Evaluation of suspected tuberculous pleurisy: clinical and diagnostic findings in HIV-1-positive and HIV-negative adults in Uganda
Abstract:SETTING: National Tuberculosis Treatment Centre, Mulago Hospital, Kampala, Uganda.
OBJECTIVES: To compare clinical and radiographic presentation, and diagnostic methods, in adults with tuberculous pleurisy who are negative and positive for the human immunodeficiency virus (HIV).
DESIGN: Adults with suspected pleural tuberculosis were screened by clinical examination, thoracocentesis and closed pleural biopsy. Biopsy material was cultured on Middlebrook 7H-10 solid medium and in BACTEC 12B radiometric vials. Pleural fluid was cultured using Löwenstein-Jensen slants, BACTEC and Kirchner liquid medium.
RESULTS: Of 156 individuals enrolled, 142 had tuberculosis, of whom 80% were HIV-positive. Among those with tuberculosis, HIV-positive patients had a more severe and longer illness. The size of effusions was similar in HIV-positive and HIV-negative patients. A higher proportion of HIV-positive patients had parenchymal infiltrates but this difference was not statistically significant. Pleural fluid lymphocytosis was present in all HIV-negative and 97% of the HIV-positive patients. HIV-positive patients had lower pleural fluid lymphocyte counts. Pleural fluid cultures were more often positive in HIV-positive patients. BACTEC and Kirchner liquid media gave higher yields than solid media.
CONCLUSION: HIV-positive patients with tuberculous pleurisy had a more severe illness than HIV-negative patients. Mycobacterial cultures from HIV-positive patients were more often positive, suggesting more mycobacterial extension from the lungs into the pleural space. Liquid culture media were superior to solid media with regard to diagnostic yield and time until diagnosis.
Document Type: Regular Paper
Affiliations: 1: National Tuberculosis Treatment Centre, Kampala, Uganda and Uganda-Case Western Reserve University Research Collaboration, Mulago Hospital, Kampala, Uganda 2: Medical Research Council Programme on AIDS, Uganda Virus Research Institute, Entebbe, Uganda and London School of Hygiene & Tropical Medicine, London, UK 3: Uganda-Case Western Reserve University Research Collaboration, Mulago Hospital, Kampala, Uganda 4: Department of Pathology, Makerere University, Kampala, Uganda 5: Medical Research Council Programme on AIDS, Uganda Virus Research Institute, Entebbe, Uganda 6: London School of Hygiene & Tropical Medicine, London, UK 7: Uganda-Case Western Reserve University Research Collaboration, Mulago Hospital, Kampala, Uganda and Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA 8: Uganda-Case Western Reserve University Research Collaboration, Mulago Hospital, Kampala, Uganda and Department of Medicine, Makerere University, Kampala, Uganda
Publication date: August 1, 2001
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