Tuberculous Pericarditis Research Articles

P692Percutaneous pericardioscopy in a population with a high prevalence of tuberculous pericarditis: the potential value of mycobacterial DNA amplification in establishing an early definite diagnosis

P692Percutaneous pericardioscopy in a population with a high prevalence of tuberculous pericarditis: the potential value of mycobacterial DNA amplification in establishing an early definite diagnosis

P691The clinical course of tuberculous pericarditis in immunocompetent hosts based on serial echocardiography

P691The clinical course of tuberculous pericarditis in immunocompetent hosts based on serial echocardiography

Correlation study between ADA and IFN-γ gene polymorphisms and the risk of developing tuberculous pericarditis

ObjectiveTo study the correlation between adenosine deaminase (ADA) and IFN-γ gene polymorphism and the risk of tuberculous pericarditis (TBP). MethodsTwo-hundred and forty-five patients with TBP were enrolled as a study group, including 140 males and 105 females. According to the general information of TBP patients in the study group, 115 patients with non-tuberculous pericarditis were recruited as the control group. Four ADA single nucleotide polymorphisms (SNPs; rs121908715, rs79281338, rs121908723, and rs61737144) and the rs2069707 locus of the IFN-γ polymorphism were detected using PCR and Sanger sequencing. ResultsCarriers with the T allele at the rs121908715 locus of ADA had a higher risk of TBP (adjusted OR = 3.986, 95% CI = 1.858–8.718, p < 0.001). There was a significantly higher risk of TBP in carriers with the G allele at the rs121908723 locus of ADA (adjusted OR = 2.334, 95% CI = 1.084–5.102, p = 0.018). The risk of TBP was higher in carriers with the G allele at the rs2069707 locus of IFN-γ (adjusted OR = 2.844, 95% CI = 1.399–5.853, p = 0.002). TB patients who carry both the T allele at the rs121908715 locus of ADA and the G allele of the IFN-γ gene, or who both carry the G allele at the rs126908723 locus of ADA and the G allele at the rs2069707 locus of IFN-γ have a higher risk of contracting TBP (adjusted OR = 11.034, 95% CI = 2.781–15.328, p < 0.001 and adjusted OR = 10.315, 95% CI = 4.522–13.854, p < 0.001). ConclusionThe ADA SNPs rs12190871 and rs121908723, and the rs2069707 locus SNPs of IFN-γ are risk factors for contracting TBP.

Cardiac manifestations of tuberculosis in a tertiary care center of Nepal

Background and Aims: Tuberculosis remains an important etiological cause of pericarditis and pericardial effusion in developing countries like Nepal. The objective of this study is to identify the various presentations of tuberculous pericarditis along with the demographic profile in our context and their short term outcome.Methods: We studied 53 patients from September 2015 to August 2017 regardless of age and gender who presented to Manmohan Cardiothoracic Vascular and Transplant Center with pericarditis of tubercular origin. The various manifestations of the disease were categorized with 2D echocardiography. Pericardiocentesis was done in patients with large pericardial effusion especially in cardiac tamponade and pericardiectomy done in chronic constrictive pericarditis(CCP). Antitubercular therapy with steroids was instituted.Results: Out of 53 patients, 62% were male and 38% were female. The ages ranged from 6-71 years (42±19.5). Twenty three percent of patients were from the age group 61-70yrs, 20% seen in age group 21-30 years, 8% in less than 10 yrs and 2% in above 70yrs old patients. The most common manifestation seen was large pericardial effusion (32%), followed by CCP (22.6%), 19% presented in cardiac tamponade, 2% had pyopericardium, 2% had perimyocarditis and 4% had acute pericarditis. Adenosine deaminase (ADA) was positive in 75% of the cases when pericardial fluid was tapped. Two patients developed CCP during follow up. Two patients succumbed to death during hospital stay.Conclusion: A high index of suspicion of tubercular pericarditis is inevitable in our settings where other sophisticated investigations are still lacking.Nepalese Heart Journal 2018; 15(1) 35-38

Systematic review and meta-analysis of adjunctive corticosteroids in the treatment of tuberculous pericarditis.

