Tuberculous Myocarditis Research Articles

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.

The Case of Tuberculous Myocarditis Manifested by Extensive Myocardial Calcification

The Case of Tuberculous Myocarditis Manifested by Extensive Myocardial Calcification

Infectious Myocarditis on FDG-PET Imaging Mimicking Sarcoidosis

Cardiac positron emission tomography with fluorine-18 fluorodeoxyglucose (FDG-PET) is often used for the diagnosis of cardiac involvement in sarcoidosis. Areas of segmental perfusion defects coupled with FDG uptake are considered to represent active inflammation. However, these findings may be associated with other inflammatory myocardial diseases. We describe a case of tuberculous myocarditis with imaging findings mimicking those found in cardiac sarcoidosis.

Patterns and clinical manifestations of tuberculous myocarditis: a systematic review of cases.

Tuberculosis is a rare cause of myocarditis. It is however associated with a high mortality when it occurs and is often diagnosed at post-mortem. Tuberculous myocarditis prevalence in males is twice that in females. Most of the reported cases of tuberculous myocarditis are predominantly in immunocompetent patients. Out of the reported fatalities (sudden cardiac deaths), eighty one percent (81%) occur in the ‘young’ patients (below 45years). Antituberculosis drug therapy does not appear to offer mortality benefit against sudden cardiac deaths.

O029 Patterns And Clinical Manifestations Of Tuberculous Myocarditis: A Systematic Review Of Cases

Tuberculosis is a rare cause of myocarditis. It is however associated with a high mortality when it occurs and is often diagnosed at post-mortem. Tuberculous myocarditis prevalence in males is twice that in females. Most of the reported cases of tuberculous myocarditis are predominantly in immunocompetent patients. Out of the reported fatalities (sudden cardiac deaths), eighty one percent (81%) occur in the ‘young’ patients (below 45years). Antituberculosis drug therapy does not appear to offer mortality benefit against sudden cardiac deaths. Pan African Medical Journal. 2015; 21:118 doi:10.11604/pamj.2015.21.118.4282 This article is available online at: http://www.panafrican-med-journal.com/content/article/21/118/full/ © Brian Nyasani Michira et al. The Pan African Medical Journal ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pan African Medical Journal – ISSN: 19378688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net) Review Open Access

Tuberculous myocarditis presenting as a refractory ventricular tachycardia of biventricular origin

Ventricular tachycardia (VT) is one of the difficult clinical problems for the physician. Its evaluation and treatment are complicated because of its life-threatening nature and urgent need of rapid management. Any process that creates myocardial scar tissue could be the substrate for ventricular tachycardia. The coronary artery disease is the most common cause of myocardial scar. The dilated cardiomyopathies, hypertrophic cardiomyopathy, right ventricular dysplasia, Chagas disease, sarcoidosis, myocarditis including tubercular and other chronic granulomatous conditions and surgical incisions in the ventricle also can create myocardial scar and can lead to ventricular tachycardia. Occasionally, the arrhythmia may be well-tolerated, but in most of the situations it is associated with grave, life-threatening hemodynamic compromise. Regardless of the arrhythmia mechanism, the severity of clinical symptoms and hemodynamic compromise determines the urgency with which VT must be treated. Rarely, patients present with repetitive runs of nonsustained or sustained VT despite the medical treatment and poorly respond to the conventional treatment. Such refractory VT may cause a tachycardia-induced cardiomyopathy in long run. In such cases, long-term management also include looking beyond the VT and work up for the possible and treatable cause of VT. Here we are presenting a case report of a young patient with tubercular myocarditis who has presented to us with recurrent ventricular tachycardia of both right bundle and left bundle branch block morphology and LV dysfunction. A review of literature has been carried out on causes and management of refractory VT.Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-2, 60-66DOI: http://dx.doi.org/10.3126/jcmsn.v7i2.6686

Sudden death in tuberculous myocarditis

Tuberculous myocarditis is one of the rare causes of sudden death. We report a case of 65-year-old female who came with diabetic foot and died suddenly after 2 days of hospital stay. On autopsy, she was found to have tuberculous myocarditis with granulomatous inflammation only in the liver and without pulmonary or mediastinal lymph node involvement. These findings are very unusual in tuberculous myocarditis.

