TB effusions include TB pleuritis, TB empyema and lipid effusions. TB pleuritis is characterised by an effusive T-helper cell type 1 immune reaction in the pleural space. Pleural fluid ADA is the most widely available biomarker for TB effusions. However, unstimulated interferon-? may be superior and will soon be readily available. Pleural biopsy from thoracoscopy has the highest diagnostic yield. Image-guided closed pleural biopsy is valuable as rapid culture of pleural tissue and fluid is often required to exclude drug resistance. PCR-based techniques have a low sensitivity on both pleural fluid and tissue. The most common radiological complication is residual pleural thickening, yet the long-term functional sequelae are not known. Current treatment recommendations for TB pleuritis are the same as for pulmonary TB. Shorter regimens with fewer drugs are under investigation. Intrapleural fibrinolytic therapy is beneficial in loculated effusions and may improve long-term outcomes. Chronic active pleural infection results in TB empyema, usually necessitating prolonged therapy and surgical decortication to release encased lung.

Cite as: Shaw JA, Ahmed L, Koegelenberg CFN. Effusions related to TB. In: Maskell NA, Laursen CB, Lee YCG, et al., eds. Pleural Disease (ERS Monograph). Sheffield, European Respiratory Society, 2020; pp. 172–192 [https://doi.org/10.1183/2312508X.10023819].