Tuberculosis (TB) is a serious infectious disease caused by Mycobacterium tuberculosis. While most people think of TB as a lung disease, it can actually affect different parts of the body. Two common forms are pulmonary tuberculosis (TB in the lung tissue) and pleural tuberculosis (TB in the lining around the lungs). Although they share the same cause, they are not the same illness. Let’s break down the differences.
Pulmonary TB: The bacteria invade the lung tissue (parenchyma), forming lesions and cavities inside the lungs.
Pleural TB: The infection affects the pleura – the thin membranes surrounding the lungs. This often leads to pleural effusion (fluid build-up), thickening, or adhesion of the pleura.
About 80% of all TB cases are pulmonary.
Pleural TB is less common, accounting for 5–10% of cases, but often develops as a complication of pulmonary TB when bacteria spread from the lungs into the pleural space.
Pulmonary TB: Highly contagious. Patients can spread bacteria through coughing, sneezing, or even speaking.
Pleural TB: Considered non-contagious by itself, since the bacteria are trapped in the pleural cavity. However, if pulmonary TB is present at the same time, the patient can still transmit the disease.
Both types can cause fever, night sweats, fatigue, and weight loss.
Pulmonary TB: Persistent cough, phlegm, coughing up blood, chest pain, shortness of breath.
Pleural TB: Chest tightness, one-sided chest pain, and difficulty breathing due to fluid compressing the lung. Cough is usually less severe.
Pulmonary TB: Sputum smear microscopy, culture, GeneXpert test, bronchoscopy, and chest X-ray or CT scan.
Pleural TB: Imaging (X-ray, ultrasound, CT scan), pleural fluid aspiration for analysis, and sometimes pleural biopsy.
Treatment: Both require a full course of anti-TB drugs (usually 6 months or longer). Strict adherence is essential to avoid relapse or drug resistance.
Complications:
Pulmonary TB may leave scarring, bronchiectasis, or pneumothorax (collapsed lung).
Pleural TB may cause thickened or calcified pleura, long-term breathing difficulty, or recurrent pleural effusion.
BCG vaccination in childhood.
Early detection and treatment of active TB cases.
Maintaining good nutrition, hygiene, and a healthy lifestyle to strengthen immunity.
Avoiding close, unprotected contact with patients who have active pulmonary TB.
If you have been diagnosed with pleural TB, it is important to also screen for pulmonary TB to make sure no hidden infection in the lungs is missed. The good news is that with early detection and strict treatment, both forms are curable.
Dr. Phuthom
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