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We reviewed the records of 1,738 cases of tuberculosis seen during the period from 1968 to 1988 in Mobile, Alabama. Seventy cases of tuberculous pleural effusion were identified and constituted 4.9 percent of all disease due to Mycobacterium tuberculosis during this period. Tuberculous pleural effusion was diagnosed if the patient had M tuberculosis cultured from sputum, pleura, or pleural fluid and had a roentgenographic pleural effusion without an alternative explanation for the presence of the effusion. The diagnosis of tuberculous pleural effusion was made in the absence of a positive culture if the patient had an undiagnosed lymphocytic exudative pleural effusion and all clinical and roentgenographic abnormalities resolved on antimycobacterial chemotherapy. The mean age of all patients was 47 +/- 18.4 years. The 70 cases were evenly divided between 35 that were accompanied by roentgenographic pulmonary parenchymal infiltrates and 35 that occurred in the absence of parenchymal infiltrates. We conclude that cultures of all potentially diagnostic specimens (sputum, pleural fluid, and pleura) and an intermediate-strength skin test, are sensitive tests for the diagnosis of tuberculous pleural effusion. In addition, the age of patients with tuberculous pleural effusion appears to be increasing.

Fiberoptic bronchoscopy using a protected brush catheter was done in 65 patients with suspected pulmonary infections to obtain uncontaminated specimens for culture. Quantitative aerobic and anaerobic cultures were done on each specimen. Forty-one patients had pneumonia. Ten bacteremic patients had the same organisms recovered from the catheter and blood cultures. Seven patients had received antibiotics before the procedure, and cultures grew no organisms in high concentration. In 23 of 24 remaining patients probable pathogens were recovered in high concentrations, and specific therapy resulted in clinical improvement in all of these patients. Five patients with lung abscesses and seven with necrotizing pneumonia had mixed aerobic and anaerobic organisms recovered. Twelve patients had final diagnoses of nonbacterial lung disease, and cultures were negative or revealed low concentrations of organisms. Quantitative cultures were necessary in distinguishing pathogens from nonpathogens. There were no complications. The results of this study indicate that fiberoptic bronchoscopy using a special protected catheter is an accurate and safe technique for identification of etiologic agents in lower respiratory tract infections.