Likely Tuberculous Myocarditis Mimicking an Acute Coronary Syndrome

Acute systemic infections may involve the heart, mostly represented by myocarditis and pericarditis. We report the case of a likely myopericarditis in an adult, leading to the diagnosis of tuberculosis infection. The clinical presentation was an acute coronary syndrome with elevated troponin Ic. An alternative diagnosis of myopericarditis was considered. Chest X-ray depicted a miliary pattern and a CT-scan demonstrated bilateral micronodules with a "tree-in-bud" pattern associated with parenchymal consolidations in the apical segment of the left upper lobe, suggesting infectious bronchiolitis. As the direct microscopic examination of the bronchial expectoration revealed the presence of Koch's bacterium, a diagnosis of a tuberculous myocarditis was likely. The clinical, electrocardiographic and CT-scan findings are shown; cardiac effects associated with tuberculosis are discussed.

Sudden Death from Tubercular Myocarditis

Tuberculous myocarditis is a rare finding. We present the case of a 33-year-old woman who was in good health and who died suddenly at home. Autopsy and histopathologic examinations revealed granulamatous lesions in the myocardium, lungs, lymph nodes, liver, and spleen. No fast acid bacilli were demonstrated on histological examination. The presence of a Mycobacterium tuberculosis DNA complex was identified using a polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded histological samples. An HIV test carried out on the blood obtained during the autopsy was negative according to the DNA amplification technique (PCR) and enzyme-linked immunosorbent assay serological test. We hypothesize that the mechanism of death was severe ventricular arrhythmia due to granulomatous proliferation in the structures of the interventricular septum.

Tuberculosis and sudden death: A case report and review

Although deaths from tuberculosis (TB) are increasing, TB-related sudden death (TBRSD) is rarely reported in the literature. We present a case report of fatal pulmonary TB with extrapulmonary extension in a patient infected with the human immunodeficiency virus (HIV) and a review of published reports of TBRSD in MEDLINE (1966 to October 2000). Forty-six cases of TBRSD were reported. The most common cause of TBRSD was tuberculous bronchopneumonia in 30 (64%) patients, followed by hemoptysis in 14 (30%) patients. Tuberculous myocarditis and isolated TB of the adrenal glands are seldom causes of TBRSD. The early detection of TB, use of directly observed therapy, and individualization of treatment can be helpful in decreasing the incidence of TBRSD. (Heart Lung® 2001;30:388-91.)

Tuberculosis myocarditis: a case report

A 35-year old man presented with fever, weight loss, drenching night sweats and symptoms of cardiac failure for three months. Examination revealed wasting, peripheral oedema, bilateral pleural effusion and constrictive pericarditis. A diagnosis of constrictive pericarditis with bilateral pleural effusion probably due to tuberculosis was made. Human immunodeficiency virus antibodies and six sputum for acidfast bacilli were negative. Electrocardiograph revealed low voltages globally and echocardiography showed global myocardial hypokinesia. He had pericardiectomy, pericardial and pleural histology was non-specific inflammatory reaction but myocardial histology showed granulomatous changes of tuberculous myocarditis. We suggest that in experienced hands myocardial biopsy could be useful in making the diagnosis.

Tuberculous myocarditis presenting as long QT syndrome

An increasing QT interval can precipitate life-threatening tachyarrhythmias such as ventricular fibrillation. Tuberculous myocarditis is a very unusual diagnosis commonly made at autopsy . Mycobacterium tuberculosis can invade the cardiac conduction system and produce potentially dangerous arrhythmias. This case presents an HIV-infected man with tuberculous infection and long QT syndrome. We comment on the pathology, clinical features and outcome of this rare form of tuberculous infection.

