisy.  J Infect Dis . 1998;  178 1450-1456
    CrossrefPubMedGoogle Scholar
  • 34 Lorgat F, Keraan M M, Lukey P T, Ress S R. Evidence for in vivo generation of cytotoxic T cells: PPD-stimulated lymphocytes from tuberculous pleural effusions demonstrate enhanced cytotoxicity with accelerated kinetics of induction.  Am Rev Respir Dis . 1992;  145 418-423
    PubMedGoogle Scholar
  • 35 Ota T, Okubo Y, Sekiguchi M. Analysis of immunologic mechanisms of high natural killer cell activity in tuberculous pleural effusions.  Am Rev Respir Dis . 1990;  142 29-33
    PubMedGoogle Scholar
  • 36 Arruda S, Chalhoub M, Cardoso S, Barral-Netto M. Cell-mediated immune responses and cytotoxicity to mycobacterial antigens in patients with tuberculous pleurisy in Brazil.  Acta Trop . 1998;  71(1) 1-15
    PubMedGoogle Scholar
  • 37 Hua C C, Chang L C, Chen Y C, Chang S C. Proinflammatory cytokines and fibrinolytic enzymes in tuberculous and malign pleural effusions.  Chest . 1999;  116(5) 1292-1296
    CrossrefPubMedGoogle Scholar
  • 38 Tsicopoulos A, Hamid Q, Varney V. Preferential messenger RNA expression of TH1-type cells (IFN-gamma+, IL-2+) in classical delayed-type (tuberculin) hypersensitivity reactions in human skin.  J Immunol . 1992;  148 2058-2061
    PubMedGoogle Scholar
  • 39 Berger H W, Mejia E. Tuberculous pleurisy.  Chest . 1973;  63 88-92
    CrossrefPubMedGoogle Scholar
  • 40 Ellner J J. Supressor adherent cells in human tuberculosis.  J Immunol . 1978;  121 2573-2579
    PubMedGoogle Scholar
  • 41 Rossi G A, Balbi B, Manca F. Tuberculous pleural effusions: evidence for a selective presence of PPD-specific T lymphocytes at site of inflammation in the early phase of the infection.  Am Rev Respir Dis . 1987;  136 575-579
    PubMedGoogle Scholar
  • 42 Nasreen N, Mohammed K A, Ward M J, Antony V B. Mycobacterium-induced transmesothelial migration of monocytes into pleural space: role of intercellular adhesion molecule-1 in tuberculous pleurisy.  J Infect Dis . 1999;  180 1616-1623
    CrossrefPubMedGoogle Scholar
  • 43 Allen J C, Apicella M A. Experimental pleural effusion as a manifestation of delayed hypersensitivity to tuberculin PPD.  J Immunol . 1968;  101 481-487
    PubMedGoogle Scholar
  • 44 Leckie W JH, Tothill P. Albumin turnover in pleural effusions.  Clin Sci . 1965;  29 339-352
    PubMedGoogle Scholar
  • 45 Plans Bolibar C, Aranda Torres A, Roca Montanari A. Pleuritis tuberculosa: diagnostico histológico y bacteriológico en 310 pacientes.  Arch Bronconeumol . 1980;  16 106-110
    PubMedGoogle Scholar
  • 46 Epstein D M, Kline L R, Albelda S M, Miller W T. Tuberculous pleural effusions.  Chest . 1987;  91 106-109
    PubMedGoogle Scholar
  • 47 Trajman A, Neto E B, Belo M T. Pleural tuberculosis and human immunodeficiency virus co-infection.  Int J Tuberc Lung Dis . 1997;  1 498-501
    PubMedGoogle Scholar
  • 48 Yilmaz M, Kumcuoglu Z, Utkaner G, Yalniz O, Erkmen G. Computed tomography findings of tuberculous pleurisy.  Int J Tuberc Lung Dis . 1998;  2 164-167
    PubMedGoogle Scholar
  • 49 Relkin F, Aranda C P, Garay S M, Smith R, Berkowitz K A, Rom W N. Pleural tuberculosis and HIV infection.  Chest . 1994;  105 1338-1341
    PubMedGoogle Scholar
  • 50 Ferrer J, Muñoz X, Orriols R, Light R W, Morell F. Evolution of idiopathic pleural effusion: a prospective, long-term follow-up study.  Chest . 1996;  109 1508-1513
