Abstract
Pleural fluid culture yield in tuberculous pleural effusion (TPE) is disappointing in immunocompetent hosts. Herein, we attempt to define the role of serial sputum cultures in the diagnosis of TPE. We identified cases diagnosed with TPE over a16-year period in ahigh-prevalence US hospital. Absolute yields of one, two, and three sputa were calculated as well as the incremental yield of adding second and third sputa. These calculations were then performed separately for expectorated and induced sputum and for patients with and without infiltrates on chest X-ray. Sixty sputum collections were performed in 46 patients with TPE. The per-patient sensitivity of sputum culture was 45.6%. On aper-sputum collection basis, the overall yield of the first sputum was 30%, of two sputa 39%, and of three sputa 54%. The corresponding incremental yields were 9% and 15%, respectively. The three-sputum yields of expectorated and induced collections were similar. The three-sputum yield in patients with infiltrates on X-ray was 11% lower than that in those without infiltrates. Serial sputum collection of three specimens can be expected to produce ayield of > 50% in cases of suspected TPE regardless of whether obtained by expectoration or induction, and the yield increases incrementally.
Highlights
Pleural fluid culture yield in tuberculous pleural effusion (TPE) is disappointing in immunocompetent hosts
A lymphocyte-predominant exudative effusion with a high adenosine deaminase (ADA) level can be virtually diagnostic of TPE in such settings, microbiological confirmation may be desirable in uncertain cases and allows determination of antibiotic sensitivity
The 158 cases identified were screened for the presence of TPE, which was diagnosed if one or both of the following two sets of criteria was met: a) Pathological/mycobacteriological criteria: ——Granulomas on pleural biopsy with or without mycobacterial tissue smear/culture positivity; —— Pleural fluid or tissue mycobacterial smear/culture positive for M. tuberculosis; b) Clinical criteria: ——Exudative, lymphocyte-predominant pleural effusion;
Summary
Pleural fluid culture yield in tuberculous pleural effusion (TPE) is disappointing in immunocompetent hosts. Two, and three sputa were calculated as well as the incremental yield of adding second and third sputa These calculations were performed separately for expectorated and induced sputum and for patients with and without infiltrates on chest X-ray. Conclusions: Serial sputum collection of three specimens can be expected to produce a yield of > 50% in cases of suspected TPE regardless of whether obtained by expectoration or induction, and the yield increases incrementally. The United States has experienced a sharp decline in TB incidence over the last two decades after an increase during the early years of the acquired immunodeficiency syndrome (AIDS) epidemic Despite this trend, US urban centers such as New York City (NYC) continue to experience a heavy disease burden owing to their large immigrant populations from regions endemic for TB. Pleural fluid culture for acid-fast bacilli (AFB) has been associated with yields well below 30% in multiple studies among human immunodeficiency virus (HIV) negative
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