Myocardial Tuberculosis Research Articles

Multimodality imaging of myocardial tuberculosis presenting as right ventricular cardiomyopathy: A case report.

An 18-year male with no significant past medical history presented with features of right-sided heart failure. Haematological investigations revealed raised erythrocyte sedimentation rate (23 mm/h). Transthoracic echocardiography (TTE) demonstrated biventricular systolic dysfunction with thickened free wall of right ventricle (RV). Whole-body fluorodeoxyglucose (FDG)-positron emission tomography (PET) computed tomography (FDG-PET-CT) showed intensely increased FDG uptake in the thickened RV wall and an FDG avid lesion in the left medial temporal lobe. Cardiac magnetic resonance imaging (CMR) characterized thickening and suggested an infiltrative disease (isointense on TI, hyperintense on myocardial oedema sensitive sequence with transmural enhancement on late gadolinium sequence). Magnetic resonance imaging (MRI) brain showed a thick rim enhancing ring lesion in the body of hippocampus. Endomyocardial biopsy revealed moderately dense lymphomononuclear inflammation with the formation of granulomas. Since tuberculosis is endemic in our country and considering all laboratory, imaging and biopsy findings a working diagnosis of tuberculosis was considered, and standard anti-tubercular treatment was started. There was an improvement in clinical status and follow-up imaging (TTE, CMR, brain MRI and FDG-PET-CT) showed improvement in biventricular function with regression in myocardial thickening and resolution of brain lesion, confirming the diagnosis of tuberculosis.

Myocardial tuberculosis: A rare case report

Tuberculosis (TB) is one of the most common causes of mortality and morbidity globally, with Indian subcontinent having quite a large number of TB cases. TB can involve any organ system in humans; however, the disease affecting the cardiovascular system is rare. On the other hand, myocardial tuberculosis is a serious entity and can, unfortunately, be fatal if the diagnosis is missed or delayed. Therefore, the possibility of TB involving the myocardium should always be considered in areas with a high prevalence of TB, like the Indian subcontinent. Anti-TB therapy (with corticosteroids in some cases), along with early detection and suspicion, is proven to be quite effective in management and cure in most cases. We describe a case of sputum AFB (acid-fast bacilli) positive pulmonary TB with dilated cardiomyopathy, and impaired/decreased left ventricular systolic function, which gradually improved after anti-tubercular decongestive therapy.

UNCOMMON MANIFESTATION OF TUBERCULOSIS IN AN IMMUNOCOMPETENT HOST

Tuberculous myocarditis is a very unusual manifestation of tuberculosis.Our case serves to highlight a potentially life threating and rare presentation of tuberculosis.We discuss here the epidemiology,clinical presentation , the diagnostic approach and the management of the myocardial tuberculosis.

Capper, Garon and Harold Stewart (Amer. J. Das. Child. 44, pp. 798-805)

Capper, Garon and Harold Stewart report (Amer. J. Das. Child. 44, pp. 798-805) of a case of primary myocardial tuberculosis with an unaffected pericardium. The case refers to a 3 year old. a black woman without a tuberculous history. With progressive emaciation and anemia, transient meningism and terminal seizures, the disease ended fatally in two months. On the section: caseous masses and cavities in the left lung, caseous decay of the mammary and abdominal lymph glands.

Genitourinary tuberculosis in the structure of autopsy morphological findings in deceased patients at the late stages of HIV infection

