Treatment Effectiveness of the Patients with Respiratory Tuberculosis Complicated by Pleural Empyema

Abstract

The objective: to study treatment effectiveness of respiratory tuberculosis complicated by pleural empyema.

Subjects and Methods. Treatment outcomes of 208 patients treated at Krasnoyarsk Regional TB Dispensary were analyzed. The most often, the course of tuberculosis was complicated by pleural empyema in the patients with disseminated and fibrous cavernous pulmonary tuberculosis – 163 patients (78.4%). On the side of empyema, tuberculous lesions in the lung tissue were total in 179 (86.1%) patients, of whom 128 (61.5%) had totally affected contralateral lung as well. In terms of extent, total (56.7%) and subtotal (28.8%) empyema prevailed. Bronchopleural fistula was found in 168 (80.7%) patients. 111 (53.4%) patients received conservative treatment of empyema, in 73 (32.2%) patients, pleural cavity drainage with aspiration of gas and purulent contents was applied, and 30 (14.4%) patients received combined treatment (at the first stage – conservative or pleural cavity drainage, and at the subsequent stage – surgical treatment).  

Results. Complication of pulmonary tuberculosis by pleural empyema significantly deteriorates the prognosis of the disease outcome: complete clinical effect was achieved only in 29.3% of patients, with the mortality rate of 20.2%. The main predictor of unfavorable treatment outcome is total pleural empyema with bronchopleural fistula, and the most effective treatment method is the combination of conservative therapy and surgery. However, due to disseminated tuberculous lesions, insufficiency of external respiration function, comorbidities, and asocial behavior, surgery was possible in no more than 20% of patients. At the same time, 92.3% of patients referred for medical help late, 62.7% of patients had a history of early discharge from hospital for gross violation of hospital rules.