Pleural tuberculosis

Pleural tuberculosis's disease overview

pleura is made up of the walls and organ leaves, creating a virtual compartment in the pleural cavity. Pleural effusion is the occurrence of fluid in the pleural cavity more than normal physiological levels causing clinical manifestations.

pleural tuberculosis is a disease caused by Mycobacterium tuberculosis, which is the main manifestation of pleural effusion. Pleural effusion (TPE) due to mycobacterium tuberculosis of pleura and is characterized by the strong chronic accumulation of liquid cells and inflammation in pneumothorax

  • is the most cause of pleural effusion in Vietnam accounting for 70-80% of the causes of pleural effusion
    • pleural tuberculosis is a disease that is common in tuberculosis in the lungs, accounting for about 5% in tuberculosis forms and ranked second among tuberculosis in the lungs (after lymph nodes). Pleural tuberculosis usually appears after tuberculosis and accounts for about 25-27% of the tuberculosis forms outside the lungs. 
  • Objects of pleural tuberculosis in men, with the proportion of male / female overall is 2: 1. In an epidemiological analysis from the United States, pleural tuberculosis occurs usually often More than tuberculosis in people> 65 years old and the average age of the patient with this disease is 49 years old: about 50% younger than 45 years old and 30% over 65 years old. In contrast, pleural tuberculosis mainly affects young people (average age = 34 years old) in areas with a higher burden of tuberculosis, of which primary infection accounts for a large proportion of patients with pleural tuberculosis. . Pleural tuberculosis can be encountered at any age, but adolescence is more than (from 16-30 years old)

    • Most pleural tuberculosis is due to complications of tuberculosis. A small part is a complication of secondary tuberculosis due to broken cave into the pleural cavity. 

    Causes of Pleural tuberculosis's disease

  • The most common cause is human tuberculium (Mycobacterium tuberculosis) is aerobic bacteria. A anti -alcoholic anti -alcoholic bacilli, not destroyed by acid and alcohol at other bacteria, long -lasting in the air.
  • Bacteria of tuberculosis and tuberculosis is not typical, which is also a cause of pleural tuberculosis but rarer

    • Bacterial spread line

  • Blood sugar and lymph are the main lines of tuberculosis bacteria from pleural lesions to pleura
  • The approach is tuberculosis lesions in the pulmonary parenchyma near the pleura and then progresses to penetrate the pleura.

    • Symptoms of Pleural tuberculosis's disease

    Acute onset (1 week) or acute (1 month) sometimes chronic or silent onset

    Typical form is pleural pleural tuberculosis

    Stage of onset

  • Acute developments: about 50% of cases with acute signs. Expression of sudden, intense chest pain with high fever 39 0C - 40 0C, dry cough, shortness of breath increasing.

    • Slow movements: about 30% of the cases with the signs: continuous chest pain, mild fever in the afternoon and evening, dry cough, shortness of breath increasing.

  • Potential evolution: Poor and discreet clinical signs. Often overlooked or discovered by chance through lung X -ray examination.

    • The full phase

  • Systemic signs: Pale patients, fatigue, thinning, continuous fever, 38 ° C - 40 ° C, fast pulse, lower blood pressure, nausea, vomiting, amount Little urine.
  • Mechanical signs:

    • Cough in each attack, the cough appears suddenly when changing positions. 

    Chest pain: decreased than the onset period.

    Difficulty breathing, both, increasing.

    When pleura is few, there are few patients who often lie on their side healing, when the fluid is more than a patient who lies on the side or leaning on the wall to reduce shortness of breath.

  • Realistic signs: The most typical of the pleural spill is a decrease syndrome:
  • Look: The chest side is overflow, the chest is reduced than the good side, the wide slot.
  • Touch: vibration decreases.

    • Type: opaque, can determine the upper limit of the opaque area if the overflow is moderate

  • above the opaque area, under the collarbone when the sound is too echoed as the echo of the lungs.

    • Perfect overflow: Type all half of the chest. Many overflow on the left, the heart is pushed to the right, the traubes are tapping.

  • Listen to the lungs whispering alveolar or completely disappeared. If you hear ran exploded, ran moist is lesions in the pulmonary parenchyma (usually tuberculosis).

    • Some clinical forms rarely encountered

  • Local pleural tuberculosis: Clinical signs are often discreet and difficult to diagnose. Epidism can be localized in: Lien lobe groove, armpit area, mediastinum, on diaphragm.
  • Dry pleural tuberculosis can hear the sound of pleural brushes.
  • Infusion combination of pneumothorax due to tuberculosis
  • pleural tuberculosis with tuberculosis or tuberculosis in other organs

    • In addition to the signs of pleural effusion, there are signs of lung lesions: moist, explosion, and mucus: patients coughing up or coughing Blood.