Introduction. The problem of tuberculosis (TB) has not lost its significance due to the overlapping epidemic of HIV infection and the addition of specific lesions at its late stages. It is due to the lack of adherence to antiretroviral therapy in a large number of patients. The high mortality rate in HIV-associated TB requires an increase in the interest of all doctors for the early detection of various TB localizations against the background of HIV, allowing the patient to be cured. For urologists, information on the frequency of genitourinary TB in HIV patients is of interest to improve its diagnosis. Purpose of the study. To identify the proportion of genitourinary TB in the structure of the specific lesions in patients with HIV-associated TB. Materials and methods. The case-records of 115 deceased patients with a combination of HIV infection and TB were retrospectively analyzed using a continuous method. The number of men among them was 81.7 ± 3.6% (94). The average age of men was 37.1 ± 27.2 years, women — 31.9 ± 6.3 years. The research results were processed statistically. Results. The average period from the moment of HIV infection detection to the registration of a lethal outcome was 2.8 ± 1.3 years, from the moment of TB diagnosis — 6.96 ± 7.3 years. The majority of patients with HIV infection had a stage of secondary diseases (93.1 ± 2.4%). At the time of admission to the TB dispensary, the average CD4 + lymphocyte level was 131.06 ± 75.8 cells/pL, 10.03 ± 2.5%. Anti-retroviral therapy was observed only in 19 (16.5 ± 3.5%) patients. In deceased patients disseminated pulmonary TB was more often verified at autopsy — 52.2 ± 4.7%, miliary — 7.8 ± 2.5%, infiltrative — 11.3 ± 3.0%. In patients with disseminated and miliary pulmonary TB, foci of dropout were often observed in the spleen (71.7 ± 5.8% and 55.6 ± 16.6%) and liver (46.7 ± 6.4% and 33.3 ± 15,7%). The kidney damage occurred in 60.0 ± 6.3% of patients with disseminated and 44.4 ± 16.6% miliary pulmonary TB. Kidneys TB was confirmed by bacterioscopic urine examination in three cases only (2.6 ± 1.5%) during life. Prostate TB was confirmed by analysis of expressed prostatic secretion on Mycobacterium tuberculosis (2.6 ± 1.5%) and was combined with kidney TB. The lesions of the lymphatic system during life were exposed in 17.4 ± 3.5% of patients. A pathomorphological examination revealed TB of intrathoracic lymph nodes in 37.4 ± 4.5%, intra-abdominal lymph nodes — in 22.6 ± 3.9%, peripheral — 6.1 ± 2.2%, more often in miliary and disseminated pulmonary TB. TB meningitis was registered in 31 cases as well as meningoencephalitis in 32 patients during life and at autopsy, respectively. Intestinal TB was confirmed by autopsy in 9.6 ± 2.7% of patients; during life, it was accompanied by the detection of the pathogen in the feces. The pancreatic TB was detected in 2.6 ± 1.5%, TB spondylodiscitis in 1.7 ± 1.2%, myocardial TB in 0.9 ± 0.9% and pericardium TB in 0.9 ± 0.9% cases. Conclusion. Thus, generalized TB is diagnosed in patients in the late stages of HIV infection, in the structure of which kidney damage is in second place, yielded only to spleen damage. Obtaining this information should form the alertness of urologists in terms of detecting and diagnosing genitourinary TB in patients with HIV infection.

Management of patients with myocardial tuberculosis: A case series

BackgroundMyocardial Tuberculosis (MT) is exceedingly rare. We aimed to report on myocardial involvement in tuberculosis (TB). MethodsAll adult patients admitted in a department of Internal Medicine over an 8-year period with microbiologically proven MT were retrospectively reviewed. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records. ResultsSix patients (4 women, 37.6 [21.3–62.1] years) with MT were identified. MT included cardiac mass (n = 1), coronaritis (n = 1), left ventricle spontaneous rupture (n = 1) and myocarditis (n = 3). Pericardial effusion was associated with myocardial involvement in 2 cases. Four patients presented with acute heart failure. CRP serum level was high in all cases. The mean delay between the first symptoms and TB diagnosis was of 6 [1–44] months. The time from admission to diagnosis was of 18 (9–28) days. No patient had human immunodeficiency virus infection. Fluorodeoxyglucose - positron emission tomography (FDG-PET) detected extra-cardiac asymptomatic Mycobacterium tuberculosis infection localization and guided biopsy in 5 cases. As compared to TB patients without cardiac involvement, patients with MT were younger and more frequently women. All patients received antituberculosis therapy for 7.5 to 12 months associated with steroids for at least 6 weeks. Cardiac surgery was required in all but one patient. No patient died over a median follow-up of 1.2 [0.2–4.4] years. ConclusionOur study emphasizes the clinical spectrum of life-threatening MT. Early diagnosis using FDG-PET imaging to target biopsy in extra-cardiac tissues and combined treatment strategy associating antituberculosis therapy, corticosteroids and surgery prevent complications and death.