Tuberculosis (TB) is the most common cause of pericarditis worldwide and carries a high mortality, even with effective anti-tuberculosis treatment. In the light of a randomized control trial in 2014, the American Thoracic Society and the Centers for Disease Control and Prevention/Infectious Diseases Society of America recently revised their recommendations against the routine use of adjunctive corticosteroids. To evaluate the strength of evidence that resulted in this reversal of the guideline recommendations on the use of adjunctive corticosteroids in TB pericarditis by a meta-analysis, followed by a sensitivity analysis. Systematic review and meta-analysis of published randomized control trials. We identified five randomized control trials that met the eligibility criteria. Combining the results of the included trials, there was no overall mortality benefit from adjunctive corticosteroids (a random-effects model yielded a non-significant relative risk of 0.66 and 95%CI of 0.35-1.27). A sensitivity analysis further confirmed that the results of the meta-analysis were robust. Routine addition of oral corticosteroids to standard anti-tuberculosis treatment does not reduce mortality among patients with TB pericarditis.

Diagnostic accuracy of interferon-gamma in pericardial effusions for tuberculous pericarditis: a meta-analysis

Several studies have investigated the diagnostic accuracy of tests of pericardial effusion interferon-gamma for tuberculous pericarditis in patients with pericardial effusion, but the results have varied. The aim of this study was to investigate the diagnostic accuracy of interferon-gamma for tuberculous pericarditis using meta-analysis. The PubMed and EMBASE databases were searched to identify studies investigating the diagnostic accuracy of tests for interferon-gamma in pericardial effusion for tuberculous pericarditis. The quality of eligible studies was assessed by the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2), and the sensitivities and specificities of interferon-gamma across eligible studies were pooled by a bivariate model. A total of four studies encompassing 488 subjects were included. The pooled sensitivity, specificity, positive and negative likelihood ratios (NLRs) were 0.97 [95% confidence interval (CI): 0.87-0.99], 0.99 (95% CI: 0.74-1.00), 187 (95% CI: 3-12,542) and 0.03 (95% CI: 0.01-0.14), respectively. Testing for interferon-gamma in cases of pericardial effusion is adequate for identifying or ruling out tuberculous pericarditis.

Childhood Heart Disease in C&amp;#244;te d’Ivoire: Retrospective Multicentric Study about 228 Cases

Introduction: In Cote d’Ivoire, the paediatrician has to face a diagnosis and management problem in front of pediatric heart disease, with consequent a high lethality. Objective: To describe the epidemiological, diagnostic, therapeutic and progressive aspects of childhood cardiopathy for the improvement of prognosis and professional practice. Materials and methods: This was a multicenter retrospective and descriptive study conducted from January 2011 to March 2016 in two main hospitals universities, one located in Abidjan and the other in Bouaké. It concerned children aged 0 to 15 admitted for cardiac disease diagnosed on clinical and/or echocardiographic arguments. The variables studied were the epidemiological, diagnostic, therapeutic and evolutionary aspects. Results: A total of 49.760 admissions including 228 infantile heart disease cases (congenital 113, acquired 51, indeterminate 64) are overall prevalence of 4.6‰. They involved 106 boys and 122 girls. In 74.6% of cases, the age was between 0 and 2 years. Respiratory distress 73.7% was the main reason for consultation. The main congenital heart diseases (CHD) are ventricular septal defect (VSD) (31%), atrial septal defect (ASD) (20.4%), atrioventricular canal (AVSD) (12.4%) and tetralogy of Fallot (TOF) (11.5%). As for acquired forms (AHD), rheumatic mitral insufficiency (41.2%) and tuberculous pericarditis (15.7%) were the two main causes. Treatment progress is marked by stabilization (71.1%) and death (14%). Death was significantly associated with low socioeconomic status (p = 0.01) and with complication (p 0.001). Conclusion: Infantile heart diseases are relatively less frequent and serious in Cote d’Ivoire. To improve the prognosis, close collaboration between the pediatrician and the cardiologist is required for early diagnosis and management.

Effect of prednisolone on inflammatory markers in pericardial tuberculosis: A pilot study

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.

