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Observations of Pleural Tuberculosis in the United States

TB infection This study is the most recent and comprehensive assessment of the epidemiology of pleural TB in the United States. Although the total number of pleural TB cases decreased between 1993 and 2003, the proportion of pleural TB cases compared to the total number of cases in the United States remained relatively stable (median proportion, 3.6%) [Fig 1]. This confirms earlier estimates and counters thoughts that those estimates were low. The total number and proportion of pulmonary TB cases have been steadily decreasing.

However, concerns about the underreporting of pleural TB owing to frequently negative mycobacterial culture results may continue to raise concerns that our pleural TB incidence findings were underestimated. Pleural TB is thought to arise primarily as the sequela of primary pulmonary TB infection or as the reactivation of pulmonary TB disease. The decline in the numbers of both pleural and pulmonary TB cases reflects the overall decline in TB in the United States since the resurgence (ie, 1986 to 1992). This can be attributed to the aggressive efforts of the public health community and health-care providers, which resulted in improved diagnostic, therapeutic, and prevention strategies.

Investigation of Pleural Tuberculosis in the United States

pulmonary TBThe national TB surveillance system uses a standardized case report form (Report of Verified Case of Tuberculosis) to collect information on newly diagnosed persons with TB from 50 states and the District of Columbia. Demographic, clinical, laboratory, and sociodemographic data, including country of origin, date of arrival in the United States, HIV seropositivity status, and anti-TB drug resistance, were collected.

We analyzed data from the national TB surveillance database, which is maintained by the Centers for Disease Control and Prevention, from January 1, 1993, through December 31, 2003, using reports that were complete as of April 14, 2005. For the purpose of this analysis, pulmonary only was defined when “pulmonary” was reported as the major site of disease without any additional sites of disease reported. Pleural only was defined when “pleural” was reported as the major site of disease without any additional sites of disease reported. Unless specified, pleural-only and pulmonary-only cases will be termed pleural and pulmonary, respectively. We compared pleural TB cases to pulmonary TB cases in our analysis.

Canadian Health&Care Mall: Pleural Tuberculosis in the United States

Pleural tuberculosisPleural tuberculosis (TB) should be considered in any patient with an exudative effusion, particularly a lymphocyte-predominant exudative pleural effusion. To date, there have been no in-depth national pleural TB epidemiologic studies. In 2003, 14,874 TB cases were reported in the United States, of which 3,029 cases (20.4%) were exclusively ex-trapulmonary. Of patients with extrapulmonary TB, the pleura was reported as the major site of disease in 559 patients (18.5%). The precise incidence of pleural TB can be difficult to determine, since it may not be routinely distinguished from other forms of respiratory TB when reported. Pleural TB incidence may also be impacted by coinfection with HIV.