Pleural tuberculosis: diagnostic approach

<b>Introduction:</b> In Tunisia, tuberculosis typically represents the most frequent cause of exudative pleural effusion with clear fluid. Different tools are used in the diagnosis of tuberculous pleurisy. <b>Aim:</b> to determine the diagnostic approach of the pleural tuberculosis. <b>Methods:</b> A retrospective study was conducted in the IBN NAFISS pneumo-allergology department at the Abderrahmane Mami Hospital in Ariana, Tunisia, involving 95 cases of pleural tuberculosis collected over a nine-year period from October 2009 to January 2019. <b>Results:</b> The mean age of our patients was 38 years. The study population was predominantly male (55%). Two patients had a history of tuberculosis. A tuberculous contagion was revealed in 17 cases (18%). The onset of symptomatology was progressive in 74% of cases. The patients presented chest pain in 84 cases (88%), fever in 62 cases (65%) and weight loss in 58 cases (61%). An associated pulmonary tuberculosis was revealed in 18 patients (19%). The diagnosis of tuberculous pleurisy was established after microscopy for acid fast bacilli (AFB) in sputum in 14 cases (15%), microscopy for AFB in pleural fluid in 4 cases (4%), Abrams pleural needle biopsy in 63 cases (66%) and thoracoscopic pleural biopsy in 4 cases (4%). Eight patients were treated for pleural tuberculosis considering the symptoms and a positive tuberculin skin test. The tuberculin skin test was positive in 65% of cases. The Abrams pleural needle biopsy was performed in 76 patients (80%) with a profitability of 83%. <b>Conclusion:</b> The Abrams pleural needle biopsy, a simple method that does not require general anesthesia, represent a key-step in the etiological diagnosis of exudative pleurisy with clear fluid and especially tuberculous pleurisy with a good efficiency.