Pleural Effusion

[nagaprasad]

My Father aged 59 Years having water accumuation in left lung, and it was intially treated as Tuber Culosis (TB) and around 3.5 Liters of water was aspirated in 5 Days.After taking 15 days of ATT Medicine, again water accumulated in the left lung, further analysis of Plural Fluid, CT Scan and Bioposy, Reports confirmed it was TB and there is a massive effusion in the left pleural space with complete collapse of left lower lobe.Hence Doctor suggested removal of plural fluid by chest tube method.My father was operated (1 Liter drained) and got the fluid levels as Day 1- 600 Ml, Day -2 -400 Ml, Day-3 300 Ml, Day-4 200 Ml and still fluid is coming (Fluid colour changed from Pale Red to Orange to Pale yellow, what this indicates?)

How many days it will take for complete draining of the plural fluid? and what is the allowable quantity of plural effusion per day?
Is it recommeneded to use Talc powder/Bleuomycin after removel of chest tube?
What are the chances of reoccurences and how to prevent that?

Requested for your valuable suggestion at the earliest

[Davy9]

Your father has a lung infection that is weeping into his pleural space. It is also modifying the normal flux of pleural fluid that the space usually employs to keep the lung lubricated causing it to accumulate. At any rate the pace of the fluid accumulation warrants the placement of a chest tube for constant drainage until the infection can be controlled and/or the rate of fluid accumulation subsides. They then intend to assist the pleural space in scarring over so that the fluid build up will be better managed. Yes effusions can recur but if the lung is scarred over they will likely be loculated or pocketed instead of freely collecting in the pleural space and collapsing a lung. Exactly what period of time this will require depends on how severe the circumstances are. Look for the pace of fluid evacuation to diminish and hopefully the character of the fluid will become less exudative (infectious).

[nagaprasad]

Dear Davy, Thank you very much for your valuable advise, Just to further clarify, what is the quantity of the normal flux of pleural fluid that the space usually employs to keep the lung lubricated?

As per the reports the cause of infection in the Lung is due to TB, How can we ensure that the ATT Drug is acting on the infection or not? and the pace of the fluid evacuation from last two days is 200 mg per day, and Doctor advised target level is 50 mg. Kindly give your valuable advise.

[Davy9]

This effusion is just a consequence of the infection that requires specific treatment. As you note the volume of fluid accumulation is diminishing. As to how effective the antibiotic treatment will be for the TB infection I cannot guess. These infections present in all sorts of ways and can even have been spread around the body. The exact sensitivity of the organism involved, how advanced the infection has gotten and how the infection is being expressed all factor into how the treatment will proceed. But, the effusion does seem to be getting resolved and that is positive news.

Be certain that all of the family members and his friends are tested for TB. It is highly infectious so anyone having contact with him for however long he's been actively infected has been exposed.