Abstract
BackgroundPericardial disorders are a common cause of heart disease, and the most common cause of pericarditis in developing countries is tuberculous (TB) pericarditis. It has been shown that prednisolone added to standard anti-TB therapy leads to a lower rate of constrictive pericarditis. We conducted a pilot study to evaluate the effect of adjunctive prednisolone treatment on the concentration of inflammatory markers in pericardial tuberculosis, in order to inform immunological mechanisms at the disease site. MethodsPericardial fluid, plasma and saliva samples were collected from fourteen patients with pericardial tuberculosis, at multiple time points. Inflammatory markers were measured using multiplex luminex analysis and ELISA. ResultsIn samples from 14 patients we confirmed a strongly compartmentalized immune response at the disease site and found that prednisolone significantly reduced IL-6 concentrations in plasma by 8 hours of treatment, IL-1beta concentrations in saliva, as well as IL-8 concentrations in both pericardial fluid and saliva by 24 hours. ConclusionMonitoring the early effect of adjunctive immunotherapy in plasma or saliva is a possibility in pericarditis.
Highlights
Tuberculosis (TB) is the most common opportunistic infection in HIV1 infected persons in Sub-Saharan Africa
The recently completed Investigation of the Management of Pericarditis (IMPI), a large clinical trial examining the effect of prednisolone or Mycobacterium indicus pranii or both added to the standard regimen of isoniazid, rifampin, ethambutol and pyrazinamide showed, that neither
Since we have recently shown that pericardial tuberculosis is characterised by a compartmentalized profibrotic immune response, we hypothesised that prednisolone had a suppressive effect on the concentration of inflammatory and potentially profibrotic cytokines in the pericardium [4]
Summary
Pericardial disorders are a common cause of heart disease, and the most common cause of pericarditis in developing countries is tuberculous (TB) pericarditis. It has been shown that prednisolone added to standard anti-TB therapy leads to a lower rate of constrictive pericarditis. We conducted a pilot study to evaluate the effect of adjunctive prednisolone treatment on the concentration of inflammatory markers in pericardial tuberculosis, in order to inform immunological mechanisms at the disease site
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