Tuberculous Pleural Effusion in Children

Background and Aim: Pleural effusion is the second most common type of extra pulmonary tuberculosis with an incidence of 4.9%. This study aims to describe the age distribution, main clinical, laboratory and radiographic findings and outcome of patients with Tuberculous Pleural Effusion (TPE).
Materials and Methods: This is a retrospective study of TPE patients admitted in pediatric ward of Masih Daneshvari Hospital from 2002 to 2008. Eighteen patients under 18 years of age were included in our study.
Results: The patients in our study were 12 boys (66.7%) and 6 girls (33.3%) who were all in the 10-18 age bracket. The most common presenting symptoms and signs were cough (17 patients, 94.4), anorexia (14 patients, 77.8%), fever (13 patients, 72.2%), chest pain (10patients, 55.6%), tachypnea and respiratory distress (2 patients, 11%), cyanosis (1 patient, 5.5%). All subjects showed exudative pleural fluid with lymphocytosis >50%. Acid fast bacilli (AFB) were not detected in the sputum, gastric and/or pleural fluid of any of the patients. Sputum culture was positive in 4(23.5%). Positive pleural culture was not seen in any of the patients. Pleural biopsies were available in 88% of which showed necrotizing granulomatous inflammation. The most common radiographic findings were unilateral PE (100%), mediastinal lymphadenopathy (22%) and consolidation (11.1%). Eighteen patients received medical treatment.
Conclusion: The clinical manifestation of childhood TPE is not specific and especially in countries with high prevalence of TB it should always be considered in the differential diagnosis for older children suffering from parapneumonic effusion.