    PubMedGoogle Scholar
  • 51 Light R W, Erozan Y S, Ball W C. Cells in pleural fluid: their value in differential diagnosis.  Arch Intern Med . 1973;  132 854-860
    CrossrefPubMedGoogle Scholar
  • 52 Ellison E, Lapuerta P, Martin S E. Cytologic features of mycobacterial pleuritis: logistic regression and statistical analysis of a blinded, case-controlled study.  Diagn Cytopathol . 1998;  19 173-176
    CrossrefPubMedGoogle Scholar
  • 53 Jones D, Lieb T, Narita M, Hollender E S, Pitchenik A E, Ashkin D. Mesothelial cells in tuberculous pleural effusions of HIV-infected patients.  Chest . 2000;  117 289-291
    CrossrefPubMedGoogle Scholar
  • 54 Bueno C E, Clemente G, Castro B C. Cytologic and bacteriologic analysis of fluid and pleural biopsy specimens with Cope's needle.  Arch Intern Med . 1990;  150 1190-1194
    CrossrefPubMedGoogle Scholar
  • 55 Valdes L, Alvarez D, San Jose E. Tuberculous pleurisy: a study of 254 patients.  Arch Intern Med . 1998;  158 2017-2021
    CrossrefPubMedGoogle Scholar
  • 56 Kirsch C M, Kroe D M, Azzi R L, Jensen W A, Kagawa F T, Wehner J H. The optimal number of pleural biopsy specimens for a diagnosis of tuberculous pleurisy.  Chest . 1997;  112 702-706
    CrossrefPubMedGoogle Scholar
  • 57 Heyderman R S, Makunike R, Muza T. Pleural tuberculosis in Harare, Zimbabwe: the relationship between human immunodeficiency virus, CD4 lymphocyte count, granuloma formation, and disseminated disease.  Trop Med International Health . 1998;  3 14-20
    PubMedGoogle Scholar
  • 58 Maaertens G, Bateman E D. Tuberculous pleural effusions: increased culture yield with bedside inoculation of pleural fluid and poor diagnostic value of adenosine deaminase.  Thorax . 1991;  46 96-99
    PubMedGoogle Scholar
  • 59 Cheng A F, Li M SK, Chan C Y. Evaluation of three culture media and their combinations for the isolation of Mycobacterium tuberculosis from pleural aspirates of patients with tuberculous pleurisy.  J Trop Med Hyg . 1994;  97 249-253
    PubMedGoogle Scholar
  • 60 Cheng A FB, Tai V HB, Li M SK. Improved recovery of Mycobacterium tuberculosis from pleural aspirates: bedside inoculation, heparinized containers, and liquid culture media.  Scand J Infect Dis . 1999;  31 485-487
    PubMedGoogle Scholar
  • 61 Walzl G, Wyser C, Smedema J, Corbett C, van de Wal B. Comparing the diagnostic yield of Abrams needle biopsy and thoracoscopy.  Am J Respir Crit Care Med . 1996;  153 A460
    PubMedGoogle Scholar
  • 62 Valdés L, San José E, Alvarez D. Diagnosis of tuberculous pleurisy using the biologic parameters adenosine deaminase, lysozyme, and interferon gamma.  Chest . 1993;  103 458-465
    PubMedGoogle Scholar
  • 63 Verea Hernando R H, Masa Jimenez F J, Dominguez Juncal L, Garcia-Buela J P, Martin Egana T M, Fontan Bueso J. Meaning and diagnostic value of determining the lysozyme level of pleural fluid.  Chest . 1987;  91 342-345
    PubMedGoogle Scholar
  • 64 Ribera E, Ocaña I, Martinez-Vazquez J M, Rossell M, Español T, Ruibal A. High level of interferon gamma in tuberculous pleural effusion.  Chest . 1988;  93 308-311
    PubMedGoogle Scholar
  • 65 Shimokata K, Saka H, Murate T, Hasegawa Y, Hasegawa T. Cytokine content in pleural effusion: comparison between tuberculous and carcinomatous pleurisy.  Chest . 1991;  99 1103-1107