Tuberculous and Infectious Pericarditis

Viral pericarditis is the most common cause of acute pericarditis and it is typically responsive to aspirin or nonsteroidal anti-inflammatory drugs. Tuberculous pericarditis is common in immunocompromised patients or in immunocompetent patients in endemic areas. The diagnosis of tuberculous pericarditis usually requires a multidisciplinary approach, and presumptive treatment should be started for people with suspected infections living in endemic areas. Antituberculous treatment along with corticosteroid therapy can reduce complications from constrictive pericarditis. Purulent pericarditis is fatal if untreated. Bacterial and fungal cultures from pericardial fluid and blood are essential to determine the best treatment.

Protocolo diagnóstico y tratamiento de las afectaciones pericárdicas de etiología infecciosa

TypesInfectious pericarditis encompasses three different aetiologies: viral, purulent and tuberculous. DiagnosisDiagnosis of each of these three entities requires specific study which should be protocolised. Viral pericarditis requires integral testing of the pericardial fluid or tissue which includes histological, cytological, immunohistological and molecular study. In the case of purulent pericarditis, diagnosis is based on findings of pericardial fluid of purulent appearance with a predominance of leukocytes and microbiological analysis. Finally, tuberculous pericarditis requires the tubercle bacillus to be demonstrated in the pericardial fluid or tissue. TreatmentTreatment will be specific to the aetiology.

Multimodality Imaging of Pericardial Diseases.

Pericardial diseases have changed their epidemiology in the past few years. With the aging population and decreasing incidence of communicable diseases, the causes of pericardial diseases have significantly changed from infectious and malignant to postradiation and cardiac surgery causes. Despite that, pericardial diseases remain difficult to diagnose. The accurate and timely diagnosis of these diseases is essential to avoid the late sequela of pericardial constriction and pericardial cirrhosis. Echocardiography remains the first test of choice for the assessment of patients with suspected pericardial diseases. Most patients with acute pericarditis have a self-limiting course and do not need further imaging. However, in the era of multimodality imaging, other modalities, namely, computed tomography (CT) and magnetic resonance imaging (CMR), are often utilized in complex cases. These two modalities provide a wide-open view of the pericardium and adjacent structures. They have high resolution to assess pericardial calcification, a hallmark of many diseases especially tuberculous constrictive pericarditis. CMR is also unique in its ability to assess pericardial late gadolinium enhancement (LGE) and edema. These have been recently suggested to be very important in the progression from acute pericarditis to constrictive pericarditis. In addition, they provide prognostic value to assess which patients are at high risk of developing heart failure and resource utilization. Thus, in the current era, patients with suspected complex pericardial diseases will need a multimodality approach rather than a single modality approach.

Interventions for treating tuberculous pericarditis.

