Document 0506
 DOCN  M9550506
 TI    Diagnosis of tuberculosis in patients with pleural effusion in an area
       of HIV infection and limited diagnostic facilities.
 DT    9505
 AU    Richter C; Perenboom R; Swai AB; Kitinya J; Mtoni I; Chande H; Kazema
       RR; Chuwa LM; Mwakyusa DH; Maselle SY; Department of Medicine, Muhimbili
       Medical Centre, Dar es Salaam,; Tanzania.
 SO    Trop Geogr Med. 1994;46(5):293-7. Unique Identifier : AIDSLINE
       MED/95159218
 AB    In a prospective study of 118 patients with pleural effusion,
       tuberculosis (TB) was diagnosed in 112. In 84 patients the diagnosis of
       TB was made by detection of acid-fast bacilli by stain (auramine,
       Ziehl-Neelsen) or by culture of mycobacteria (Lowenstein-Jensen medium)
       in pleural fluid or pleural tissue (obtained by closed biopsy) or by the
       presence of caseating granulomas in histological sections. In 28
       patients the diagnosis of TB was considered probable, based on good
       response to anti-tuberculous therapy. The highest diagnostic yield was
       obtained by histology (85%), followed by culture of pleural biopsy (37%)
       and pleural fluid culture (36%). Pulmonary tuberculosis was found in 8
       patients and dissemination of TB to other sites in 25 patients of whom
       20 were HIV positive. By logistic regression analysis we identified 2
       independent diagnostic markers for TB pleuritis: pleural fluid protein >
       50 g/l (Odds ratio 12.1, 95% confidence interval (CI): 1.1-128.3) and
       adenosine deaminase of > 10 U/l (Odds ratio 11.08, 95% CI: 1.3-96.4). We
       conclude that conventional facilities of a referral hospital are
       sufficient to diagnose tuberculous pleuritis as well as disseminated
       tuberculosis irrespective of HIV infection. However, for regions with
       overstretched health services and high prevalences of tuberculous
       pleurisy in patients with pleural effusion we suggest a simplified
       diagnostic approach based on exclusion of other causes of pleural
       effusion by simple means and use of these diagnostic markers.
 DE    Adult  Human  HIV Seroprevalence  Medically Underserved Area  Pleural
       Effusion/*ETIOLOGY  Predictive Value of Tests  Prevalence  Prospective
       Studies  Support, Non-U.S. Gov't  Tanzania/EPIDEMIOLOGY  Tuberculosis,
       Pleural/*COMPLICATIONS/*DIAGNOSIS/EPIDEMIOLOGY  JOURNAL ARTICLE

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