LAUSR

Purpose Tuberculous pleural disease accounts for a minority of TB disease in England and yet in 2018, of the 17 acute admissions for TB diagnosis to a major teaching hospital, 5 patients had pleural tuberculosis (PLTB) Methodology All adults diagnosed with PLTB between January 2011 and December 2018 were retrospectively evaluated with regard to their clinical history, investigations, management and outcomes. Results In total, 92 patients (median age 34 years; range 17–89; male 70%; UK born 14%) with PLTB were identified. TB was identified in 122 sites with the most common additional sites (AS) affected being pulmonary (25/35), mediastinal lymphadenopathy (20/35) and cervical lymphadenopathy (9/35) accounting for 65.6% additional non-pleural disease sites. 64/92 (69%) were admitted to hospital as a result of their TB disease (median adjusted length of stay (LOS) 10 days; range 2–239). 46% of admitted patients had pleural disease alone compared with 18% of those not admitted (RR 1.41; 95% CI 1.1 to 1.8; p 0.0069). Pleural culture was positive in 36/85 (42%). In the pleural culture negative cohort, AS sampling was undertaken in 24/46 patients and yielded positive culture results in 13/24 (54%). Therefore, overall culture positivity 49/90 (54%). Only 2 patients had neither pleural nor AS sampling undertaken. Eleven patients with culture negative pleural disease were consistently culture negative following AS sampling. Admitted patients with PLTB were significantly more likely to have a positive pleural culture compared to those managed in the out-patient setting: 58% vs 9% (RR 6.39; 95% CI 1.7 to 24.3; p 0.0066). Conclusions Admission is likely to be a marker of TB disease burden/severity and those with pleural disease have prolonged LOS and pleural culture positivity. Pleural fluid is invariably AFB smear negative. Thus, if a second site is accessible, sampling should be undertaken to improve culture positivity with subsequent drug sensitivities.