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Aetiology of pleural effusions diagnosed by routine culture and molecular techniques in children living in a high tuberculosis-endemic setting
BACKGROUND: Confirming aetiology of pleural effusion in children may be difficult in tuberculosis (TB)-endemic settings. We investigated the role of polymerase chain reaction (PCR) and routine biochemical tests in discriminating pleural effusion caused by bacteria from other aetiologies. METHODS: Th...
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| Format: | Thesis |
| Language: | English English |
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Department of Paediatrics and Child Health
2025
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| _version_ | 1867613302146727936 |
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| access_status_str | Open Access |
| author | Wordui, Seyram |
| author2 | Gray, Diane |
| author_browse | Gray, Diane Wordui, Seyram |
| author_facet | Gray, Diane Wordui, Seyram |
| author_sort | Wordui, Seyram |
| collection | Thesis |
| description | BACKGROUND: Confirming aetiology of pleural effusion in children may be difficult in tuberculosis (TB)-endemic settings. We investigated the role of polymerase chain reaction (PCR) and routine biochemical tests in discriminating pleural effusion caused by bacteria from other aetiologies. METHODS: This is a post-hoc analysis of a cross-sectional study among children with pleural effusion in a tertiary hospital in South Africa, incorporating data from PCR testing of stored pleural fluid. Aetiological classification was defined by microbiological confirmation. RESULTS: Ninety-one children were enrolled, median age 31 months (IQR 12-102). Aetiology of pleural effusion was 40 % (n=36/91) bacteria, 11% (n=10/91) TB, 3% (n=3/91) viruses, 11% (n=10/91) polymicrobial and 35% (n=32/91) had no pathogen identified. The commonest pathogen was Staphylococcus aureus (n=27/91; 30%) with similar yields on culture and PCR, followed by Streptococcus pneumoniae (n=12/91; 13%), detected more commonly by PCR. PCR reduced the number of children with unconfirmed aetiologies from 48 to 32. Characteristics of children with no pathogen most resembled those with TB. Pleural fluid lactate dehydrogenase ≥1716 U/L best discriminated bacterial pleural effusion from other aetiologies (sensitivity of 86%; specificity 95%). CONCLUSION: PCR improved detection of pathogens and reduced number of children with unconfirmed aetiologies in presumed exudative pleural effusion. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/41934 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:33:59.204Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Department of Paediatrics and Child Health |
| publisherStr | Department of Paediatrics and Child Health |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/41934 Aetiology of pleural effusions diagnosed by routine culture and molecular techniques in children living in a high tuberculosis-endemic setting Wordui, Seyram Gray, Diane Zampoli, Marco TB BACKGROUND: Confirming aetiology of pleural effusion in children may be difficult in tuberculosis (TB)-endemic settings. We investigated the role of polymerase chain reaction (PCR) and routine biochemical tests in discriminating pleural effusion caused by bacteria from other aetiologies. METHODS: This is a post-hoc analysis of a cross-sectional study among children with pleural effusion in a tertiary hospital in South Africa, incorporating data from PCR testing of stored pleural fluid. Aetiological classification was defined by microbiological confirmation. RESULTS: Ninety-one children were enrolled, median age 31 months (IQR 12-102). Aetiology of pleural effusion was 40 % (n=36/91) bacteria, 11% (n=10/91) TB, 3% (n=3/91) viruses, 11% (n=10/91) polymicrobial and 35% (n=32/91) had no pathogen identified. The commonest pathogen was Staphylococcus aureus (n=27/91; 30%) with similar yields on culture and PCR, followed by Streptococcus pneumoniae (n=12/91; 13%), detected more commonly by PCR. PCR reduced the number of children with unconfirmed aetiologies from 48 to 32. Characteristics of children with no pathogen most resembled those with TB. Pleural fluid lactate dehydrogenase ≥1716 U/L best discriminated bacterial pleural effusion from other aetiologies (sensitivity of 86%; specificity 95%). CONCLUSION: PCR improved detection of pathogens and reduced number of children with unconfirmed aetiologies in presumed exudative pleural effusion. 2025-10-01T11:47:58Z 2025-10-01T11:47:58Z 2025 2025-10-01T11:08:55Z Thesis / Dissertation Masters Masters http://hdl.handle.net/11427/41934 en eng application/pdf Department of Paediatrics and Child Health Faculty of Health Sciences University of Cape Town |
| spellingShingle | TB Wordui, Seyram Aetiology of pleural effusions diagnosed by routine culture and molecular techniques in children living in a high tuberculosis-endemic setting |
| thesis_degree_str | Master's |
| title | Aetiology of pleural effusions diagnosed by routine culture and molecular techniques in children living in a high tuberculosis-endemic setting |
| title_full | Aetiology of pleural effusions diagnosed by routine culture and molecular techniques in children living in a high tuberculosis-endemic setting |
| title_fullStr | Aetiology of pleural effusions diagnosed by routine culture and molecular techniques in children living in a high tuberculosis-endemic setting |
| title_full_unstemmed | Aetiology of pleural effusions diagnosed by routine culture and molecular techniques in children living in a high tuberculosis-endemic setting |
| title_short | Aetiology of pleural effusions diagnosed by routine culture and molecular techniques in children living in a high tuberculosis-endemic setting |
| title_sort | aetiology of pleural effusions diagnosed by routine culture and molecular techniques in children living in a high tuberculosis endemic setting |
| topic | TB |
| url | http://hdl.handle.net/11427/41934 |
| work_keys_str_mv | AT worduiseyram aetiologyofpleuraleffusionsdiagnosedbyroutinecultureandmoleculartechniquesinchildrenlivinginahightuberculosisendemicsetting |