Role of sputum examination for acid fast bacilli in tuberculous pleural effusion

Abstract

Background:Sputum for acid fast bacilli (AFB) is seldom looked for in the etiological diagnosis of tuberculous pleural effusion usually due to the absence of any parenchymal lesion radiologically, but presence of tubercle bacilli in sputum may have important epidemiological and therapeutic implication.Aims:This study aims to evaluate the role of sputum examination for AFB in the patients of tuberculous pleural effusion with no apparent lung parenchymal lesion radiologically.Settings and Design:Forty-five consecutive indoor patients of suspected tuberculous pleural effusion having no apparent lung parenchymal lesion on chest radiography were selected for our study. It was a prospective and observational study conducted over a period of 1 year.Materials and Methods:After confirming the etiology of pleural effusion as tuberculous by biochemical, cytological, histopahtological, and microbiological tests, emphasis was given on sputum examination for AFB by smear examination and culture for Mycobacterium tuberculosis.Results:Sputum was bacteriologically (smear and /or culture) positive for tuberculosis in 10 out of 30 cases (33.33%) in which tuberculous etiology was confirmed by histology and /or bacteriology (definite tuberculosis). No sputum AFB (smear and culture) was found in 15 cases of probable tuberculosis where tuberculous etiology was established by indirect methods like Adenosine de aminase level more than 40 unit/l and other relevant investigations. Over all, sputum was bacteriologically smear and/or culture positive in 10 out of 45 cases (22.22%).Conclusion:Careful and thorough sputum examination in cases of tuberculous pleural effusion may help as a diagnostic tool and it has therapeutic and epidemiological implications.

Yield of Sputum for Afb in Tubercular Pleural Effusion With or Without Any Radiological Manifestations.

“…Most of the patients were in the age group of 46-55 yrs and the mean age of the patients was 40.44 yrs ±11.35 yrs. This finding is comparable with the study done by A D Choudhuri, S Bhuniya, S Pandit et al 3 . and Marcus B. Conde , Angela Chindamo Loivos, Valeria et al 6 where they found male female ratio was 3:1.…”

“…But this was not statistically significant as the p value was >0.05. In the study all patient's pleural fluid was lymphocytic predominant while it was 95.45% in the study conducted by A D Choudhuri, S Bhuniya, S Pandit et al 3 . In the study it was found that 50% of patients with parenchymal lesions on chest radiography were positive for sputum smear for AFB while only 7.14% for whom parenchymal lesion was absent.…”

Diagnostic Implications of Bronchial Lavage in Patients with Pleural Tuberculosis

“…Conde et al [8] demonstrated that the yield of sputum culture was 6% to 13% higher than that described previously (4-9%) in patients with no parenchymal lesions and similar to those with lesions on chest radiograph [3,9,10]. Other similar studies from Los Angeles [11] and India [5,12] also reported a high yield of sputum induction in pleural tuberculosis.…”

“…For a confirmatory diagnosis of tuberculosis, isolation of the bacterium from pleural fluid or pleural tissue is required which is mostly not possible due to the pathogenesis of the disease [3]. It is known that pleural space infections are acquired from initial parenchymal lesions which are usually not obvious on chest radiography [4,5]. With the use of computed tomography, parenchymal lesions and focal areas of subpleural cavitation can be visualized [6].…”

A Tuberculosis Case Is Discovered to Be Carney Complex Instead!

“…9 On the other hand, sputum may be bacteriologically smear and/or culture positive in less than 1/3 of cases with tubercular pleural effusion. 10 Cardiac myxoma associated with Carney complex is often multicentric, occurs at a younger age and at unusual sites, and shows a higher tendency of recurrence after resection in comparison to solitary ones. Our patient had three myxomas in three different chambers of the heart, while her 6-year-old son had one solitary myxoma in the right atrium.…”