Complicated tuberculous pleural disease in children

Abstract

The reader will come to appreciate: • Pleural tuberculosis (TB) is the most common presentation of extrapulmonary TB and the most common cause of pleural effusion worldwide. • The paucibacillary nature of pleural TB in children makes microbiological confirmation difficult. • The most severe form of residual pleural thickening (RPT) is a fibrothorax, which affects both the visceral and parietal pleura, leading to encasement and contracture of the affected hemithorax which may need surgical treatment. • Tuberculous empyema is a chronic Mycobacterium tuberculosis (Mtb) infection of the pleura, presenting with high fever and a purulent pleural effusion containing Ziehl-Neelson (ZN) positive bacilli. • Bronchopleural fistula (BPF) in children with TB is seen mostly in advanced cystic disease, in patients with large bullae, in older children, and more commonly in children living with HIV infection. Pleural tuberculosis (TB) is the most common presentation of extrapulmonary TB and the most common cause of pleural effusion worldwide. Effusion due to TB is rare in children younger than 5 years and more common in adolescent boys. Pleural disease can range from small effusions associated with parenchymal disease in young children to large effusions seen mostly in older children and adolescents. The effusion can progress from a simple effusion to complicated pleural disease with the development of TB empyema or involvement of the chest wall. There is a paucity of information on the management of complicated TB pleural disease. Although most children will be treated conservatively, surgical intervention may be required to prevent post-TB lung disease and functional loss. Bronchopleural fistula (BPF) is a rare complication in children but can be very difficult to manage, especially in children with severe chronic or cystic lung disease, leading to prolonged hospitalization. Interventional bronchoscopy may have a role in the management of persistent BPF with the placement of either blood clots or valves, but there is limited evidence for these procedures in paediatrics