Current approaches to tuberculous pleural effusion

A common expression of pleural pathologies, most pleural effusions can be diagnosed correctly by the use of simple laboratory investigations, but 15–20% of them fail the test and remain undiagnosed. This paper highlights the advances made in the field of diagnosing a tubercular pleural effusion. In a highly endemic country like India, drug resistant (DR) tuberculosis (TB) is a major public health problem and a low bacillary load in the pleural fluid often results in a negative acid fast bacilli (AFB) culture. Image-guided and pleuroscopic-guided pleural biopsies can increase the yield rates of AFB culture and molecular diagnostic tests like GeneXpert. These tools hold a dual use: they can make a diagnosis of TB and can also detect the DR strains of TB. In the clinical arena, malignant pleural effusions are not uncommonly misdiagnosed initially and treated with antitubercular drugs. The use of newer diagnostic modalities can help limit the risk of such an erroneous diagnosis and unproductive management.