    PubMedGoogle Scholar
  • 66 Ito M, Kojiro N, Shirasaka T, Moriwaki Y, Tachibana I, Kobuku T. Elevated levels of soluble interleukin-2 receptors in tuberculous pleural effusions.  Chest . 1990;  97 1141-1143
    PubMedGoogle Scholar
  • 67 Yew W W, Chan C Y, Kwas S Y, Cheung S W, French G L, Path E RC. Diagnosis of tuberculous pleural effusion by the detection of tuberculostearic acid in pleural aspirates.  Chest . 1991;  100 1261-1263
    PubMedGoogle Scholar
  • 68 Shibagaki T, Hasegawa Y, Saito H, Yamori S, Shimokata K. Adenosine deaminase isozymes in tuberculous pleural effusion.  J Lab Clin Med . 1996;  127 348-352
    CrossrefPubMedGoogle Scholar
  • 69 Ungerer J PJ, Oosthuizen H M, Retief J H, Bissbort S H. Significance of adenosine deaminase activity and its isoenzymes in tuberculous effusions.  Chest . 1994;  106 33-37
    CrossrefPubMedGoogle Scholar
  • 70 Orriols R, Muñoz X, Drobnic M E, Ferrer J, Morell F. High adenosine deaminase activity in pleural effusion due to psittacosis.  Chest . 1992;  101 881-882
    PubMedGoogle Scholar
  • 71 Petterson T, Ojala K, Weber T H. Adenosine deaminase in the diagnosis of pleural effusions.  Acta Med Scand . 1984;  215 299-304
    PubMedGoogle Scholar
  • 72 Ocaña I, Martinez-Vazquez J M, Segura R M, Fernandez-DeSevilla T, Capdevila J A. Adenosine deaminase in pleural fluids: test for diagnosis of tuberculous pleural effusion.  Chest . 1983;  84 51-53
    PubMedGoogle Scholar
  • 73 Maritz F J, Malan C, Le Roux I. Adenosine deaminase estimations in the differentiation of pleural effusions.  SA Med J . 1982;  62 556-558
    PubMedGoogle Scholar
  • 74 Ena J, Valls V, Pérez de Oteyza C, Enríquez de Salamanca R. Utilidad y limitaciones de la adenosina desaminasa en el diagnóstico de la pleuresía tuberculosa: estudio metaanalítico.  Med Clin (Barc) . 1990;  95 333-335
    PubMedGoogle Scholar
  • 75 Valdés L, Alvarez D, San Jose E. Value of adenosine deaminase in the diagnosis of tuberculous pleural effusions in young patients in a region of high prevalence of tuberculosis.  Thorax . 1995;  50 600-603
    PubMedGoogle Scholar
  • 76 Burgess L J, Maritz F J, Le Roux I, Frans Taljaard J J. Use of adenosine deaminase as a diagnostic tool for tuberculous pleurisy.  Thorax . 1995;  50 672-674
    PubMedGoogle Scholar
  • 77 Riantawan P, Chaowalit P, Wongsangiem M, Rojanaraweewong P. Diagnostic value of pleural fluid adenosine deaminase in tuberculous pleuritis with reference to HIV coinfection and a bayesian analysis.  Chest . 1999;  116 97-103
    CrossrefPubMedGoogle Scholar
  • 78 Nathan C F, Murray H W, Wiebe M E, Rubin B Y. Identification of interferon-gamma as the lymphokine that activates human macrophage oxidative metabolism and antimicrobial activity.  J Exp Med . 1983;  158 670-689
    CrossrefPubMedGoogle Scholar
  • 79 Aoki Y, Katoh O, Nakanishi Y, Kuroki S, Yamada H. A comparison study of IFN-gamma, ADA, and CA125 as the diagnostic parameters in tuberculous pleuritis.  Respir Med . 1994;  88 139-143
    PubMedGoogle Scholar
  • 80 Villena V, López-Encuentra A, Echave-Sustaeta J, Martín-Escribano P, Ortuño-de Solo B, Estenoz-Alfaro J. Interferon-gamma in 388 immunocompromised and immunocompetent patients for diagnosing pleural tuberculosis.  Eur Respir J . 1996;  9 2635-2639
