Version October 2024
| Etiology | History/physical exam/lab findings | Pleural fluid characteristics | Additional tests of pleural fluid | Other helpful tests |
| Parapneumonic effusion | Short duration of symptoms suggesting infection; parenchymal opacities on chest radiograph | Low pH Increased neutrophils | Blood culture | |
| Septic embolism | Intravenous drug abuse | Exudative | Blood culture Echocardiogram Chest CT may show multiple nodules | |
| Pneumocystis jirovecii | Fever Dyspnea Inhaled pentamidine prophylaxis Low CD4 | Small to moderate effusion Serous or sanguinous Lymphocytic Eosinophilic aggregates LDH increased | Grocott silver for P. jiroveci cysts or Diff-Quik for trophozoites | Induced sputum or bronchoalveolar lavage for P. jiroveci |
| Mycobacterial disease | History of exposure Residence in an endemic area Low CD4 | Lymphocytic effusion Adenosine deaminase >50 U/L | Mycobacterial smear and culture | PPD Induced sputum Pleural biopsy for histology, culture, and molecular testing |
| Nocardia | Acute or subacute onset of fever, night sweats, fatigue, anorexia, cough, dyspnea Low CD4 | Modified Kinyoun acid fast stain PCR for Nocardia Maintain aerobic culture for 5 to 21 days | Blood culture | |
| Cryptococcus | Fever, cough, dyspnea CD4 <100/microL | Serous exudate | Cryptococcal antigen Cryptococcal culture (positive in 42 percent) | Serum cryptococcal antigen Pleural biopsy |
| Histoplasma | History of residing in endemic area Subacute febrile illness | Serous or serosanguinous effusion | Wright-Giemsa stain for intracellular Histoplasma yeast forms | |
| Toxoplasma | Usually evidence of disseminated toxoplasmosis CD4 <100 cells/microL | Unilateral or bilateral | Giemsa stain for tachyzoites within neutrophils | |
| Leishmaniasis | Fever Leukopenia Lymphopenia Thrombocytopenia | Serologic studies positive in 50 percent Peripheral smear Bone marrow smear positive 67 percent |
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