Tuberculous exudative pleuritis in the correspondence to extrapulmonary tuberculosis and the total number of exudative pleurisy

Abstract

Objective — to discover the correlation between exudative pleurisy of tuberculous genesis and pleural effusions of other genesis and to establish correlation with other forms of extrapulmonary tuberculosis. Materials and methods. The results of surveys of 1382 patients with pleural effusion who were treated at the Lviv Pulmonary Health Centre in 2015—2018 were analyzed. The frequency of exudative pleurisy of tuberculous genesis was assessed, the ratio of pleural effusions of other genesis was determined, the tuberculous pleurisy fraction was estimated in relation to other forms of extrapulmonary tuberculosis, the genesis of exudative pleurisy and ratio between them was evaluated.All patients underwent a general labolatory, radiological and instrumental examinations. Microscopic examination for acid-resistant bacilli of sputum smear, culture media for the detection of Mycobacterium tuberculosis, and molecular genetic testing for test Xpert/MBT/RIFAssay were performed. An ultrasound method was used to detect residual fluid in the pleural cavity after pleural puncture. Thoracoscopy and video thoracoscopy were used for differential diagnosis of pleural effusion.Results and discussion. In 2015, 50 cases of tuberculous pleurisy (TP) were identified, in 2016 — 59, in 2017 — 55, in 2018 — 34 cases of tuberculous pleurisy. Correspondingly, significant stable datas on this nosology were found. The number of cases of exudative pleurisy (EP) as complications of pulmonary tuberculosis (PT) during the indicated years were respectively: 2015 — 61, 2016 — 65, 2017 — 98, 2018 — 120. Thus, a persistently high level of indicators of complicated form of PT — EP, with a tendency to increase, remains. The total number of all pleural effusions (non-exudative pleurisy, oncopleuritis, transudative, etc.) for the specified period was: 2015 — 284, 2016 — 315, in 2017 — 386, in 2018 — 397 cases. A sufficiently stable level of indicators of EP of different genesis for the period from 2016 to 2018 was established — 39.4 %, 2017 — 39.6 %, 2018 — 38.8 %. A high dominant percentage of TP was detected.In the Lviv Pulmonary Health Centrein 2015, extrapulmonary tuberculosis of breathing organs (EPTBO) in the structure of extrapulmonary tuberculosis (EPT) was 54.3 %, and the TP in the structure of extrapulmonary tuberculosis of breathing organs was 98 %. In 2016, EPTBO in the structure of EPT was 57.7 %, and TP in the structure of EPTBO — 78.7 %. In 2017, EPTBO was found in the structure of EPT — 53.4 %. TP was 100 % relative to EPTBO. In 2018, the TP compared to EPTBO was 97.1 %. Thus, there is a consistently high value of the amount of TP in the structure of respiratory tuberculosis.Conclusions. TP is the most common form among EP of different genesis at present. TP is the most common nosology among pathologies of extrapulmonary tuberculosis. TP covers respiratory tuberculosis almost completely, from 78.8 to 98 % Given the dominant indicators of TP, we review it appropriate to consider and present them in reports and analytical forms.