L'esperienza che insegna
Pleurite tubercolare: una diagnosi non sempre immediata
Tuberculous pleuritis: a not always immediate diagnosis
Silvia Nider1,2, Giulia Gortani1, Alessandro Ventura1,2
1IRCCS Materno-Infantile “Burlo Garofolo”, Trieste; 2Università di Trieste
Dicembre 2014 - pagg. 642 -646
Abstract
Tuberculous pleuritis usually presents as an acute illness with fever, cough and pleuritic
chest pain. The pleural fluid is an exudate that usually shows predominant lymphocytes.
Pleural fluid cultures are positive for Mycobacterium tuberculosis in less than 40% and
sputum is virtually always negative. In questionable cases the diagnosis can be established
by demonstrating granulomas or organisms on tissue specimens obtained via needle
biopsy of the pleura or thoracoscopy. The chemotherapy for tuberculous pleuritis is
the same as that for pulmonary tuberculosis. The present paper reports a case of a 17-
year-old girl with pleural effusion, without parenchymal disease. Tuberculin skin test,
bacterial and AFB cultures as well as cytology are negative. The diagnosis of tuberculous
pleural effusion is established by demonstrating granuloma in the parietal pleura
and by a positive AFB stain.
Suggerite dall'AI
Classificazione MeSH
Contenuto riservato
Per leggere l'articolo completo è necessario effettuare il login.
Non sei ancora registrato? Registrati
Bibliografia
1. Merino JM, Carpintero I, Alvarez T, Rodrigo
J, Sánchez J, Coello JM. Tuberculous pleural
effusion in children. Chest 1999;115:26-30.
2. Light RW. Pleural diseases, 5th ed. Philadelphia:
Lippincott Williams & Wilkins, 2007:211-
24.
3. Chiu CY, Wu JH, Wong KS. Clinical spectrum
of tuberculous pleural effusion in children.
Pediatr Inter 2007;49:359-62.
4. Tuberculosis. In: Red Book, American
Academy of Pediatrics, 2009.
5. Light RW. Establishing the diagnosis of tuberculous
pleuritis. Arch Intern Med 1998;
158:1967-8.
6. Liang QL, Shi HZ, Wang K, Qin SM, Qin XJ.
Diagnostic accuracy of adenosine deaminase
in tuberculous pleurisy: a meta-analysis. Respir Med 2008;102:744-54.
7. Doosoo J. Tuberculous pleurisy: an update.
Tuberc Respir Dis 2014;76:153-9.
8. Lee CH, Wang WJ, Lan RS, Tsai YH, Chiang
YC. Corticosteroids in the treatment of tuberculous
pleurisy. A double blind, placebo-controlled,
randomized study. Chest 1988;84:
1256-9.
9. Galarza I, Canete C, Granados A, Estopa R,
Manresa F. Randomised trial of corticosteroids
in the treatment of tuberculous
pleurisy. Thorax 1995;50:1305-7.
10. Critchley JA, Young F, Orton L, Garner P.
Corticosteroids for prevention of mortality in
people with tuberculosis: a systematic review
and meta-analysis. Lancet Infect Dis 2013;13:
223-37.
11. Sahn SA, Huggins JT, San Jose E, et al. The
art of pleural fluid analysis. Clin Pulm Med
2013;20:77.
12. Gonlugur U, Gonlugur TE. The distinction
between transudates and exudates. J Biomed
Sci 2005;12:985.
13. Carr DT, McGuckin WF. Pleural fluid glucose.
Serial observation of its concentration
following oral administration of glucose to patients
with rheumatoid pleural effusions and
malignant effusions. Am Rev Respir Dis 1968;
97:302.
14. Venekamp LN, Velkeniers B, Noppen M.
Does “idiopathic pleuritis” exist? Natural history
of non-specific pleuritis diagnosed after
thoracoscopy. Respiration 2005;72:74.
Corrispondenza: silvia_naider@yahoo.it