Evaluation of different laboratory methods for rapid diagnosis of tuberculous pleurisy

Tuberculous pleurisy is a diagnostic challenge due to its nonspecific clinical presentation, paucibacillary nature of the effusion together with the inefficiency of conventional laboratory methods motivating the evaluation of variable diagnostic strategies.

Using thoracoscopy, the pleural cavity of 50 patients with undiagnosed exudative pleural effusion were fully examined and biopsy specimens of affected parietal pleura were taken under direct vision. Pleural fluid and biopsy specimen were subjected to microscopic examination (direct and after cytocentrifugation), culture, PCR, and histopathological examination.

The pleural biopsy specimens proved to have a higher detection rate of tubercle bacilli than pleural fluid. Also, cytocentrifugation improved the sensitivity of microscopic detection for both pleural fluid and biopsy specimens.

The combination of microbiological results and histopathology examination of the pleural biopsy specimens is essential for the diagnosis of tuberculous pleurisy, as microbiological examination of pleural biopsy specimens has proved to have a higher detection rate than pleural fluid examination.