Pleural tuberculosis: an update

PURPOSE OF REVIEW: Pleural tuberculosis accounts for fewer than 1% of all exudative effusions in western countries, occurring in only 3-5% of tuberculous patients. However, in developing countries like India, it is responsible for 30-80% of all pleural effusions encountered and may complicate tuberculosis in 31% of all cases. Thus, tuberculous pleuritis remains a major contributor to global morbidity and mortality. Tuberculous pleurisy presents a diagnostic and therapeutic problem due to the low sensitivity of the diagnostic tools. There have been many advances in the field that we have attempted to update. RECENT FINDINGS: Due to the limitations of conventional tests and the delay of several weeks for mycobacterial culture results, there has been a resurgence of interest in newer rapid tests and biomarkers. This review highlights the deficiencies of the traditional tests, while providing an overview of the newer tests. In addition, we provide an update on the changing epidemiology, clinical features and current treatment options. SUMMARY: Newer immunological tests and scoring systems will revolutionize the way tuberculous pleurisy is diagnosed in the years ahead. Future research needs include validating the available diagnostic tests in larger randomized studies, finding newer specific biomarkers that are simple, accurate and cost-effective for the developing world and determining treatment regimens specific for tuberculous pleurisy.