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Background: Pleural effusion being excessive accumulation of fluid in the pleural cavity can occur as a result of lung, pleural or systemic disorders. For appropriate treatment, the specific cause must be known. Patients and methods: Retrospective chart analysis of 105 patients with non purulent pleural effusion was done for demography, symptoms, pleural fluid biochemical, microbiological, cytological, and pleural biopsy studies. Results: Of the 105 patients studied, there were 50 males and 55 females (M: F = 1:1.1) with age from six months to 69 years and mean 37.8 (± 11.5). The most common symptoms were difficulty in breathing, cough and chest pain which were complained of by 100%, 97.1% and 92.4% of the patients. The pleural fluid was serous in about 75% (79 patients) and haemorrhagic in 26 patients (25%). Biochemical quantitative analysis of the pleural fluids for protein and lactate dehydrogenase differentiated the pleural effusion into 12 transudative and 93 exudative pleural effusions based on cut-off pleural fluid protein of 30g/L and LDH of 200U/L. The transudative pleural effusions were diagnosed in nine of the 10 patients with congestive heart failure while the remaining three patients with transudative pleural effusions had amoebic liver abscess with sterile sympathetic right pleural effusion (two cases) and one case of chronic renal failure. Gram stains were suggestive of infection in 21 (20%) patients while cultures confirmed the infection in only nine (42.8%) of the 21 patients. Pneumonia was the most common cause of non purulent pleural effusion accounting for 31.4% of the cases while tuberculosis ranked second with 28.6%. Breast cancers (all in women), congestive heart failure, urogenital cancers, and lung cancers accounted for 10.5%, 9.5%, 6.7% and 4.8% respectively. Conclusion: This study shows that pneumonia and tuberculosis are the two most common causes of non purulent pleural effusions in the region.

Causes of non-purulent pleural effusions in a region with high prevalence of tuberculosis and HIV infections