Tuberculous Empyema Thoracis: Clinical, Bacteriological Features, and Its Medical Management

Background: Tuberculous (TB) empyema is a chronic infection of pleural space which carries a signifi cant morbidity and mortality. Aims: The aim of this study was to observe clinical, radiological, bacteriological features, and the outcomes obtained by the medical management of TB empyema. Methodology: A retrospective case analysis of all the adult patients admitted with TB empyema was performed. Results: Records of 100 patients with TB empyema showed that Cough, expectoration, and chest pain were present in 96%, 94%, and 64% patients, respectively. Direct smear of Pus and sputum showed acid-fast bacilli (AFB) in 57 and 46 patients, respectively, whereas 32 patients had smear positivity for both. Mycobacterial culture of pus was positive in 32/100 patients. The chest radiographs had moderate and far advanced parenchymal lesions in 37 patients each. The median duration of hospital stay was 57 (41-97) days. Eight patients were managed using closed needle aspiration, whereas in others intercostals drainage tube was inserted. About 47 patients were discharged after removal of the intercostal tube (ICD) tube, whereas 36 patients had residual empyema space, so was discharged with an open drainage tube. Eight patients died and four left the treatment against advice and 5 were referred for thoracic surgery. Conclusion: Confi rmation of diagnosis by presence of mycobacteria in pus and sputum sample and draining of empyema cavity using ICD tube or closed needle aspiration along with effective anti-tubercular drugs results in healing, and many patients may not requires surgery.