TBeff - TUBERCULOSIS PLEURAL EFFUSION MANAGEMENT...

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TUBERCULOSIS PLEURAL EFFUSION - MANAGEMENT Introduction : ETB – 15-20% Pleural effusion – 20% in non HIV Under reporting because of AFB negative in fluid In HIV patients: EPTB – 20% PTB + EPTB – 50% Pleural Effusion – 20% It is more common in young populations. Now tendency to affect aged patients. ( IndianJMedical Res )
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PATHOGENESIS Typically 4-7 months following initial infection with TB. Rupture of small subpleural focus Delayed hypersensitivity reaction Possibility the intense inflammation obstructs the lymphatic pores in the parietal pleura which causes accumulation of protein in pleural cavity.
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CLINICAL MANIFESTATION Most commonly manifests as an acute illness Cough 70% , usually non productive Chest pain 75% Usually unilateral Bil – Occurs in 10%
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NATURAL HISTORY OF UNTREATED EFFUSION 90% usually subside spontaneously Effusion usually resolve and all other symptoms disappear within 2-4 months Follow up over time – 40-60% develop tuberculosis Size of original effusion and the presence or absence of small radiologic residual pleural disease do not correlate with subsequent tuberculosis Residual pleural thickening common sequelae ~ 50%.
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DIAGNOSIS Diagnosis depends on the demonstration of tubercle bacilli – In sputum Pleural fluid Pleural biopsy specimen Granuloma in pleura The diagnosis can also be established with reasonable certaintly by ADA
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TUBERCULIN TEST Positive in 60-75% patients, many of negative patients will become tuberculin positive in 6-8 week Negative tuberculin HIV patients & malnutrition There may sequestration of PPD reactive lymphocytes in the pleural space.
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