Tuberculosis of the pleura

Background. Tuberculosis is a leading cause of mortality worldwide, with a growing death rate. Pleuritis remains the most common extrapulmonary site of involvement. Epidemiologic trends have altered the presentation of disease. The advent of molecular biology has allowed new insights into disease mechanisms. In this paper, I review the salient features of pleural tuberculosis, highlighting recent epidemiologic trends and advances in diagnosis. Methods. Literature concerning pleural tuberculosis was identified by a MEDLINE search; additional sources were identified by review of the bibliographies from these papers. Results. Tuberculous pleuritis is uncommon in the United States and now more commonly reflects reactivation of old infections. Patients with coexistent tuberculosis and HIV infection have a higher rate of pleural reaction than non-HIV-infected persons. Conclusions. Closed pleural biopsy remains the diagnostic procedure of choice; newer diagnostic methods do not have favorable operating characteristics in areas of low tuberculosis incidence. Recommended anti-tuberculous therapy is identical to active pulmonary disease; corticosteroids should not be routinely given.