PREVALENCE AND MANAGEMENT OF THE DIABETIC FROZEN SHOULDER

The term frozen shoulder was first introduced by Codman in 1934. He described a painful shoulder condition of insidious onset that was associated with stiffness and difficulty sleeping on the affected side. Codman also identified the marked reduction in forward elevation and external rotation that are the hallmarks of the disease. Long before Codman, in 1872, the same condition had already been labelled periarthritis by Duplay. In 1945, Naviesar coined the term adhesive capsulitis. [2] The pathophysiology of idiopathic adhesive capsulitis (frozen shoulder) is poorly understood. Most authors have reported various degrees of inflammatory changes in the synovial membrane. Adhesions between the shoulder capsule and the humeral head have been noted by some, but not all, authors. [4] The aetiology of periarthritis of the shoulder, however, is not clearly understood. Amongst the factors suggested are trauma myocardial infarction hemiplegia, pulmonary tuberculosis, thyrotoxicosis, cerebral tumour, and epilepsy. [7] Subjects with Frozen Shoulder Syndrome group A treated with ERM and MWM and group B treated with MRM. The duration of each treatment was 3 weeks. There was an improvement in mobility and functional ability at 12 weeks in subjects treated with the 3 mobilization techniques. Comparing the effectiveness of the 3 treatment strategies in subjects with unilateral Frozen Shoulder Syndrome, ERM and MWM were more effective than MRM in increasing mobility and functional ability. [22].

Life-threatening ventricular arrhythmia as first presentation of Tuberculosis-Early diagnosis and successful treatment: A case series.

Tuberculosis of the myocardium is an extremely rare entity with few published case reports. Diagnosis is often delayed, and outcomes are unfavorable: particularly when cardiac involvement has been the presenting entity. Four patients, aged 24-51 years, presented with life-threatening ventricular arrhythmia (VA). None had a previous history of tuberculosis or any structural heart disease. Electrocardiogram during sinus rhythm and Echocardiography did not show any gross abnormality. All patients underwent contrast-enhanced computer tomography of thorax and cardiac magnetic resonance imaging. Attempts to obtain tissue (cardiac or associated mediastinal lymph nodes) were associated with increased risk to the patients thus indirect evidence of Mantoux skin test and interferon gamma release assay results were used to aid diagnosis. Based on clinicoradiological findings, patients were put on antitubercular therapy (ATT). Supportive therapy included antiarrhythmic drugs (all patients), catheter ablation (two patients), and implantable cardioverter defibrillator (one patient). Arrhythmia suppression was achieved in all patients predischarge. On a follow-up of 2-24 months, none of the patients has had any recurrence of arrhythmia. ATT and antiarrhythmic drug therapy have been stopped in two patients who have completed the 6 months of ATT. Their radiological lesions showed resolution. Myocardial tuberculosis presenting as life-threatening VA in a rare but definite clinical entity. A high index of suspicion and cardiac imaging can lead to early diagnosis and appropriate treatment that ensures survival in all patients.

