Tuberc Respir Dis.  2006 May;60(5):516-522.

Clinical Characteristics of Tuberculous Empyema

• Shin MC
• Lee SJ
• Yoon SJ
• Kim EJ
• Lee EB
• Cha SI
• Park JY
• Jung TH
• Kim CH

Abstract

BACKGROUND: In contrast to tuberculous pleurisy, tuberculous empyema is a chronic active infectious disease of the pleural cavity that is frequently accompanied by cavitary or advanced pulmonary lesions. The condition requires long-term anti-tuberculous medication with external drainage. The clinical features and treatment outcome of tuberculous empyema are unclear despite the high prevalence of tuberculosis in Korea.
METHODS
From January 1991 through April 2004, 17 patients diagnosed with tuberculous empyema in Kyungpook National University Hospital were enrolled in this study. Their medical records and chest radiographs were reviewed.
RESULTS
Twelve patients(71%) had a history of tuberculosis and six of the 12 patients were under current anti-tuberculous medication. Productive cough, fever, and dyspnea were the main complaints. There was no predominance between the right and left lungs. Nine patients(53%) had far-advanced pulmonary tuberculosis, two(12%) had a cavitary lesion, and seven(41%) had a pyopneumothorax on the chest radiograph. All eight cases in whom the data of pleural fluid WBC differential count was available showed polymorphonuclear leukocyte predominance. Eight patients(47%) had other bacterial infections as well. The overall rates of a positive sputum AFB smear and culture for M. tuberculosis were 71% and 64%, respectively. The positive AFB smear and culture rates for M. tuberculosis from the pleural fluid were 33% and 36%, respectively. Twelve of the 16 patients(75%) were treated successfully. Three underwent additional surgical intervention. Two patients (12%) died during treatment.
CONCLUSION
Tuberculous empyema is frequently accompanied by advanced pulmonary lesions, and polymorphonuclear leukocytes are predominant in the pleural fluid. Other accompanying bacterial infections in the pleural cavity are also common in tuberculous empyema patients. Therefore, tuberculous empyema should be considered in differential diagnosis of patients with polymorphonuclear leukocyte-predominant pleural effusion. In addition, more active effort will be needed to achieve a bacteriological diagnosis in the pleural fluid.

Keyword

Tuberculosis; Empyema

MeSH Terms

Bacterial Infections
Communicable Diseases
Cough
Diagnosis
Diagnosis, Differential
Drainage
Dyspnea
Empyema
Empyema, Tuberculous*
Fever
Gyeongsangbuk-do
Humans
Korea
Lung
Medical Records
Neutrophils
Pleural Cavity
Pleural Effusion
Prevalence
Radiography, Thoracic
Sputum
Treatment Outcome
Tuberculosis
Tuberculosis, Pleural
Tuberculosis, Pulmonary

Figure

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  Figure 1 Treatment outcome of 17 patients with tuberculous empyema. Mean durations of chemotherapy were 18.0(±5.4)* and 9.1(±3.0)† months, respectively. CTx=chemotherapy, Tx=treatment.

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