A comparative study of clinico-biochemical and thoracoscopic findings of tubercular and non-tubercular pleural effusion patients Undergoing Medical Thoracoscopy: A Hospital Based Prospective Cohort Study

Abstract

Extra pulmonary tuberculosis accounts for 15% of TB cases. Tubercular Pleural effusion is the second most common form of EPTB. The diagnosis of TB pleural effusion is quite challenging due to paucibacillary nature of the disease and often delays. The definite diagnosis of tubercular pleurisy still largely depends primarily on the demonstration of positive Mycobacterium tuberculosis culture in the pleural fluid which not only lacks sensitivity, but is also time-consuming, often leading to delayed diagnosis of pleural effusion cases.

Several pleural fluid markers including adenosine deaminase (ADA), lactate dehydrogenase (LDH), glucose, and differential count of white blood cells have been used to distinguish TPE from non-tubercular exudative effusions, but none of these is confirmatory for tubercular pleurisy [2,3]. Thus, even after thorough clinical assessment and detailed pleural fluid analysis, the etiology of many cases of exudative pleural effusions remains elusive and requires pleural biopsy for confirmation.

Medical thoracoscopy or pleuroscopy with semi-rigid thoracoscope is a minimally invasive procedure for diagnosing pleural diseases especially undiagnosed exudative pleural effusion and has gained lot of interest of pulmonologist in recent years. It is safe and cost effective. It allows the pulmonologist to enter the pleural space, inspect it and directly taking pleural biopsy from suspicious areas. It is done usually in local anesthesia.

In this study we compare clinico-biochemical features and pleural fluid characteristics of patients with unexplained exudative pleural effusions in our resource limited setup and compare it with medical thoracoscopy findings as a reference standard for diagnosis of tubercular pleurisy to see if they can aid in early diagnosis and obviate the need for invasive diagnostic work up in our set up.

KEYWORDS

Extra pulmonary tuberculosis, adenosine deaminase (ADA), lactate dehydrogenase (LDH),

Medical thoracoscopy.