Chest
Volume 131, Issue 4, April 2007, Pages 1125-1132
Journal home page for Chest

Original Research
Pleural Tuberculosis
Pleural Tuberculosis in the United States: Incidence and Drug Resistance

https://doi.org/10.1378/chest.06-2352Get rights and content

Background

Pleural tuberculosis (TB) should be considered in any patient with a lymphocytic pleural effusion. The diagnostic approach is under debate. Knowledge of pleural TB epidemiology would be beneficial. To help clarify pleural TB epidemiology, we analyzed US national TB surveillance data for 1993 to 2003.

Methods

We compared pleural TB to pulmonary TB (where each was reported as the major site of TB disease, and no additional sites of disease were reported). Applicable statistical tests were performed; p < 0.05 was considered to be significant.

Results

From 1993 through 2003, 7,549 cases of pleural TB and 156,779 cases of pulmonary TB were reported (in 2003: pleural TB, 536 cases; pulmonary TB, 10,551 cases). The annual proportion of pleural TB was relatively stable (median rate, 3.6%; range, 3.3 to 4.0%) compared to that for pulmonary TB, which steadily decreased (average annual decrease, 0.9%; p < 0.01). Pleural TB occurred significantly more often than pulmonary TB among persons ≥ 65 years old (30.4% vs 23.3%, respectively; p < 0.01), and it occurred significantly less often among children < 15 years old (1.8% vs 6.1%, respectively; p < 0.01) and persons 45 to 64 years old (22.9% vs 27.9%, respectively; p < 0.01). Pleural TB patients (63.4%) were born slightly more often in the United States than were pulmonary TB patients (60.9%; p < 0.01). Drug-resistance patterns of pleural TB broadly reflected those of pulmonary TB. However, isolates from pleural TB patients were less often resistant to at least isoniazid (6.0% vs 7.8%, respectively; p < 0.01) and to at least one first-line TB drug (9.9% vs 11.9%, respectively; p < 0.01) compared with pulmonary TB patients.

Conclusions

Knowledge of pleural TB demographic, clinical, and drug-resistance patterns may assist clinicians in making diagnostic and therapeutic decisions.

Section snippets

Materials and Methods

The national TB surveillance system uses a standardized case report form (Report of Verified Case of Tuberculosis) to collect information on newly diagnosed persons with TB from 50 states and the District of Columbia.1213 Demographic, clinical, laboratory, and sociodemographic data, including country of origin, date of arrival in the United States, HIV seropositivity status, and anti-TB drug resistance, were collected.

We analyzed data from the national TB surveillance database, which is

Demographic Characteristics

From 1993 through 2003, a total of 210,978 TB cases were reported in the United States. The major sites of TB disease were pulmonary (n = 167,261; 79.3%), pleural (n = 8,354; 3.9%), and other (eg, lymph node, bone/joint, genitourinary, meningeal, and peritoneal) [n = 35,363; 16.8%]. For the 167,261 reports of pulmonary TB, 156,779 (93.7%) gave no secondary sites of disease, 3,392 (2.0%) listed “pleural” as a secondary site, and 7,090 (4.3%) listed “other” as a secondary site. For the 8,354

Discussion

This study is the most recent and comprehensive assessment of the epidemiology of pleural TB in the United States. Although the total number of pleural TB cases decreased between 1993 and 2003, the proportion of pleural TB cases compared to the total number of cases in the United States remained relatively stable (median proportion, 3.6%) [Fig 1]. This confirms earlier estimates and counters thoughts that those estimates were low.36 The total number and proportion of pulmonary TB cases have

References (21)

There are more references available in the full text version of this article.

Cited by (128)

  • Serosal membrane tuberculosis in Iran: A comprehensive review of evidences

    2023, Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
  • Pleural Tuberculosis

    2021, Clinics in Chest Medicine
    Citation Excerpt :

    In the United States, approximately 6% of all patients with pleural TB between 1993 and 2003 had isolates resistant to Isoniazid (H), and 9.9% were resistant to at least 1 first-line drug, compared with 7.8% and 11.9% for pulmonary TB, respectively.7 Only 1% was multidrug resistant (MDR).7 In 1 center in Taiwan between 2001 and 2008, 10% of isolates was resistant to any anti-TB drug, and 2% was MDR.17

  • Pleural Effusion: Tuberculous Effusion

    2021, Encyclopedia of Respiratory Medicine, Second Edition
View all citing articles on Scopus

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

View full text