[Tuberculous pleurisy--still difficult diagnostic problem]

In years 1989-2000 in Lung Diseases Hospital in Łódź tuberculous pleurisy TP was diagnosed in 271 patients; in 130 (48%) cases this diagnosis was confirmed by microbiological and histopathological examinations. Presence of tubercle bacilli in pleural fluid was discovered by smear and culture only in 13 cases, only by culture in 95 and in Bactec method in 7. During this period in 135 patients with pleural effusion of unknown etiology biopsy of the pleura (with Abrams needle) was performed and specific granuloma was found in 17 (13%) persons. In 15 (12%) patients it was the only method establishing diagnosis of TP (because in 2 remaining patients tubercle bacilli in pleural fluid were also found). Assessment of clinical symptoms indicates that onset of TP was insidious and course of the disease was subacute in about 30% of patients, manifested mainly by: fatigue, general weakness, night sweats. Radiological estimation of patients with TP disclosed (besides pleural effusion) lung infiltrations in 38 (28%) cases, including 13 (10%) with cavitation. Tuberculin induration with diameter 0 mm was found in 32% of patients with TP and with greater than 10 mm in 29% of patients. Because of low sensitivity of microbiological examinations of pleural fluid for tubercle bacilli biopsy of pleura should be method of choice in the diagnosis of TP in selected cases.