Tuberculous myocarditis presenting as sudden cardiac death

A 71-year-old Chinese male presented as sudden death and autopsy revealed miliary tuberculosis with tuberculous myocarditis. Though miliary tuberculosis is not as common as in the past, it remains one of the possible causes of sudden cardiac death.

Studies on the virulence of tubercle bacilli; the relationship of the physiological state of the organisms to their pathogenicity.

On the basis of earlier observations dealing with the relation of a petroleum ether-soluble material (cord factor) obtained from young cultures of virulent tubercle bacilli to the pathogenicity of these organisms, it was expected that young cultures yielding more cord factor than older ones of the same strain would also be more virulent for susceptible animals. By infecting mice with equal numbers of bacteria from 3 day and 3 week old cultures, significant differences in the character of disease produced were observed. The mice infected with the younger cultures died of a rapid, septicemic infection with tuberculous lesions in many organs including the heart. A tuberculous myocarditis was probably the immediate cause of death. Mice infected with the older bacteria died of a chronic disease corresponding to the well known mouse tuberculosis. In these cases, the heart was completely free of lesions. No histologic tissue reactions typical of tuberculosis were seen in the animals dying from the acute type of the disease. A similar rapidly progressing infection was observed in rabbits infected with bacteria from young cultures. The symptoms corresponded to the ones seen in the disease known as the Yersin type of tuberculosis. It seems that the pathology of this latter can be produced with every type of pathogenic mycobacteria, human as well as bovine and avian, provided the cultures used are young. Thus it may be inferred that the acute type of tuberculosis is more frequent than commonly accepted both in experimental infection and in the naturally occurring disease. It is proposed to explain the mechanism of this acute infection within the framework of the cord factor hypothesis.

Embolic thrombosis of the abdominal aorta with tuberculous (histologic) lesions of the heart containing giant cells with radial inclusions

Tuberculous myocarditis with endocardial thrombosis is not infrequent, but embolism from these thrombi seem to occur rarely. Tuberculous lesions of the myocardium and endocardium, associated with mural thrombosis and obturator thrombosis (embolism) of the abdominal aorta and other vessels, is reported. Some of the giant cells in the lesions of the myocardium, lymph nodes, and lungs contained radial inclusions.

TUBERCULOSIS OF THE MYOCARDIUM

While tuberculous pericarditis is not uncommon, tuberculous involvement of the myocardium is decidedly rare. Some idea of the incidence of the latter condition can be gained from the reports of Raviart 1 and Norris, 2 the former finding only 49 cases among 7,683 autopsy reports collected from French and German sources, and the latter 5 cases among 7,319 protocols. In all, we have been able to find reports of only a few more than 200 instances of tuberculous myocarditis (Raviart, 1 Norris 2 and others 3 ). In spite of its apparent rarity, we have secured during the past year six examples of tuberculous myocardial involvement from the postmortem material of the Philadelphia General Hospital. A brief history of these cases follows. REPORT OF CASES Case 1.—History. —F. E., a colored woman, aged 51, was admitted to the neuropsychiatric wards of the Philadelphia General Hospital on Oct. 7, 1930,

TUBERCULOSIS OF THE MYOCARDIUM

Tuberculosis of the heart is uncommon. This is not at all strange when one realizes how rarely tuberculosis attacks muscle tissue in general. Tuberculosis of the pericardium is by far a more frequent finding than tuberculosis of the myocardium. Sir William Osler, 1 for instance, reported the finding of 275 tuberculous subjects in 1,000 autopsies, of which 7 had tuberculosis of the pericardium. Wells 2 found 10 cases of tuberculous pericarditis in 1,048 autopsies. Brooks and Lippincott, 3 among 1,000 autopsies, found 23 cases of tuberculous pericarditis. Tuberculosis of the myocardium, however, is a much rarer finding. Nevertheless, a fairly large number of cases of tuberculosis of the myocardium has been reported. This is because many of the cases are secondary to a tuberculous pericarditis. True cases of primary tuberculous myocarditis are quite rare. Virchow once declared that tuberculosis cannot appear in the muscle of the heart. Despite that statement,