Triple Cultures Increase the Diagnostic Sensitivity of Mycobacterial Tuberculosis Empyema

BACKGROUND: There is a continuous debate on the appropriate diagnostic approach and surgical management of mycobacterial empyema, with widely varied diagnostic practices and surgical outcomes. The aim of this study is to highlight the diagnostic approach and clinical features of patients who required surgical intervention for mycobacterial empyema. METHODS: We performed a 5-year retrospective cohort study of all patients with mycobacterial empyema requiring surgery in a single institution from November 2009 to November 2014. RESULTS: Eighteen patients (15 males and 3 females, median age 48.5 years) required surgery. Seventeen patients required decortication via posterolateral thoracotomy and one patient underwent video-assisted thoracic surgery drainage and pleural debridement. Prolonged air leak was the commonest surgical complication (50%, n = 9). 94.4% (n = 17) had necrotizing granulomatous inflammation on histological examination. The sensitivity of mycobacterium smear and culture ranged between 12.5% and 75% for pleural tissue, sputum, and pleural fluid individually. The combination of all 3 samples increased the diagnostic yield to 100%. CONCLUSION: With the implementation of pleural tissue culture at surgery, the novel combination of sputum, pleural fluid, and pleural tissue culture provides excellent diagnostic yield.