A comparison of presumptive Diagnosis of tuberculosis and pleural histology with microbiology in empyema thoracis in the University Teaching Hospital, Lusaka

Abstract

Background Empyema Thoracis is known to result from the infection of pleural effusions arising from many different causes. The histology of the pleura, and the microbiology of the pus contained is what this study was attempting to uncover. Objectives 1. To determine the pleural histology of patients with Empyema Thoracis at UTH 2. To identify bacterial infections causing Empyema Thoracis by examining the pus from the pleural space. 3. To introduce the Abram’s needle in obtaining pleural biopsy at The University Teaching Hospital in Lusaka. Methods The study was descriptive, in which consecutive consenting adult patients with Empyema Thoracis were recruited. The presumptive diagnosis of pleural Tuberculosis was compared with the pleural histology and microbiology. The study was carried out in the casualty Department of the University Teaching Hospital, in Lusaka. The sample size calculated was 37, and the study was done over 9 months. Pleural biopsy was done for histology and ZN, as well as collection of the pleural pus for microbiological analysis. The outcome measures were the pleural histopathology and culture results of the pus. Results 37 patients were recruited in the study, with 24 male and 13 females. The age range was from 22 to 54 and of different levels of education. Of the participants, 23 were HIV positive and 14 negative. Of the HIV positive participants, nearly half (47.8%) were on HAART. Pleural Biopsy was done in all the participants, and no complications identified. No specific disease was identified on histology of the pleura, save for the different forms of inflammation, and no granulomata were identified. Bacteria were identified in only 54% of the pus submitted. Of them, 50% grew Streptococcus species. All the others grew different types of gram negative bacteria namely enterobacter agglomerans, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Proteus vulgaris. Conclusion Abram’s needle was used for pleural biopsy successfully without complications. However, its use in Empyema thoracis did not give clear, specific histologic diagnosis of the aetiology. Many different gram positive and negative bacteria were identified from the pleural pus. Therefore microbiology of the pus was more useful than the biopsy of parietal pleura.