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\begin{document}

\title{Pleural tuberculosis in children and adolescents: a difficult diagnosis?}



\author[1]{Magda Lunelli}%
\author[2]{Isabel Cristina  Ferreira}%
\author[3]{Muriel Sarmento}%
\author[3]{Valentina Chakr}%
\author[1]{Gilberto Fischer}%
\affil[1]{UFCSPA}%
\affil[2]{Hospital de Clínicas de Porto Alegre}%
\affil[3]{Hospital de Clinicas de Porto Alegre}%


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  \date{June 18, 2024}


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\begin{abstract}
Objective This study aimed to describe the clinical and laboratory
findings of patients diagnosed with pleural tuberculosis (PT) at two
tertiary university hospitals in Southern Brazil. Methods Patients below
18 years of age admitted to the study hospitals were retrospectively
evaluated. Medical and epidemiological history, tuberculin skin test
(TST) results, radiological and pathological findings, and pleural fluid
(PF) analysis were retrieved from health records. Results Ninety-two
patients with PT were identified during the study period. Among them, 51
(55\%) were males. The mean age was 10.9 years old. Twenty-one percent
was represented by children aged six years or less. The most common
symptoms were fever (88\%), cough (72\%) and chest pain (70\%). The time
between the onset of symptoms and diagnosis varied between 2 and 300
days, with a median of 16 days. Unilateral pleural effusion was
described in 96\% of the cases. Lymphocyte predominance was found in
90\% of PF samples. The adenosine deaminase dosage of PF was greater
than 40 U/L in 85\% of the patients. Prior diagnosis of community
acquired pneumonia and antibiotic use were observed in 76\% of the
cases. Conclusion We suggest consider the diagnosis of PT in children
and adolescents with the following characteristics: fever, cough and
thoracic pain as presenting symptoms; history of contact with
tuberculosis; Mantoux test? 10 mm; unilateral pleural effusion;
lymphocytes predominance in PF sample; pleural fluid ADA greater than 40
U/L and poor response to antibiotics prescribed for community-acquired
pneumonia.%
\end{abstract}%



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