Features of diagnostics for exudative pleurisy of tuberculosis etiology
Аннотация
Background: To study the features of diagnosis and therapy for exudative pleurisy of tuberculous etiology (EPTE). Materials and methods: There analyzed 122 cases with EPTE. Men were 76 (62, 3%), women-46 (37, 7%), aged between 17 to 69 years. 1-group included 59 (48, 4%) patients who had revealed/or suspected EPTE based on clinical and X-ray data after admitting in out-patient clinic or antituberculous dispensary. 2-group included 63 (51,6%) patients who primarily were hospitalized in general medical network (GMN) clinics and underwent erroneous treatment for different diseases (pneumonia, intercostal neuralgia, acute respiratory diseases, myocardial infarction, cholecystitis etc.) within 7-34days. Results: Focal TB was diagnosed in 55 (45, 1%), infiltrative –34 (27, 9%), disseminated- 11 (9, 0%), pleural TB - in 8 (6,6%), intrathoracic lymphatic nodes – in 14 (11, 5%). Bronchoscopy revealed active specific changes in 34 from 63 examined patients including rough deformed cicatrical changes in 11 patients. Mantoux test was positive in 84 (68, 9%). M.Tuberculosis (MBT) were found in sputum by Tsil-Nelson in 16 (13,1%) patients, by PCR- in 27 (22,1%). By culture method MBT in sputum was detected in 21 (17,2%) cases, in pleural fluid –in 12 (9,8%). Blood-sedimentation test rise was noted in 102 (83,6%), leukocytosis in 105 (86,1%). Revolt positive test was revealed in exudates. Treatment was managed by standard scheme of DOTS strategy and with punctures of pleural sac. Liquidation and resorption of exudate was obtained within 8-28 days from treatment date. Conclusion: Exudative pleura diagnostics is a challenge. It should be paid an important place to general medical network doctors' high concern in regard to TB.