PHYSIOLOGIC STUDIES OF THE SEQUELAE OF TUBERCULOUS PLEURAL EFFUSION IN CHILDREN TREATED WITH ANTIMICROBIAL DRUGS AND PREDNISONE.

Abstract

The occurrence of pleural' effusion has been considered to be a potentially serious complication of pulmonary tuberculosis because it may be followed by residual thickening and adhesions of the pleura (1, 2). It is generally accepted that the longer the effusion is present, the greater the likelihood of extensive fibrin deposits on the pleural surface and, consequently, the later development of adhesions (3). In the past, these sequelae interfered with the induction of pneumothorax as a form of treatment of pulmonary tuberculosis (2). More recently, there has been some concern regarding the possible effects of these pleural reactions on the mechanics of breathing. Studies in adult patients showed a severe impairment of pulmonary function after the subsidence of the pleural effusion (4, 5). Early antimicrobial treatment of the disease was suggested for the possible prevention of these mechanical and functional complications (5, 6). The use of adrenocorticosteroids was recommended to decrease the amount of fibrinous exudate (7) and to hasten the resorption of the effusion (8). The availability of groups of children with tuberculous pleural effusion provided an opportunity to study this problem in patients who had received various forms of treatment. The present study was designed to utilize measurements of pulmonary function to obtain the data required to answer the following questions: Does tuberculous pleural effusion in children lead to prolonged pulmonary disability? If so, does the administration of adrenocorticosteroids in the acute phase result in a more favorable outcome than antimicrobial therapy alone? In an attempt to MATERIALS AND METHODS