Tuberc Respir Dis.  2017 Jan;80(1):35-44. 10.4046/trd.2017.80.1.35.

Loculated Tuberculous Pleural Effusion: Easily Identifiable and Clinically Useful Predictor of Positive Mycobacterial Culture from Pleural Fluid

• Ko Y
• Kim C
• Chang B
• Lee SY
• Park SY
• Mo EK
• Hong SJ
• Lee MG
• Hyun IG
• Park YB

• KMID: 2396339
• DOI: http://doi.org/10.4046/trd.2017.80.1.35

Abstract

BACKGROUND
Isolation of M. tuberculosis (MTB) is required in cases of Tuberculous pleural effusion (TBPE) for confirming diagnosis and successful therapy based on drug sensitivity test. Several studies have focused on predictors of MTB culture positivity in TBPE. However, the clinical role of loculated TBPE as a predictor of MTB cultivation from TBPE remains unclear. The aim of this study was to examine possible predictors including loculation of TBPE of MTB culture positivity in TBPE.
METHODS
We retrospectively examined associations between clinical, radiological, microbiological, and laboratory characteristics and positive MTB culture from TBPE to determine a potent predictor of culture positivity.
RESULTS
From January 2011 to August 2015, 232 patients with TBPE were identified. Of these, 219 were finally analyzed. Among them, 69 (31.5%) were culture positive for MTB in TBPE and 86 (39.3%) had loculated TBPE. In multivariate logistic regression analysis, the loculation of TBPE was independently associated with culture positivity for MTB in TBPE (adjusted odds ratio [OR], 40.062; 95% confidence interval [CI], 9.355-171.556; p<0.001). In contrast, the lymphocyte percentage of TBPE (adjusted OR, 0.934; 95% CI, 0.899-0.971; p=0.001) was inversely associated with culture positivity for MTB in TBPE.
CONCLUSION
In clinical practice, identification of loculation in TBPE is easy, reliable to measure, not uncommon and may be helpful to predict the possibility of positive mycobacterial culture.

Keyword

Tuberculosis; Pleural Effusion; Pleurisy

MeSH Terms

Diagnosis
Humans
Logistic Models
Lymphocytes
Odds Ratio
Pleural Effusion*
Pleurisy
Retrospective Studies
Tuberculosis

Figure

• 

  Figure 1 The representative radiographic finding of loculated tuberculous pleural effusion. (A) Chest plain X-ray shows no shifting of pleural fluid on decubitus film, as compared with chest posteroanterior view. (B) Thoracic real-time sonography shows complex septated pleural effusion. (C) Chest computed tomography shows loculated pleural fluid, accumulated in nondependent portion.

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