Should we continue to perform medical thoracoscopy in pleural tuberculosis?

BACKGROUND: Tuberculosis in 5% of cases interests pleura with pleural effusion. In a patient with pleural tuberculosis (PT) the diagnosis may be established via demonstration of Mycobacterium tuberculosis in sputum, bronchial aspiration, pleural fluid or in pleural biopsy. Nowadays, having the possibility to perform many exams to detect mycobacteria, should we continue to perform medical thoracoscopy (MT) in patients with suspected PT? METHODS: We have performed a retrospective analysis of patients with pleural effusion underwent to MT with diagnoses of PT. We have evaluated the results including hematochemical analysis of blood count, reactive C protein, Quantiferon TB-Gold, sputum smears for acid fast-bacilli (AFB), microbiological culture with AFB coloration in bronchial aspirate and pleural fluid. RESULTS: We included 9 male patients with PT, 2 Italian and 7 by nations out of the European Union. Leucocytes were normal with high protein C reactive. Quantiferon TB-Gold were positive in 8 patients (88.9%). The microbiological culture of sputum and bronchial aspiration was positive in 3 patients, and all presented parenchymal consolidation on chest X-ray. The microbiological examination of pleural fluid was positive in 3 patients and only one had a positive AFB. CONCLUSIONS: Microbiological culture plus AFB coloration in sputum smears and bronchial aspiration, are not sufficient for the diagnoses of PT. QuantiFERON (R)-TB GOLD have an high sensibility to detect mycobacterial infection but have a great limit: it does not define latent or active infection. MT should be performed to detect the right diagnoses of PT.