Intracardiac Tuberculoma in the Immunocompromised Population – A review

PurposeTo understand the peculiar factors which guide the diagnosis of intracardiac tuberculoma especially in sick children with altered immunity.MethodLiterature review of scientific papers in Med‐line/Pub Med, and other popular search engines.ResultsTuberculosis (TB) is a contagious airborne disease. WHO ranks TB alongside HIV/AIDS as a leading cause of death worldwide. [1] At least one‐third of people living with HIV worldwide in 2014 were infected with TB bacteria. HIV patients are 20 to 30 times more likely to develop active TB disease. It is estimated that pediatric cases account for 10–15% of the global TB. Majority of them occur in infants and children under 5 years of age. [2] Diagnosis of TB in children is more difficult than in adults, because few signs are associated with primary infection, interferon‐gamma release assays (IGRA) and tuberculin skin test (TST) are less reliable in younger children.[3] In the pediatric age, the prodromal stage is often very short, and the risk of progression to active disease is higher (30–40% in those younger than 1 year of age) and children (24% in 1–5 years of age) compared to the subsequent ages if treatment is inadequate. Following the inhalation of mycobacteria, innate immunity controls infection in immune‐competent patients. [3] Children are prone to develop extra‐pulmonary TB; about 4% of children infected under the age of 5 years, develop tubercular meningitis or miliary TB. [4] Cardiac tuberculosis is usually found at postmortem examination. Endocardial tuberculoma is extremely rare, found in only 0.14% of autopsy cases. Studies carried out before the introduction of specific anti‐tuberculous therapy assert that the myocardium is involved in less than 0.30% of patients dying of tuberculosis. [5] The myocardium might be affected by direct spread from the mediastinal gland, by the lymphatic routes, or the bloodstream. Organ involvement with M. tuberculosis infection was classified as being miliary or nodular. Nodular myocardial tuberculosis might develop into a ventricular aneurysm. [6] A tuberculoma is a clinical manifestation of tuberculosis which conglomerates tubercles into a firm lump, and so can mimic cancer tumors of many types in medical imaging studies. [7] Since these are evolutions of primary complex, the tuberculomas may contain within caseum or calcification. They can affect any organ such as the brain, intestines, ovaries, breast, lungs, esophagus, liver, pancrease, bones, the heart and many others. As the histological and clinical indications, as well as tumor markers such as CA‐125, are similar, it is often difficult to differentiate tuberculoma from cancer. For these reasons, tuberculosis should always be considered in differential diagnosis of cancer. [8] Intracardiac tuberculomas may be localized at any part of the heart. They were found at the proximal superior vena cava and the right atrium in a 17year old male patient initially diagnosed as angiosarcoma or rhabdomyosarcoma. [9] “Clinically, tuberculomas may be asymptomatic or may present with arrhythmias, complete heart block, congestive heart failure, superior vena caval obstruction, right ventricular outflow obstruction, aortic insufficiency and sudden cardiac death”. [11]ConclusionsIntracardiac tuberculoma is a rare finding, often diagnosed in patients with miliary tuberculosis. The increased prevalence of HIV/AIDS and other immunosuppressive conditions lead to their emergence among infants and adults with tuberculosis.Support or Funding InformationAPS Minority Travel Award (applied)This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Acute myocarditis secondary to cardiac tuberculosis: a case report

Isolated myocardial involvement in tuberculosis is exceedingly rare but there are reports it can present with sudden cardiac death, atrioventricular block, ventricular arrhythmias or congestive cardiac failure. We report the case of a 33-year-old male, of South Asian descent, who presented with chest pain, shortness of breath and an abnormal ECG. The patient had no significant past medical history and coronary angiogram showed no evidence of coronary artery disease. Of note, the patient had recently been discharged from a local district hospital with an episode of myocarditis. The patient was found to be severely hypoxic with evidence of severe biventricular failure on echocardiography. Computed tomography of the chest demonstrated hilar lymphadenopathy, and the differential diagnosis was thought to be tuberculosis or sarcoidosis. A TB Quantiferon gold test performed at the district hospital was positive; however, fine needle aspiration was negative for acid-fast bacilli. Despite aggressive diuresis, the patient became increasingly hypoxic and suffered a cardiac arrest. Post-mortem confirmed a diagnosis of myocardial tuberculosis–a rare case of acute decompensated heart failure.