BackgroundTuberculous pericarditis can impair the heart's function and cause death; long term, it can cause the membrane to fibrose and constrict causing heart failure. In addition to antituberculous chemotherapy, treatments include corticosteroids, drainage, and surgery.ObjectivesTo assess the effects of treatments for tuberculous pericarditis.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register (27 March 2017); the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library (2017, Issue 2); MEDLINE (1966 to 27 March 2017); Embase (1974 to 27 March 2017); and LILACS (1982 to 27 March 2017). In addition we searched the metaRegister of Controlled Trials (mRCT) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal using 'tuberculosis' and 'pericard*' as search terms on 27 March 2017. We searched ClinicalTrials.gov and contacted researchers in the field of tuberculous pericarditis. This is a new version of the original 2002 review.Selection criteriaWe included randomized controlled trials (RCTs) and quasi‐RCTs.Data collection and analysisTwo review authors independently screened search outputs, evaluated study eligibility, assessed risk of bias, and extracted data; and we resolved any discrepancies by discussion and consensus. One trial assessed the effects of both corticosteroid and Mycobacterium indicus pranii treatment in a two‐by‐two factorial design; we excluded data from the group that received both interventions. We conducted fixed‐effect meta‐analysis and assessed the certainty of the evidence using the GRADE approach.Main resultsSeven trials met the inclusion criteria; all were from sub‐Saharan Africa and included 1959 participants, with 1051/1959 (54%) HIV‐positive. All trials evaluated corticosteroids and one each evaluated colchicine, M. indicus pranii immunotherapy, and open surgical drainage. Four trials (1841 participants) were at low risk of bias, and three trials (118 participants) were at high risk of bias.In people who are not infected with HIV, corticosteroids may reduce deaths from all causes (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.59 to 1.09; 660 participants, 4 trials, low certainty evidence) and the need for repeat pericardiocentesis (RR 0.85, 95% CI 0.70 to 1.04; 492 participants, 2 trials, low certainty evidence). Corticosteroids probably reduce deaths from pericarditis (RR 0.39, 95% CI 0.19 to 0.80; 660 participants, 4 trials, moderate certainty evidence). However, we do not know whether or not corticosteroids have an effect on constriction or cancer among HIV‐negative people (very low certainty evidence).In people living with HIV, only 19.9% (203/1959) were on antiretroviral drugs. Corticosteroids may reduce constriction (RR 0.55, 0.26 to 1.16; 575 participants, 3 trials, low certainty evidence). It is uncertain whether corticosteroids have an effect on all‐cause death or cancer (very low certainty evidence); and may have little or no effect on repeat pericardiocentesis (RR 1.02, 0.89 to 1.18; 517 participants, 2 trials, low certainty evidence).For colchicine among people living with HIV, we found one small trial (33 participants) which had insufficient data to make any conclusions about any effects on death or constrictive pericarditis.Irrespective of HIV status, due to very low certainty evidence from one trial, it is uncertain whether adding M. indicus pranii immunotherapy to antituberculous drugs has an effect on any outcome.Open surgical drainage for effusion may reduce repeat pericardiocentesis In HIV‐negative people (RR 0.23, 95% CI 0.07 to 0.76; 122 participants, 1 trial, low certainty evidence) but may make little or no difference to other outcomes. We did not find an eligible trial that assessed the effects of open surgical drainage in people living with HIV.The review authors found no eligible trials that examined the length of antituberculous treatment needed nor the effects of other adjunctive treatments for tuberculous pericarditis.Authors' conclusionsFor HIV‐negative patients, corticosteroids may reduce death. For HIV‐positive patients not on antiretroviral drugs, corticosteroids may reduce constriction. For HIV‐positive patients with good antiretroviral drug viral suppression, clinicians may consider the results from HIV‐negative patients more relevant.Further research may help evaluate percutaneous drainage of the pericardium under local anaesthesia, the timing of pericardiectomy in tuberculous constrictive pericarditis, and new antibiotic regimens.2 April 2019Up to dateAll studies incorporated from most recent searchAll eligible published studies found in the last search (27 Mar, 2017) were included and one ongoing study was identified (see 'Characteristics of ongoing studies' section)

Tuberculous pericarditis treated with steroid in a dialysis patient

Mycobacterium tuberculosis has spread worldwide and its mortality rate had been very high. The prevention technology and antituberculosis (TB) chemotherapy has improved its prognosis. However, immunocompromised patients, such as those...

TUBERCULOUS PERICARDITIS, A TOPICAL PATHOLOGY IN PEDIATRICS – A CASE REPORT AND A REVIEW OF THE LITERATURE

Tuberculosis is one of the most frequent infectious pathologies, representing a major health public problem worldwide, with increased incidence in pediatric ages. We present the case of a 15-year-old male patient, who was admitted in our clinic for fever, malaise, vomiting, productive cough, dizziness and thoracic pain. His personal history underlined the fact that the patient also presented thoracic pain approximately 6 month before, which was interpreted as an intercostal neuralgia. The laboratory tests showed: leukocytosis, neutrophilia, monocytosis, increased inflammatory biomarkers and hyponatremia. The echocardiography revealed pericardial effusion. Despite the wide-spectrum antibiotics, the quantity of pericardial fluid increased, therefore a pericardial puncture was required. Due to the slow favorable evolution and the negative results of the common tests from the puncture fluid, we performed also PCR assays, which identified the bacterial DNA in the fluid establishing the diagnosis of tuberculous pericarditis. The particularity of the case consists in diagnosing a tuberculous pericarditis in a 15-year-old male teenager, with a recent history of thoracic pain, only based on the detection of M. tuberculosis DNA in the pericardial fluid, in the lack of other positive tests for this infection.

