Empiric antituberculous therapy in patients with unexplained exsudative pleural effusion. Is it valid in Senegal?

Aim. Pleural biopsy and adenosine deaminase activity are not available at our center and the treatment begins without substantiation diagnosis in patients with tuberculous pleural effusion (PE). Methods. In order to evaluate the validity of an empiric antituberculous therapy in exsudative PE with high prevalence of lymphocytes, we conducted a retrospective study during 1 year. Patient was enrolled if no signs of tuberculous infection, pneumonia or cancer were present. Results. During 1 year, 38 patients were enrolled (23 males, mean age =36 years). PE was major (> 2/3 of the lung) in 14 cases, moderate (between 1/3 and 2/3) In 18 cases and minor (< 1/3) in 6 cases. Tuberculous contagion was observed in 10 patients. Tuberculinic test was positive in all patients (1224 mm). Clinical and radiological cure was obtained in 37 cases, except 1 patient who died from acute heart failure. No recurrence of PE was observed after 1 year follow-up. Conclusion. In our endemic areas, empiric antituberculous treatment seems to be an effective strategy in patients with exsudative PE. © 2007. Elsevier Masson SAS.