Management of undiagnosed pleural effusions in positive tuberculin reactors.

Abstract

The current practice is to consider as tuberculous all significant pleural effusions in tuberculin-reacting patients for which nontuberculous etiologies cannot be established and in whom tuberculosis cannot be excluded. The historic background for this concept has been admirably reviewed by Roper and Waring ( 1), and strong support for this practice was provided by their five-year study of 141 positive tuberculin-reacting soldiers with primary serofibrinous pleural effusion. Chronic pulmonary tuberculosis or extrapulmonary tuberculosis developed within five years in 65 per cent of the soldiers. This high incidence of subsequent tuberculosis occurred whether or not the effusion was proved bacteriologically to be due to tuberculosis. Generally, pleural biopsy evidence of a granulomatous pathologic process supports the diagnosis of tuberculosis in many cases when Mycobacterium tuberculosis is not recovered on culture of the fluid, however, there remains the problem of whether a negative biopsy can exclude tuberculosis.