Clinical profile of Tuberculous Pleural Effusion in Children

Aim: To determine the age distribution, clinical and laboratory findings, and outcomes of patients with tuberculous pleural effusion (TPE). Methods: This retrospective study was done over a period of 5 years in children between 1 month -15 years of age who were referred to our tertiary referral center with TPE. Results: Seventy-six (5.3%) children were diagnosed with pleural effusion of which 43 (56.6%) patients had right-sided affection, 31 (40.8%) had left sided affection and 2 (2.6%) bilateral involvement. Mean age of presentation was 6.8±3.2 years. Mean ADA values in pleural fluid were 107.6±115.7 IU/L. High ESR was found in 58 (77.8%) with mean values of 79.1±28.5 mm at end of 1 hour. Left sided effusion was seen at a mean age of 7.9±3.5 whereas right sided effusion was seen at a mean age of 6.1± 2.8 (p=0.016). Conclusion: Most of the pleural effusions are seen in children < 10 years of age and does not have a predilection for adolescents as mentioned in literature. Elevated ADA and ESR may suggest TPE. Though right sided effusion is more common, left sided effusion is seen in older children. Introduction Tuberculosis (TB) is most common cause of infections related death globally. It is estimated that childhood TB constitutes 10–20% of all TB in high-burden countries.1 Tuberculous pleurisy is the second most common form of extrapulmonary tuberculosis (TB)2 and a common cause of pleural effusion in endemic TB areas. There is limited data regarding the prevalence of tuberculous pleural effusion (TPE) in children but estimated literature has shown that frequency of pleural involvement in pediatric tuberculosis ranges from 238%.3,4,5,6 Effusion is not a common characteristic of primary pulmonary TB in young children and it is more probable to be detected in adolescents and adults.7 The aim of this study was to describe the age distribution of pediatric patients with TPE, with the clinical and laboratory findings and outcome of these patients. Methods & Materials This was a retrospective study done over 5 years in children between 1 month -15 years of age who were referred to our tertiary referral center. Patients identified as TPE were included in the analysis. TPE was diagnosed if the chest radiograph depicted a pleural effusion and at least one of the following criteria: (1) positive culture or positive cartridge based nuclear acid amplification test (CBNAAT) or presence of acid-fast bacilli (AFB) for Mycobacterium tuberculosis (MTB) from pleural fluid, (2) Compatible clinical picture with pleural fluid showing lymphocytic predominance or levels of adenosine deaminase activity (ADA) more than 35 IU/l with/without a positive tuberculin skin test or contact with an adult having TB. Records of all patients were evaluated and clinical history; examination findings and laboratory investigations were noted. Malnutrition was defined as weight or height less than 3 centile as per Agarwal charts.8 Associated serositis in form of pericardial effusion or ascites was noted. Drug resistance TB was diagnosed as per World Health Organization (WHO) criteria.9 Pulmonary TB was defined by WHO as a patient with tuberculosis disease involving the lung parenchyma.10 TB contact was defined as defined as person who shared the same enclosed living space for one or more nights or for frequent or extended periods during the day with the index case during the 3 months before commencement of the current treatment episode.11 High ESR was defined as >20 mm at end of 1 hour. The patients were followed up regularly and the outcome of their treatment was charted, along with a specific mention of those requiring an intercostal drainage (ICD) tube and those needing steroid therapy. Those developing any form of resistance to treatment or development of hepatitis were also monitored. Prevalence of TPE in all patients with TB was determined and clinical profile of patients with TPE was analyzed. Difference between left and right sided pleural effusion and various clinical and laboratory parameters was analyzed. Proportions were analyzed using the Chi square tests and Fisher Exact test. P value <0.05 was Address for Correspondance: Dr Ankita Shah, 501,Rose villa, next to filmalaya studio, ceaser road, amboli, andheri west, Mumbai 400058, India. Email: drankitashah@hotmail.com ©2021 Pediatric Oncall ARTICLE HISTORY Received 27 August 2021 Accepted 27 August 2021