Influence of age on mycobacterial myocarditis and heart failure

Abstract Mycobacterium avium complex (MAC) consists of M. avium and M. intracellulare and enters the host primarily through the gastrointestinal track and pulmonary route. MAC is a common cause of mycobacterial infection in immune compromised individuals including, the elderly and those with COPD, HIV/AIDS or cystic fibrosis. The disease symptoms are reminiscent of tuberculosis (TB). Mycobacterium can infect every organ in the body including the heart causing carditis (pericarditis, myocarditis and endocarditis). Myocardial TB is difficult to diagnose and treat and can cause heart failure and ventricular tachyarrhythmia which can ultimately lead to sudden cardiac arrest. Very little is known regarding cardiac dysfunction during mycobacterial infection in the elderly. In this study we examined cardiac electrical activity, cardiac inflammation and fibrosis in young and old mice after 32 days of M. avium infection. The electrocardiogram of old mice shows abnormalities that include sinus node pause and first degree heart block. Thus, we hypothesize that mycobacterial infection leads to increased cardiac inflammation, fibrosis and necrosis which lead to significant electrical disturbances in old mice. The proposed work will identify new molecular mechanisms and key factors that cause sudden cardiac arrest during mycobacterial infection and will thereby provide us with additional strategies to protect the heart from cardiac damage during infection.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Recurrent Giant Left Ventricular Aneurysm of Tuberculous Etiology in a Child: Case Report

We report a case of myocardial tuberculosis in a 10-year-old girl, diagnosed after recurrence of left ventricular aneurysm, treated surgically.

Intracardiac left atrial tuberculoma in an eleven-month-old infant: case report

BackgroundCardiac tuberculosis is rare and usually manifests as tuberculous pericarditis. Involvement of other part of the heart is unusual and descriptions in the pediatric literature are confined to few case reports regarding mainly myocardial tuberculosis.Case presentationWe describe a case of pulmonary miliary tuberculosis associated with intracardiac left atrial tuberculoma in an immunocompetent eleven-month-old infant successfully treated with surgery and antituberculous therapy.ConclusionAlthough unusual, involvement of endocardium in disseminated tuberculosis should be kept in mind.

Monomorphic Ventricular Tachycardia and Mediastinal Adenopathy Due to Granulomatous Infiltration in Patients With Preserved Ventricular Function

This report characterizes a syndrome of granulomatous infiltration presenting as sustained monomorphic ventricular tachycardia (SMVT) with mediastinal adenopathy in patients with preserved ventricular function. Unlike truly idiopathic ventricular tachycardia, SMVT due to granulomatous infiltration responds poorly to radiofrequency ablation and has a poor prognosis. Patients without obstructive coronary artery disease and with normal ventricular function presenting with SMVT other than posterior fascicular morphology were evaluated. Computed chest tomograms, cardiac magnetic resonance imaging, and 18-fluorodeoxyglucose positron emission tomographic scans ((18)FDG PET-CT) were performed. Significant lymph nodes were evaluated for tuberculosis and sarcoidosis. Initial treatment included antiarrhythmic drugs ± radiofrequency ablation. Additionally, patients with evidence of tuberculosis received anti-tuberculosis therapy; the rest were treated as sarcoidosis. Mediastinal adenopathy with mid-myocardial scar and/or focal myocardial inflammation was observed in 14 patients; lymph nodes revealed noncaseating granulomas in all. Evidence of tuberculosis was present in 79%. During follow-up (median duration 25 months), SMVT recurred despite initial treatment in 92%. Addition of disease-specific therapy abolished further recurrences in 64% of them. Decrease in SMVT correlated with resolution of myocardial inflammation on serial (18)FDG PET-CTs. Appropriate therapies occurred in 67% of patients receiving implantable cardioverter-defibrillators. A subset of patients with SMVT with preserved ventricular function has a syndrome of arrhythmogenic myocarditis with granulomatous mediastinal adenopathy due to myocardial tuberculosis or cardiac sarcoidosis. This entity is optimally managed with a combination of disease-specific therapy and antiarrhythmic measures.

