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Abstract
Pleural tuberculosis (TB) is a diagnostic challenge because of
its nonspecific clinical presentation and paucibacillary nature, by
smear & Z-N stain, culture, and polynucleotide chain reaction (peR).
The inefficiency of conventional laboratory methods (Z·N
smear and culture) and the expensive and sophisticated test of PCR,
have motivated the evaluation of alternative diagnostic strategies.
Hence, the most likely pathogenetic mechanism ofpleural IB is
essentially immunologic, we thought of immunologic studies in the
diagnosis of tuberculous pleural effusion. These tests included PPD
skin reactivity testing, lymphocyte proportion and level of adenine
deaminase (ADA) enzyme activity in pleural fluid.
The study was conducted on 70 children suffering pleural
effusions. Their ages ranged from 1 to 16 years old (mean age 9.35
years), 42 were males and 28 were females.
All children were subjected to
1- History taking with special stress on; contact with a tuberculous
adult, BCG·vaccination; and symptoms including fever, night
sweats, anorexia, weight loss, cough with or without expectoration,
hemoptysis, dyspnea, and chest pain.
2- General and local chest examination
3- Radiographic examination (chest x-ray).
4- Tuberculin skin test
5- Zeihl-Neelsen staining of smears obtained from sputum and
pleural aspirate.
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6- Pleural aspiration guided by clinical and radiographic findings.
The pleural fluid was subjected to:
a) Physical, chemical, cytological and histopathological
examination.
b) Culture on L-J for acid-fast bacilli
c) Estimation ofADA enzyme activity.
d) PCR for DNA amplification.