    CrossrefPubMedGoogle Scholar
  • 81 Söderbloom T, Nyberg P, Teppo A M, Klockars M, Riska H, Petterson T. Pleural fluid interferon-gamma and tumour necrosis factor-alfa in tuberculous and rheumatoid pleurisy.  Eur Respir J . 1996;  9 1652-1655
    CrossrefPubMedGoogle Scholar
  • 82 Ogawa K, Koga H, Hirakata Y, Tomono K, Fashiro T, Kohno S. Differential diagnosis of tuberculous pleurisy by measurement of cytokine concentrations in pleural effusion.  Tuber Lung Dis . 1997;  78 29-34
    CrossrefPubMedGoogle Scholar
  • 83 Wongtim S, Silachamroon U, Ruxrungtham K. Interferon gamma for diagnosing tuberculous pleural effusions.  Thorax . 1999;  54 921-924
    PubMedGoogle Scholar
  • 84 Levy H, Wayne L G, Anderson B E, Barnes P F, Light R W. Antimycobacterial antibody levels in pleural fluid reflect passive diffusion from serum.  Chest . 1990;  97 1144-1147
    PubMedGoogle Scholar
  • 85 Van Vooren P J, Farber C M, De Bruyn J, Yernault J C. Antimycobacterial antibodies in pleural effusions.  Chest . 1990;  97 88-90
    PubMedGoogle Scholar
  • 86 Chin D P, Yajko D M, Hadley W K. Clinical utility of a commercial test based on the polymerase chain reaction for detecting Mycobacterium tuberculosis in respiratory specimens.  Am J Respir Crit Care Med . 1995;  151 1872-1877
    CrossrefPubMedGoogle Scholar
  • 87 de Wit D, Maaertens G, Steyn L. A comparative study of the polymerase chain reaction and conventional procedures for the diagnosis of tuberculous pleural effusion.  Tubercle Lung Dis . 1992;  73 262-267
    CrossrefPubMedGoogle Scholar
  • 88 de Lassence A, Lecossier D, Pierre C, Cadranel J, Stern M, Hance A J. Detection of mycobacterial DNA in pleural fluid from patients with tuberculous pleurisy by means of the polymerase chain reaction: comparison of two protocols.  Thorax . 1992;  47 265-269
    PubMedGoogle Scholar
  • 89 Querol J M, Mínguez J, García-Sánchez E, Farga M A, Gimeno C, García-de-Lomas J. Rapid diagnosis of pleural tuberculosis by polymerase chain reaction.  Am J Respir Crit Care Med . 1995;  152 1977-1981
    PubMedGoogle Scholar
  • 90 Kuwano K, Minamide W, Kusunoki S. Evaluation of nested polymerase chain reaction for detecting mycobacterial DNA in pleural fluid.  Kansenshogaku Zasshi . 1995;  69 175-180
    PubMedGoogle Scholar
  • 91 Villegas M V, Labrada L A, Gore Saravia N. Evaluation of polymerase chain reaction, adenosine deaminase, and interferon-gamma in pleural fluid for the differential diagnosis of pleural tuberculosis.  Chest . 2000;  118 1355-1364
    CrossrefPubMedGoogle Scholar
  • 92 Roper W H, Waring J J. Primary serofibrinous pleural effusion in military personnel.  Am Rev Tuberc . 1955;  71 616-635
    PubMedGoogle Scholar
  • 93 Ormerod L P, McCarthy O R, Rudd R M, Horsfield N. Short course chemotherapy for tuberculous pleural effusion and culture negative pulmonary tuberculosis.  Tuberc Lung Dis . 1995;  76 25-27
    PubMedGoogle Scholar
  • 94 Dutt A K, Moers D, Stead W W. Short-course chemotherapy for pleural tuberculosis: nine years' experience in routine treatment service.  Chest . 1986;  90 112-116
    PubMedGoogle Scholar
  • 95 Dutt A K, Moers D, Stead W W. Tuberculous pleural effusion: 6-month therapy with isoniazid and rifampin.  Am Rev Respir Dis . 1992;  145 1429-1432
    PubMedGoogle Scholar
