Tuberculous Pleural Effusion in the Elderly

Background: Tuberculous pleural effusion is the second most common form of extrapulmonary tuberculosis. The relationship between the geriatric population and tuberculous pleural effusion has rarely been studied. Methods: This is a retrospective study. From January 2005 through February 2009, we retrospectively enrolled 51 patients older than 18 years of age that were diagnosed with tuberculous pleurisy. We analyzed the clinical presentations and laboratory data of pleural effusion in elderly and adult groups. Results: Of these patients, 32 were more than 65 years of age (elderly group) and 19 were less than 65 years of age (adult group). Chest pain occurred more frequently in the adult group than the elderly group (52.6 % vs. 15.6 %; p < 0.01). Ziehl-Neelsen stain and Lowenstein-Jensen culturing of the pleural fluid demonstrated similar diagnostic sensitivities between the adult and elderly groups. The pleural fluid consists almost exclusively of exudates, with lymphocytes being the most predominant finding. Regardless, lower lactate dehydrogenase (LDH) and protein contents in the pleural effusion of the elderly group were noted. The duration between thoracentesis and administration of antituberculous therapy was significantly longer in elderly group (12.4 +/- 15.4 vs. 4.4 +/- 5.5 days; p = 0.03). Conclusion: Tuberculous pleurisy in elderly patients has less specific symptoms and laboratory findings. It may require a longer time to confirm diagnosis and start treatment. Copyright (c) 2012, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.