Anasarca as the Initial Manifestation of Tuberculous Pericarditis in a Child

AbstractPericarditis is a rare manifestation of tuberculosis in children. The usual clinical features include fever, cough, tachypnea, chest pain, and pedal edema. Very rarely, generalized edema may occur as a presenting feature. We describe a 10-year-old boy, who presented with anasarca and had received treatment with corticosteroids for a mistaken diagnosis of nephrotic syndrome and was subsequently diagnosed with tuberculous pericardial effusion. The rarity of manifestations and the difficulties encountered to diagnose tuberculous pericarditis prompted us to report this case. The report may serve to sensitize pediatricians to consider systematic investigations to reach the diagnosis in children presenting with anasarca and avoid the empiric use of steroids in anasarca.

Usefulness of 18F-FDG PET/CT for the Diagnosis of Tuberculous Pericarditis

Usefulness of 18F-FDG PET/CT for the Diagnosis of Tuberculous Pericarditis

Cardiovascular clinical trials in Africa: opportunities and challenges

Africa is a continent of great diversity and consists of extremely poor and remote rural regions characterised by traditional existences, as well as highly industrialised cities populated with people following an urban westernised lifestyle. This has resulted in an interesting presentation of diseases involving the cardiovascular system. On the one hand, rheumatic heart disease, cardiomyopathy and tuberculous pericarditis remain prevalent and under-researched among the black African population, while on the other hand, cardiovascular disease and its associated risk factors are starting to emerge and currently account for 10% of all deaths. Clinical trials play a crucial role in raising public awareness and promoting good policy-making; however, the continent’s research output is still small. Opportunities and challenges facing African researchers need to be identified in order to develop a strategic plan for the way forward.

Tuberculous pericarditis: Challenges and controversies in the modern era

Tuberculous pericarditis (TBP) continues to wreak havoc across Sub-Saharan Africa (SSA). Despite more than 5 decades of treatment and research into TBP, we are not much closer to alleviating the suffering and mortality associated with this extrapulmonary manifestation of tuberculosis (TB). In the era of modern cardiology, diseases of the pericardium do not receive the same amount of research attention and investment as what diseases of lifestyle do. Interventional techniques for their diagnosis and management do not extend much further than pericardiocentesis with appropriate laboratory investigations. They also do not provide the potential for the development and use of consumable equipment, or that of expensive drugs and, consequently, fi nancial investment into their research and development is not forthcoming. Diseases of the pericardium do, however, remain important within the discipline that we practice and TBP in particular deserves our continuous efforts and attention. It is unfortunate to acknowledge that we have not made much of an impact on this ancient foe over the last 50 odd years. Despite the World Health Organisation (WHO) declaring TB a global emergency in 1993, more than 20 years later we are not much better off. In 2013 an estimated 9 million people developed the disease and 1.5 million died from it.(1) TBP is predominantly a disease of SSA and it requires a solution from the very region which it torments.

Recomendaciones en el tratamiento de la tuberculosis sensible (Según las Guías ATS/CDC/IDSA. 2016)

During 2016, American Thoracic Society: ATS, Centers for Disease Control and Prevention: CDC and Infectious Disease Society of America: IDSA jointly sponsored the development of Guidelines for the treatment of drug-susceptible tuberculosis using the P-I-C-O (Patient-Intervention-Comparison-Outcome) system to answer nine questions. The preferred regimen for treating adults with drug-susceptible tuberculosis, consider a 2 month intensive phase with isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) followed by a continuation phase of 4 months of INH and RIF For patients who have cavitation on the initial chest radiograph and have positive cultures at completion of 2 months therapy, it is recommended to extend the continuation phase to prevent relapse. EMB can be discontinued as soon as susceptibility to INH and RIF is demonstrated. The guidelines also makes recommendations for the management in different clinical situations as in patients co-infected with HIV and in extrapulmonary tuberculosis. In tuberculous pericarditis no longer is recommended the routinely use of corticosteroids together with the anti TB treatment. In the case of tuberculous meningitis it is recommended the addition of corticosteroids and to extend the continuation phase to 9-12 months.

Primary pulmonary adenocarcinoma with multiple metastases in a 23 year old male presenting as tuberculous pericarditis: a post mortem diagnosis

Primary pulmonary adenocarcinoma with multiple metastases in a 23 year old male presenting as tuberculous pericarditis: a post mortem diagnosis