pleural TB

• pleural tuberculosis presents with having few weeks of pleuritic pain-sharp stabbing,burning chest pain worsen by deep breath,cough and sneez
• TB pleurisy is associated with: dry cough,fever,night sweat,weight loss, large effusions and progressive shortness of breath
• diagnosis: we need to do chest X-ray to confirm pleural effusions,then after that perform diagnostic tap/thoracentesis to collect that fluid for check up-if there is an increase in lymphocytes start with empiric TB therapy
• once TB therapy is started,symptoms should be improved within two weeks,CXR should show improvement within 6 weeks, and there must be a complete healing within 4 months of therapy
• pleural biopsy at initial presentation should be done if:1)patient is >50years, 2)cancer is suspected 3)unusual TB symptoms presentation
• Medicine Treatment two months initial phase(RHZE-150/75/400/275):30-37kg give 2 tablets, 38-54kg 3tablets, 55-70kg 4tablets,71kg and above give 5tablets.
• medicine treatment 4 months continuation phase (RH-150/75):30-37kg give 2tablets, 38-54kg 3tablets. (RH-300/150):55kg and above give 2tablets
• the use of INH may result in the development of a peripheral neuropathy that results from drug-induced pyridoxine deficiency-vitamin B6-especially in diabetic,HIV and alcoholics,so give pyridoxine 25mg daily
• for large effussions that cause dyspnoea,drain maximum of 1L at a time
• TB pleural empyema-pus must be drained by intercoastal tube