PDF(Pubmed)
Abstract：
Tuberculosis (TB) is among the most common cause of serositis. There are many uncertainties in diagnostic and therapeutic approach to serous membranes tuberculosis. Our aim in the present review is to discuss the regional facilities for timely diagnosis, rapid decision-making and appropriate treatment regarding to serous membranes tuberculosis; with emphasis on situation in Iran. A comprehensive literature searches about the status of serous membranes tuberculosis in Iran were performed in English databases including Google Scholar, Science Direct, Scopus, Pub Med, and Web of Sciences, Persian SID databases, between 2000 and 2021. The main findings of the present review are as follow: a) pleural tuberculosis is more common than pericardial or peritoneal tuberculosis. b) Clinical manifestations are non-specific and so non-diagnostic. c) Smear and culture, PCR and characteristic granulomatous reaction have been used for definitive TB diagnosis by physicians. d) With Adenosine Deaminase Assays and Interferon-Gamma Release Assays in mononuclear dominant fluid, a possible diagnosis of TB is proposed by experienced physicians in Iran. e) In area of endemic for tuberculosis including Iran, a possible diagnosis of TB is enough to begin empirical treatment. f) In patients with uncomplicated tuberculosis serositis, treatment is similar to pulmonary tuberculosis. First line drugs are prescribed unless evidence of MDR-TB is detected. g) The prevalence of drug resistant tuberculosis (MDR-TB) in Iran is between 1% and 6%, and are treated by empirical standardized treatment. h) It is not known whether adjuvant corticosteroids are effective in preventing long term complication. i) Surgery may be recommended for MDR-TB. Tamponade or constrictive pericarditis and intestinal obstruction. In conclusion, it is recommended to consider serosal tuberculosis in patients who have unknown mononuclear dominant effusion and prolonged constitutional symptoms. Experimental treatment with first line anti-TB drugs can be started based on possible diagnostic findings.
摘要：
结核病（TB）是浆膜炎的最常见原因之一。浆膜结核的诊断和治疗方法存在许多不确定性。我们在本审查中的目的是讨论及时诊断的区域设施，关于浆膜结核的快速决策和适当治疗；重点是伊朗的情况。在包括GoogleScholar在内的英语数据库中，对伊朗浆膜结核的状况进行了全面的文献检索，科学直接，Scopus,PubMed,和WebofSciences,波斯SID数据库，2000年至2021年。本综述的主要发现如下：a）胸膜结核比心包或腹膜结核更常见。b）临床表现是非特异性的，因此非诊断性的。c)涂抹和培养，PCR和特征性肉芽肿反应已被医生用于明确的结核病诊断。d）在单核优势流体中进行腺苷脱氨酶测定和干扰素-γ释放测定，结核病的可能诊断是由伊朗经验丰富的医生提出的。e）在包括伊朗在内的结核病流行地区，结核病的可能诊断足以开始经验性治疗。f）在无并发症的结核性浆膜炎患者中，治疗类似于肺结核。除非检测到耐多药结核病的证据，否则应开具一线药物。g）伊朗耐药结核病（MDR-TB）的患病率在1％至6％之间，并采用经验标准化处理。h）尚不清楚辅助皮质类固醇是否可有效预防长期并发症。i）耐多药结核病可能建议手术。填塞或缩窄性心包炎和肠梗阻。总之,建议在单核显性积液未知且全身症状持续的患者中考虑浆膜结核.可以根据可能的诊断结果开始使用一线抗结核药物的实验性治疗。