Myocardial tuberculosis presenting with congestive heart failure and pulmonary venous occlusion

Myocardial tuberculosis is a rare but well recognized disease entity. It can either remain clinically silent or present in various different forms. The presentation of myocardial tuberculosis depends upon the structures involved by the disease process. We report a case of cardiac tuberculosis with pulmonary venous obstruction presenting with congestive cardiac failure.

Case report: Myocardial tuberculosis-MRI

Although tuberculosis can affect any organ in the body, the respiratory tract is the organ most commonly affected. Myocardial tuberculosis is extremely rare.[1] We report the MRI features of myocardial tuberculosis in a patient initially diagnosed to have a right atrial mass.

Acute myocardial infarction and pulmonary tuberculosis in a young female patient: a case report

IntroductionTuberculous coronaritis is known to be a very rare phenomenon, although Mycobacterium tuberculosis, as some other infectious agents, may also act in the coronary vessels by activating the inflammatory mechanism of atherosclerosis. The association between active pulmonary tuberculosis and acute myocardial infarction has not been reported for around three and a half decades.Case presentationWe presented here a case of a young, 30 year old, Caucasian woman who presented to Emergency Ward with severe chest pain, ECG and enzyme profile typical for acute myocardial infarction. Chest X-ray displayed high intensity shades in the left lung field, which after additional laboratory tests were shown to be due to active pulmonary tuberculosis.ConclusionAs the patient did not have any other known coronary artery disease risk factors, we held responsible Mycobacterium tuberculosis for occurrence of acute myocardial infarction in this young female patient. We believe that the presentation of this rare case of myocardial infarction in a patient with active pulmonary tuberculosis should encourage researchers to investigate the potential role of Mycobacterium tuberculosis in pathogenesis of coronary heart disease.

An Unusual Indication for Cardiac Transplantation: Isolated Myocardial Tuberculosis

We report a case of myocardial tuberculosis in an 18-year-old male. He had been diagnosed with isolated asymmetrical septal hypertrophy cardiomyopathy and presented severe congestive heart failure for 4 months. Echocardiography and magnetic resonance studies showed localized echodense shadows and cavities in the thickness of the left ventricle myocardium with severe myocardial dysfunction. No contraindications for cardiac transplantation were found and this was planned and performed. Histology of the myocardium was consistent with the diagnosis of myocardial tuberculosis. The patient's post-operative course was uneventful, and he was discharged with anti-tuberculosis medication.

Causes of death in a hospitalized geriatric population: an autopsy study of 3000 patients.

Macroscopic and histological studies of 3000 consecutive autopsies (43.9% of the registered deaths) were performed by the same pathologist in a geriatric institution over a period of 20 years. Bronchopneumonia (42.9%), malignant neoplasms--mainly of the gastrointestinal tract and its annexae and the lungs (28.1%)-pulmonary thrombo-embolism (21.2%) and acute myocardial infarction (19.6%), were the most prevalent fatal conditions observed. Next, in decreasing order were: urinary tract infection (12.3%), acute cerebrovascular disease (6.5%), internal haemorrhage (5.5%), and congestive cardiac failure (3.3%). Some "rare" causes of death noted included trauma, metabolic disease, acute asphyxia from foreign body obstruction of the upper respiratory tract and degenerative neurological diseases. Some potentially treatable disorders which led to death were unsuspected clinically: for example, acute pyelonephritis (87%), pulmonary thrombo-embolism (74%), acute myocardial infarction (74%) and active pulmonary tuberculosis (61%). With advancing age there is an increased frequency of multiple pathological processes in a given subject and interactions play an important role in morbidity and mortality. We observed that two or more co-existing conditions often determine the fatal event. We also emphasize the relevance of post-mortem examination to prevention of disease and to therapeutic medicine in a hospitalized geriatric setting.