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What is the treatment for tubercular pleurisy?

Q: I have been living in UK for the past three years. I was undergoing a treatment for lung tuberculosis from the end of the previous year till last month. I went to the GP last year due to pain in my back (at the back of my chest on the left side). The x-ray showed that three-fourth of my left lung is filled with fluid. That is when I was started on anti-TB medicines. Though the cough, liquid in the lung, fever, and night sweats have gone, I am not getting relief from the pain even after taking the medicines. During deep breaths and hiccups, I still feel the pain. The doctors say that I have pleural epilepsy, i.e., inflammation of the lung layer, after TB. They say that I may experience the pain for some more days or it may even last for years. I am really worried. How do I get rid of the pain?

A:You seem to be suffering from Tubercular pleurisy. Don't worry about the pain, as it will settle down in time. Here is some information about TB pleurisy. Tuberculous pleurisy is the most common form of TB outside the lungs (extra-pulmonary TB). It develops when a TB focus beneath the pleura (thin membranous covering of the lungs) ruptures into the pleural space, and leads to an immune response and inflammation. This can happen either after the primary phase (up to 6 months after the exposure), or during the secondary phase (when there is endogenous reactivation of the infection after many years). Usually, the pleural space contains a small amount of fluid. Once the TB bacteria invade the space, the amount of fluid increases dramatically and compresses the lung, leading to shortness of breath (dyspnoea) and sharp chest pain that worsens with a deep breath (pleurisy). Mild- or low-grade fever commonly is commonly present and a chest x-ray or CT scan shows significant amounts of fluid. Clinically, it often presents with cough, pleuritic chest pain, dyspnoea, low-grade fever, and other non-specific constitutional symptoms. PPD skin test (Mantoux test) is generally positive in 90% of cases. Radiographically, it is generally unilateral, small to moderate in size, more frequent on the right side, sometimes associated with lung disease (shadows on the same side on x-ray). Even if not treated, the clinical course is toward spontaneous resolution, with minimal pleural scarring. The pleural TB is usually treated with 4 standard ATT drugs. Steroids may hasten the pleural fluid resorption and clinical symptoms resolution, though they don't seem to prevent scar formation.


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