Clinical spectrum of tuberculous pleural effusion in children.
BACKGROUND
The aim of this study was to describe the clinical characteristics and potentially diagnostic specimens of pediatric patients with tuberculous pleural effusion (TPE) to make a prompt diagnosis.


METHODS
Children who had TPE from September 1997 to December 2003 were retrospectively reviewed at a tertiary pediatric facility in northern Taiwan.


RESULTS
There were seven boys and six girls and their ages ranged from 10 to 17 years (average, 14.6 years). Tuberculosis contact history was identified in only six patients (46%). Fever (12/92%), cough (9/69%) and malaise (6/46%) were the most common symptoms. Normal leukocyte count was found in 12 patients (92%). Chest radiograph review showed unilateral pleural effusion in 12 patients (92%) but parenchymal involvement was found in nine patients (69%). Most of the pleural fluid analysis showed a lymphocytic exudative effusion (5/6). The acid-fast bacilli (AFB) stain of sputum, gastric washing, and pleural aspirate was positive in six of 11 (55%), two of seven (29%), and one of five (20%) patients, respectively. Culture of sputum, gastric washing, and pleural aspirate yielded Mycobacterium tuberculosis in four of 11 (36%), two of seven (29%), and two of five (40%) patients, respectively. A total of 6 to 9 months of multiple-drug therapy for tuberculosis was successful without sequale.


CONCLUSIONS
Tuberculous pleural effusion usually presents as an acute illness and should always be considered in the differential diagnosis for older children and adolescents with pneumonia. A normal leukocyte count with a lymphocytic exudative effusion may provide a clue to the correct diagnosis of TPE. Diagnostic specimen of sputum seems more effective and sensitive in childhood TPE, especially those having pulmonary involvement.
Chiu
Chih-Yung
CY
Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Children's Hospital, Taoyuan, Taiwan.
Wu
Jun-Ho
JH
Wong
Kin-Sun
KS
D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D035422:Pleural Cavity / Q000382:microbiology*; D010996:Pleural Effusion / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011379:Prognosis; D013902:Radiography, Thoracic; D013624:Taiwan / Q000453:epidemiology; D014374:Tuberculin Test; D014396:Tuberculosis, Pleural / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
D000995:Antitubercular Agents