Treatment Outcomes of Tuberculous and Non-tuberculous Empyema Thoracis

Pulmonary tuberculosis remains prevalent in the developing parts of the world. Besides the consequent tuberculous pleurisy, which can be complicated by empyema thoracis, Mycobacterium tuberculosis is associated with significant lung parenchymal disease that poses an additional clinical challenge in achieving a successful outcome of management. This study compared the outcomes of management of tuberculous versus non-tuberculous empyema thoracis managed at the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria.

A prospective study of patients being managed for empyema thoracis at the ABUTH, Zaria, within a 22-month study period was conducted. Recruitment into the study included all consecutive patients managed for empyema thoracis in ABUTH, Zaria, after obtaining consent. The required data were collected using a structured proforma. These included data on aetiology, microbial isolates, and initial and total empyema volumes. Sociodemographic data (including age, gender, educational level, and occupation) were also noted. The patients were subsequently managed, and the outcomes of management were noted. These outcomes included the duration of drainage, the duration of hospital stay, complications, lung expansion following drainage, and the need for decortication. Data obtained from the study were analysed using the Statistical Package for the Social Sciences (SPSS) version 20 software (IBM Corp. IBM SPSS Statistics for Windows. Version 20.0. Armonk, NY: IBM Corp.; released 2011) and the statistical differences determined using the chi-square test and the student's t-test.

Eighty-three patients were enrolled in the study, 20 (24.1%) of whom were females. Fourteen (16.9%) patients had tuberculous empyema thoracis, whereas 69 (83.1%) had non-tuberculous empyema thoracis. Patients with tuberculous empyema were significantly older than those with non-tuberculous disease (mean age 37.9 years [standard deviation {SD} = 20.6 years] vs. 26.8 years [SD = 18.2 years], P = 0.045). Compared to non-tuberculous empyema, tuberculous empyema thoracis was associated with lower percentage of mean lung expansion (60.9% [SD = 22.7%] vs. 78.4% [SD = 16.8%], P = 0.001), more than six-fold increased need for decortication (odds ratio = 6.58 [95% confidence interval = 1.84-23.52], P = 0.004), and longer period of hospital stay (36.4 days [SD = 3.8 days] vs. 23.6 days [SD = 16.2 days], P = 0.004).

Tuberculous empyema thoracis was associated with worse outcomes (in terms of percentage of lung expansion, need for decortication, and length of hospital stay) compared to non-tuberculous empyema thoracis.