Tuberculous Pleurisy

Tuberculous pleurisy is pleural inflammation caused when pulmonary tuberculous inflammation involves the pleura. In some cases it results from hematogenous infection, and some is related to host allergic reaction. Effusions are usually small to moderate; high protein content promotes pleural adhesion and thickening.

Common Symptoms

Chest pain; pleural effusion; anorexia; night sweats; chest tightness; diminished breath sounds; orthopnea; pleuritic pain; increased vocal fremitus

Causes and Pathogenesis

(1) Etiology: Primary TB is the first infection. Tubercle bacilli have human, bovine, avian, and murine types; human and bovine types are pathogenic to humans. Most pediatric TB in China is human type. Tubercle bacilli are resistant to acid, alkali, and alcohol, and tolerate cold, heat, drying, light, and chemicals; moist heat kills them at 65°C for 30 min, 70°C for 10 min, or 80°C for 5 min; dry heat is less effective, requiring over 20 min at 100°C; direct sunlight kills sputum bacilli within 2 h, UV in 10 min, while they survive months in darkness; 5% phenol or 20% bleach takes 24 h. (2) Pathogenesis: Routes include: (1) retrograde lymphatic spread from hilar lymph node TB to the pleura; (2) rupture of adjacent pulmonary foci directly seeding the pleural space; (3) acute or subacute hematogenous disseminated TB causing pleurisy; (4) high host allergy causing exudation to tuberculous toxins; (5) thoracic vertebral or rib TB rupturing into the pleural space. The view that tuberculous effusion is purely allergic is incomplete, as needle or thoracoscopic biopsy shows typical tuberculous pathology in 80% of parietal pleura; direct pleural involvement by bacilli is the main mechanism. Early changes are pleural congestion and leukocyte infiltration, then lymphocyte predominance, with fibrinous then serous exudation; abundant fibrin deposition can form loculated effusions or diffuse pleural thickening, with tubercle nodules.

Treatment

Drug therapy, supportive therapy

Preventive Measures

1. Control the source of infection: Early detection and rational treatment of smear-positive patients is fundamental. Family members of infants with active TB should be examined; school and childcare staff should have regular checkups. 2. Universal BCG vaccination: BCG (Calmette-Guérin, 1921) is given intradermally in the upper left deltoid at 0.05 mg per dose in neonates. BCG contraindications: positive Mantoux, eczema or skin disease, recovery from acute infectious disease (1 month), congenital thymic aplasia, or severe combined immunodeficiency. 3. Preventive chemotherapy for: (1) unvaccinated children under 3 with positive Mantoux; (2) close contacts of open pulmonary TB (usually family); (3) recent Mantoux conversion; (4) strongly positive Mantoux; (5) positive Mantoux requiring prolonged corticosteroids or immunosuppressants.

Department to Visit

It is recommended to visit the Respiratory department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.