    Pleural tuberculosis in multi -membrane tuberculosis: Often with pleural tuberculosis in combination with tuberculosis in many other membranes: peritoneal, pericardium ...

    People at risk for Pleural tuberculosis's disease

  • Children must not be vaccinated in BCG.
  • Children with tuberculosis but are detected late, improper treatment.

    • Persons in regular contact, directly with patients with tuberculosis (direct sputum test: AFB positive).

  • Sudden cold infection
  • Injury to the chest

    • Systemic diseases that impair the body's immunity: diabetes, gastric cutting, HIV infection, women during pregnancy and postpartum ...

    Prevention of Pleural tuberculosis's disease

  • BCG vaccine should be vaccinated to prevent pleural tuberculosis for young children, especially children under 1 year of age.
  • If there are symptoms of pleural tuberculosis, it is necessary to immediately go to medical facilities or hospitals for accurate conclusions and appropriate treatment.
  • Healthy lifestyle, not indiscriminate sex, away from dangerous social diseases, ...

    • Can pleural tuberculosis work? 

    Most patients are worried because they do not know if pleural tuberculosis is contagious. However, it can be seen that this is a tuberculosis form outside the lungs and does not spread through respiratory tract like tuberculosis. Because pleural tuberculosis is simple, without tuberculosis, it will not spread to others through the respiratory tract, so patients with pleural tuberculosis can go to work and normal activities if there is no tuberculosis with pulmonary tuberculosis. Comes. However, in the early stages the patient needs to be rested to avoid strong and nutritious activities.

    Diagnostic measures for Pleural tuberculosis's disease

    Diagnosis of pleural effusion caused by tuberculosis

  • The pleural ultrasound technique combined with the defined X -ray of the pleural fluid. Usually the lung x -ray (straight, inclined). The pleural fluid is less: the crowd is evenly blurred in the bottom of the lungs, causing the loss of the ribs. Average overflow: The crowd is dark, accounting for half or 2/3 of the lung field, the amount of fluid is about 1-2 liters, the mediastinum is pushed to the opposite side. Many overflow: Evenly, bold the entire lung field, the mediastinum is pushed to the opposite side, the slot of the ribs is expanded, the diaphragm is pushed down low, the amount of fluid over 2 liters.
  • Passion and pleural testing:

    • Pleural testing with properties: lemon yellow, albumin secretion increased, rivalta (+), with many lymphocytes, strong mantoux reactions. . Valuable factors confirm high diagnosis: Find antibodies with Elisa technology, find tuberculosis bacteria by PCR technique in pleural fluid, pleural screening and pleural biopsy, computer -layer cutting. .. Actual applicable and often prioritized for difficult cases.

  • New testing techniques such as finding antibodies of tuberculosis in pleural fluid with Elisa technique have a diagnostic value, but the price is expensive, only some places have equipment. to do.

    • Finding TB bacteria with PCR technique can be indicated for difficult patients and in place with conditions to conduct.

  • Mantoux reaction is often positive.

    • Pleural biopsy through pleural screening or blind biopsy to take samples for anatomical tests to find specific tuberculosis lesions.

    Pleural tuberculosis's disease treatments

    Can pleural tuberculosis?

    Pleural tuberculosis can be completely cured with a long -term treatment regimen. However, the treatment may leave many severe complications such as effusion, pneumothorax, pleural inflammation, thickening of pleura and pleural sediments. Therefore, it is necessary to detect timely and have appropriate treatment as soon as possible. 

    Principle of treatment: According to the principle of tuberculosis chemotherapy

  • Combining anti -tuberculosis drugs

    • Take the right dose of the drug

    Take medication regularly

  • Take the medication enough time in 2 stages of attack and maintenance

    • Symptomatic treatment

  • Analgesic, reducing fever.
  • If it is difficult to breathe due to pleural pleura,
  • Suctions need to suck early and suck. To limit the complications when sucking the fluid (shock, air overflow, bleeding, superinfection ...), it is necessary to follow the principle of sucking the drainage of the pleural fluid, sterile and not too much, too fast. >

    • Anti -pleural thickness

    Consider using corticosteroids when there is a combination of pericarditis. 

    Other treatment:

  • Patients practicing breathing early when the fluid runs out by the method of breathing ...
  • Surgical combination treatment
  • When there is complication of pleural sediment; Superinfection causes pleural leakage ... In addition to the positive medical thing, it is necessary to combine with: minimum pleural opening, maximum pleura opening; Pleural removal surgery; Washing pleural in combination with antibiotic treatment.

    • Pleural tuberculosis has a recurrence rate after treatment called recurrent pleural tuberculosis. Recurrent pleural tuberculosis is that after the patient was determined by a tuberculosis specialist, the disease after the end of this treatment regimen reappeared with symptoms of pleural tuberculosis.

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