A survey of respiratory physicians on investigating and managing tuberculous pleuritis

Diagnosing tuberculous pleuritis (TBP) is challenging. No consensus currently guides its workup and management in tuberculosis (TB)-endemic regions. An online survey was conducted to assess real-world practices of respiratory physicians when approaching new-onset unilateral pleural effusion and the likelihood of TBP being considered in the diagnostic workup. Responses from 414 respiratory physicians across 15 countries/regions were analyzed, with 98.8% from intermediate-to-high TB burden areas. TBP was frequently considered as a differential diagnosis for new-onset unilateral pleural effusion by 80.4% of respondents. Heterogeneity was observed in the diagnostic and therapeutic approaches among respondents. Initial investigations, including pleural fluid Mycobacterium tuberculosis (MTB) culture, adenosine deaminase and pleural biopsy for histology, were performed variably. Selection of TBP-specific diagnostic tests was correlated with regional TB burden and initial consideration of TBP. Varied perceptions of diagnostic test accuracy were also evident among respondents. A definitive TBP diagnosis, supported by histological or microbiological proof, was required by 60.9% of respondents before anti-TB treatment was initiated. 77.8% of respondents had experienced a revision of the diagnosis of probable TBP cases following empirical anti-TB treatment failure. These findings highlight the need to strengthen the diagnosis and management of TBP in surveyed regions.