RELAPSE RATE OF TUBERCULOUS PLEURAL EFFUSION AMONG PATIENTS WITH RESIDUAL PLEURAL THICKENING AFTER COMPLETING SHORT COURSE DIRECTLY OBSERVED TREATMENT

RELAPSE RATE OF TUBERCULOUS PLEURAL EFFUSION

Authors

  • Itthiphat Arunsurat
  • Apichart So-ngern

Keywords:

tuberculous pleural effusion, residual pleural thickening, relapse rate, DOTS

Abstract

Residual pleural thickening (RPT) is a common residual after
tuberculous pleural effusion (TPE) treatment but it is unclear what the tuberculosis
(TB) relapse rate is among Thai patients with RPT. In this study we aimed to
determine the TB relapsed rate among patients with RPT who had been treated
by short course directly observed treatment (DOTS) and determine the
prevalence, clinical characteristics, radiographic findings and pleural fluid
analysis results of patients with RPT in order to inform TB control programs. We
retrospectively reviewed the medical records of patients with TPE who presented
to Srinagarind Hospital, Khon Kaen University, Thailand between 1 January
2014 and 30 November 2019, looking for evidence of relapse in these patients for
at least 18 months after completing therapy for TPE. A total of 49 subjects were
included in the study; 31 (63%) were male. Thirty-seven subjects (76%) developed
RPT. The mean (+standard deviation (SD)) age of subjects with RPT was 53 (+17)
years and subjects without RPT was 52 (+19). The common presenting symptoms
among study subjects were: cough in 32 subjects (65%), fever in 25 subjects (51%),
dyspnea in 21 subjects (43%) and pleuritic chest pain in 12 subjects (25%). The
common underlying illnesses among subjects were: hypertension in 14 subjects
(29%), diabetes mellitus in 8 subjects (16%) and chronic kidney disease in 6
subjects (12%). Thirty-four subjects (69%) were treated with the standard regimen
of isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months followed by
isoniazid and rifampicin for 4 months (2IRZE/4IR). None of the TPE cases were
treated with therapeutic thoracentesis or pleurodesis. There were no relapses of
TB among patients with RPT. Our results suggest the current management of TPE
cases using DOTS is adequate to prevent relapse of TB.

Published

2021-02-22