  • 96 Cañete C, Galarza I, Granados A, Farrero E, Estopá R, Manresa F. Tuberculous pleural effusion: experience with six months of treatment with isoniazid and rifampicin.  Thorax . 1994;  49 1160-1161
    PubMedGoogle Scholar
  • 97 Joint Tuberculosis Committee of the British Thoracic Society. Chemotherapy and management of tuberculosis in the United Kingdom: recommendations 1998.  Thorax . 1998;  53 536-548
    PubMedGoogle Scholar
  • 98 Task Force of ERS, WHO, and the Europe Region of IUATLD. Tuberculosis management in Europe.  Eur Respir J . 1999;  14 978-992
    PubMedGoogle Scholar
  • 99 Small P M, Schecter G F, Goodman P C, Sande M A, Chaisson R E, Hopewell P C. Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection.  N Engl J Med . 1991;  324 289-294
    PubMedGoogle Scholar
  • 100 Harries A D, Nyangulu D S, Banda H. Efficacy of an unsupervised ambulatory treatment regimen for smear-negative pulmonary tuberculosis and tuberculous pleural effusion in Malawi.  Int J Tuberc Lung Dis . 1999;  3 402-408
    PubMedGoogle Scholar
  • 101 Banda H, Kang'ombe C, Harries A D. Mortality rates and recurrent rates of tuberculosis in patients with smear-negative pulmonary tuberculosis and tuberculous pleural effusion who have completed treatment.  Int J Tuberc Lung Dis . 2000;  4 968-974
    PubMedGoogle Scholar
  • 102 Al-Majed S A. Study of paradoxical response to chemotherapy in tuberculous pleural effusion.  Respir Med . 1996;  90 211-214
    PubMedGoogle Scholar
  • 103 Large S E, Levick R K. Aspiration in the treatment of primary tuberculous pleural effusion.  Br Med J . 1958;  1 1512-1514
    PubMedGoogle Scholar
  • 104 De Pablo A, Villena V, Echave-Sustaeta J, López Encuentra A. Are pleural fluid parameters related to the development of residual pleural thickening in tuberculosis?.  Chest . 1997;  112 1293-1297
    PubMedGoogle Scholar
  • 105 Barbas C S, Cukier A, de Varvalho R C, Barbas Filho V J, Light R W. The relationship between pleural fluid findings and the development of pleural thickening in patients with pleural tuberculosis.  Chest . 1991;  100 1264-1267
    PubMedGoogle Scholar
  • 106 Lee C H, Wang W J, Lan R S, Tsai Y H, Chiang Y C. Corticosteroids in the treatment of tuberculous pleurisy: a double-blind, placebo-controlled, randomized study.  Chest . 1988;  94 1256-1259
    PubMedGoogle Scholar
  • 107 Galarza I, Cañete C, Granados A, Estopá R, Manresa F. Randomized trial of corticosteroids in the treatment of tuberculous pleurisy.  Thorax . 1995;  50 1305-1307
    PubMedGoogle Scholar
  • 108 Wyser C, Walzl G, Smedema J P, Swart F, van Schalkwyk M E, van de Wal W B. Corticosteroids in the treatment of tuberculous pleurisy: a double-blind, placebo-controlled, randomized study.  Chest . 1996;  110 333-338
    CrossrefPubMedGoogle Scholar
  • 109 Matchaba P T, Volmink J. Steroids for treating tuberculous pleurisy. In: The Cochrane Library. Oxford: Update Software; 2001;issue 1
    Google Scholar
  • 110 Light R W. Chylothorax and pseudochylothorax. In: Light RW, ed. Pleural Diseases Philadelphia, Pa: Lippincott, Williams & Wilkins; 2001: 327-343
    Google Scholar
  • 111 Vennera M C, Moreno R, Cot J. Chylothorax and tuberculosis.  Thorax . 1983;  38 694-695
    PubMedGoogle Scholar
  • 112 Mandal A K, Thadepalli H, Mandal A K, Chettipally U. Outcome of primary empyema thoracis: therapeutic and microbiologic aspects.  Ann Thorac Surg . 1998;  66 1782-1786
