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Tuberculous pleural effusion

Michael D Frye, MD
John T Huggins, MD
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Tuberculous pleural effusion is the second most common form of extrapulmonary tuberculosis (after lymphatic involvement) and is the most common cause of pleural effusion in areas where tuberculosis is endemic [1-5]. Tuberculous pleural effusion is synonymous with the term tuberculous pleurisy.

Issues related to the evaluation and management of tuberculous pleural effusions will be reviewed here. Issues related to pulmonary tuberculosis are discussed separately. (See "Treatment of drug-susceptible pulmonary tuberculosis in HIV-uninfected adults" and "Treatment of pulmonary tuberculosis in HIV-infected adults: Initiation of therapy".)


Overview — Tuberculous pleural effusions can occur in association with reactivation disease or primary tuberculosis (TB) [4,6-9]. In adults, most often they occur due to reactivation disease [7,8]; in children, most often they occur in the setting of primary disease [9].

Development of tuberculous pleural effusion occurs most commonly as a result of delayed hypersensitivity reaction to mycobacteria or mycobacterial antigens in the pleural space [10]. Less commonly, tuberculous pleural effusion develops when a subpleural focus of disease ruptures into the pleural space [11].

Patients with tuberculous pleural effusion usually have an acute febrile illness with nonproductive cough (94 percent) and pleuritic chest pain (78 percent) [12]. Night sweats, chills, weakness, dyspnea, and weight loss can also occur. The peripheral white blood cell count is typically normal [12].

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Literature review current through: Nov 2017. | This topic last updated: May 05, 2017.
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