Tuberculosis Pleural Effusion: Demography, Clinical Characteristics and Adenosine Deaminase levels in Lagos, Nigeria

Abstract

Background: Tuberculosis is a major public health problem most especially in underdeveloped countries. The global burden of this disease is huge and affects nearly one third of the world population with a disproportionately low prevalence in developed economics. Tuberculosis is an infectious disease caused by mycobacterium tuberculosis which mostly affects the lungs primarily. Tuberculous pleural effusion (TBE) is one of the commonest forms of extrapulmonary tuberculosis, most especially in tuberculosis endemic areas and in the HIV positive population. When a patient presents with an undiagnosed pleural effusion, the diagnosis of pleural tuberculosis should be strongly considered particularly in tuberculosis endemic arrears. Tuberculosis pleural effusion is usually lymphocytic and demonstration of adenosine deaminase (ADA) above 40IU/L is diagnostic. Untreated TBE may be complicated with loculation and pose complex challenges in management.
Objective: The objective of the study was to describe the demographic pattern, clinical characteristics and adenosine deaminase level of tuberculosis pleural effusion in a tertiary hospital in Lagos Nigeria
Method: This study was a hospital based retrospective study performed at the Lagos University Teaching Hospital, from January 2018 through December 2020. Case notes of 66 patients in whom tuberculous pleural effusions were diagnosed based a pleural biopsy and or isolation of tuberculosis bacilli in the pleural fluid were studied for the demography of the patients, clinical characteristic of the fluid and value of the Adenosine deaminase level in the pleural fluid, if it was carried out.
Result: A total number of 66 patients were studied with 62.1% males, and 37.9% females and the mean age was 39.39 years (SD 16.98). The effusion was on the left side in 62.11% of patents, on the right side in 34.81% and bilaterally in 3% of patients. In 84% of patients, about two third of the corresponding hemithorax was opacified. The pleural fluid was serous in 80.3% of cases and purulent in 19.7% of cases. The pleural fluid adenosine deaminase (ADA) was determined in 57 patients and ranged from 44 to 120 with a mean of 63.84 (SD 16.393).
Conclusion: Tuberculosis pleural effusions are largely serous effusions most commonly found on the left hemithorax with a high adenosine deaminase level above 40ui/L. Therefore, adenosine deaminase determination is a highly reliable and sensitive test in the diagnosis of tuberculosis pleural effusions