    CrossrefPubMedGoogle Scholar
  • 113 Jenssen A O. Chronic calcified pleural empyema.  Scan J Resp Dis . 1969;  50 19-27
    PubMedGoogle Scholar
  • 114 Al-kattan K M. Management of tuberculous empyema.  Eur J Cardiothorac Surg . 2000;  17 251-254
    CrossrefPubMedGoogle Scholar
  • 115 Rogiers P, Verschakelen J, Knockaert D, Vanneste S. Occult tuberculous postpneumonectomy space empyema four years after lung resection.  Postgrad Med J . 1991;  67 672-674
    PubMedGoogle Scholar
  • 116 Minami M, Kawauchi N, Yoshikawa K. Malignancy associated with chronic empyema: radiologic assessment.  Radiology . 1991;  178 417-423
    PubMedGoogle Scholar
  • 117 Forouhi N G, Walker W, Leitch A G. Tuberculous empyema presenting 62 years after oleothorax: a case report.  Respir Med . 1994;  88 391-392
    PubMedGoogle Scholar
  • 118 Iseman M D, Madsen L A. Chronic tuberculous empyema with bronchopleural fistula resulting in treatment failure and progressive drug resistance.  Chest . 1991;  100 124-127
    PubMedGoogle Scholar
  • 119 Sindel E A. Empyema necessitatis.  Q Bull Sea View Hospital . 1940;  6 1-49
    PubMedGoogle Scholar
  • 120 Glicklich M, Mendelson D S, Gendal E S, Teirstein A S. Tuberculous empyema necessitatis: computed tomography findings.  Clin Imag . 1990;  14 23-25
    PubMedGoogle Scholar
  • 121 Bhatt G M, Austin H M. CT demonstration of empyema necessitatis.  J Comput Assist Tomogr . 1985;  9 1108-1109
    CrossrefPubMedGoogle Scholar
  • 122 Neihart R E, Hof D G. Successful nonsurgical treatment of tuberculous empyema in an irreducible pleural space.  Chest . 1985;  88 792-794
    PubMedGoogle Scholar
  • 123 Elliot A M, Berning S E, Iseman M D, Peloquin C A. Failure of drug penetration and acquisition of drug resistance in chronic tuberculous empyema.  Tubercle Lung Dis . 1995;  76 463-467
    CrossrefPubMedGoogle Scholar
  • 124 Yim A PC. The role of video-assisted thoracoscopic surgery in the management of pulmonary tuberculosis.  Chest . 1996;  110 829-832
    PubMedGoogle Scholar
  • 125 Nakaoka K, Nakahara K, Iioka S, Mori T, Sawamura K, Kawashima Y. Postoperative preservation of pulmonary function in patients with chronic empyema thoracis: a one-stage operation.  Ann Thorac Surg . 1989;  47 848-852
    CrossrefPubMedGoogle Scholar
  • 126 Ali S M, Siddiqui A A, McLaughlin J S. Open drainage of massive tuberculous empyema with progressive reexpansion of the lung: an old concept revisited.  Ann Thorac Surg . 1996;  62 218-223
    CrossrefPubMedGoogle Scholar
  • 127 Miller J I, Mansour K A, Nahai F, Jurkiewicz M J, Hatcher Jr R C. Single-stage complete muscle flap closure of the postpneumonectomy empyema space: a new method and possible solution to a disturbing complication.  Ann Thorac Surg . 1984;  38 227-231
    CrossrefPubMedGoogle Scholar
  • 128 Tatsumura T, Koyama S, Yamamoto K. A new technique for one-stage radical eradication of long-standing chronic thoracic empyema.  J Thorac Cardiovasc Surg . 1990;  99 410-415
    PubMedGoogle Scholar
  • 129 Nomori H, Hasegawa T, Kobayashi R. The ``reversed'' latissimus dorsi muscle flap with conditioning delay for closure of a lower thoracic tuberculous empyema.  Thorac Cardiovasc Surgeon . 1994;  42 182-184
    PubMedGoogle Scholar