Comparison of Clinical Characteristics of Polymorphonuclear and Mononuclear Predominant Pleural Effusion in Tuberculous Patients

<ns3:p>Introduction Tuberculous pleural effusion (TPE) is the second most frequent manifestation of extrapulmonary tuberculosis (TB), predominantly characterised by mononuclear (MN) cells in pleural fluid. However, approximately 6.7% of cases show polymorphonuclear (PMN) cell predominance in pleural fluid, often causing delayed diagnosis and treatment, as these cases may not be initially recognised as tuberculosis. This study aimed to compare the clinical characteristics of PMN- and MN-predominant TPE. Methods This cross-sectional analytical study included 60 patients with bacteriologically confirmed TB with pleural effusion at Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Primary data were collected from patient interviews, physical examinations, and pleural fluid analysis of thoracentesis samples. The diagnosis of pleural effusion was confirmed by radiological imaging and thoracentesis. Patients were classified as PMN-predominant (≥50% PMN) or MN-predominant (≥50% MN) based on pleural fluid cell counts. Results Among the patients, 24 (40%) had PMN-predominant and 36 (60%) had MN-predominant pleural effusion. Significant differences were found between cell predominance and clinical features, including weight loss (p < 0.001), symptom duration (p = 0.034), clinical severity (p = 0.033), pleural fluid leukocyte and lactate dehydrogenase (LDH) levels (p < 0.001). PMN predominance was associated with severe clinical presentation and higher pleural leukocyte and LDH levels in pleural fluid than MN predominance. Conclusions PMN-predominant TPE reflects an early, more severe inflammatory phase characterised by severe clinical manifestations and elevated leukocyte and LDH levels. While MN predominance suggests a more chronic disease phase with longer symptoms and mild to moderate clinical</ns3:p>