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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± 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. ± A circulating adherent cell suppresses the
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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TBeff - TUBERCULOSIS PLEURAL EFFUSION - MANAGEMENT...

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