Significant resolution of tuberculous pleural effusion on chemotherapy alone

Background:
As  a  standard,  significant  pleural  effusion,  whether  tuberculous (TB) or not, requires therapeutic thoracocentesis. We tested the hypothesis that standard anti-TB chemotherapy alone can resolve significant pleural effusion.
Methods:
20  eligible  patients  with TB  pleural  effusion  of  at  least  30%  of  the hemithorax (10 with moderate-size and 10 with large-size effusion, respectively) were  retrospectively  reviewed  for  radiological  resolution  of  their  effusions  at two, six and 12 months after commencement of standard six-month therapy.
Results:
The mean percentage resolutions in both groups were comparable (48% vs 46% at two months; 59% vs 85% at six months; 84% vs 95% at 12 months). The mean sizes of effusions were also comparable (18% vs 33% at two months; 14% vs 10% at six months; 6% vs 4% at 12 months). Cigarette smoking and Indian ethnicity were univariately associated with incomplete resolution of effusions.  
Conclusion:
Standard  anti-TB  chemotherapy  alone  appears  to  be  sufficient  to resolve significant TB pleural effusion. An avoidance of therapeutic thoracocentesis may  reduce  the  risk  of  infection  exposure  or  allow  better  channelling  of resources in certain clinical settings.