The aetiology of exudative pleural effusion and its association with HIV infection in Mulago hospital.
Isabirye, Claret Charles
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The aetiology of exudative pleural effusion (PE) and its association with HIV infection in mulago hospital. BACKGROUND: An increased number of exudative PE on the medical wards has been observed. Many patients are started on anti-tuberculosis therapy without supportive evidence. Some of those who are started on anti-tuberculosis therapy ever improve while other don’t (clinical observation_. A few studies on PE have concentrated only on tuberculosis pleurisy without further concentration on the other causes of PE. OBJECTIVES: The main objective of the study was to determine the aetiology of exudative PE and its association with HIV infection in Mulago hospital. Other objectives were to determine the relative prevalence/frequency of the various aetiologies of exudative PE, the HIV sero prevalence among these patients and to describe the clinical, laboratory, radiographic and demographic features of the various causes of exudative PE. SETTING: General medical wards in mualgo9 hospital, university teaching and national referral hospital. DESIGN: A Descriptive cross-sectional study was carried out on patients aged 15-90 years inclusive who were screened for exudative PE. Clinical examination, thoracocentesis and pleural biopsy were done. Pleural fluid (PF) and tissue culture were done using Lj media. HIV serology after pre and posttest counseling was done. RESULTS: Of the 93 patients with exudative PE recruited, TB accounted for 66.7%. The other causes of the effusion were cancer (14%), empyema (3.1%), eosinophilic granuloma (1.1%) and connective tussie disorder (1.1%). The causes of the effusion remained unknown in 14% of the patients. Overall HIV prevalence among the patients recruited was 57%. The HIV prevalence in TB patients was 66.1% and 15.4% in cancer patients. Most patients with TB were in the age range 20-39 years (72.6%) while over 50% of the cancer patients were above 50 years. In TB patients, oral candida was found in both HIV positive and HIV negative patients. Herpes zoster was only found in HIV positive patients with TB. Micro bacteriological culture studies on PF was only positive for M.tuberculosis in HIV positive patients. There was more colony growths in TB HIV positive patients than in TB HIV negative patients (p=0.007). On chest x-ray, most effusions in TB were of moderate size while in cancer of massive size. CONCLUSION: Empirical treatment for TB in patients with exudative PE is a reasonable option particularly in patients in the age range 20-40 years with pleural fluid lymphocytosis. Cancer remains a common cause of exudative PE in patients over 50 years especially those without HIV infection.