Tuberculous Pericarditis Research Articles

Tuberculous Pericarditis is Multibacillary and Bacterial Burden Drives High Mortality

BackgroundTuberculous pericarditis is considered to be a paucibacillary process; the large pericardial fluid accumulation is attributed to an inflammatory response to tuberculoproteins. Mortality rates are high. We investigated the role of clinical and microbial factors predictive of tuberculous pericarditis mortality using the artificial intelligence algorithm termed classification and regression tree (CART) analysis. MethodsPatients were prospectively enrolled and followed in the Investigation of the Management of Pericarditis (IMPI) registry. Clinical and laboratory data of 70 patients with confirmed tuberculous pericarditis, including time-to-positive (TTP) cultures from pericardial fluid, were extracted and analyzed for mortality outcomes using CART. TTP was translated to log10 colony forming units (CFUs) per mL, and compared to that obtained from sputum in some of our patients. FindingsSeventy patients with proven tuberculous pericarditis were enrolled. The median patient age was 35 (range: 20–71) years. The median, follow up was for 11.97 (range: 0·03–74.73) months. The median TTP for pericardial fluid cultures was 22 (range: 4–58) days or 3.91(range: 0·5–8·96) log10CFU/mL, which overlapped with the range of 3.24–7.42 log10CFU/mL encountered in sputum, a multi-bacillary disease. The overall mortality rate was 1.43 per 100 person-months. CART identified follow-up duration of 5·23months on directly observed therapy, a CD4+ count of ≤199.5/mL, and TTP≤14days (bacillary load≥5.53 log10 CFU/mL) as predictive of mortality. TTP interacted with follow-up duration in a non-linear fashion. InterpretationPatients with culture confirmed tuberculous pericarditis have a high bacillary burden, and this bacterial burden drives mortality. Thus proven tuberculosis pericarditis is not a paucibacillary disease. Moreover, the severe immunosuppression suggests limited inflammation. There is a need for the design of a highly bactericidal regimen for this condition.

The prevalence of symptomatic infantile heart disease at Louga Regional Hospital, Senegal

ResuméLa prise en charge des cardiopathies infantiles congénitales ou acquises dans les pays d’Afrique au sud du Sahara posent encore d’énormes difficultés de diagnostic et d’accès au traitement notamment chirurgical. Les objectifs de ce travail rétrospectif étaient de déterminer la prévalence des cardiopathies observées en milieu pédiatrique au Centre Hospitalier Régional (CHR) de Louga, de décrire les différents types observés et de rapporter leur évolution à court terme.Durant la période d’étude, 1 Juillet 2009 au 31 Décembre 2012, 82 enfants sur 18 815 enfants présentaient une cardiopathie, soit une prévalence de 4.3/1 000. On note une prédominance du sexe féminin avec un sexe ratio de 1.2. Les circonstances de découverte les plus fréquentes sont représentées par la dyspnée 47.5% suivie du souffle cardiaque 35.3% et de l’insuffisance cardiaque congestive 13.4%. Les cardiopathies congénitales sont les plus fréquentes avec 69.5% des cas suivi des cardiopathies acquises avec 29.3% des cas et des formes mixtes avec 1.2%. Les principales cardiopathies congénitales retrouvées sont la communication inter ventriculaire (24.3%) suivie des canaux atrio-ventriculaires (12.1%), de la tétralogie de Fallot (9.7%) et de la persistance du canal artériel (7.3%). Les cardiopathies rhumatismales retrouvées dans 25.6% des cas et les péricardites tuberculeuses dans 3.7% des cas représentent les formes acquises. La mortalité est élevée avec 20 enfants décédés (24.4%) pendant la période d’étude. Seuls 13 patients sur 82 (15.9%) présentant une indication opératoire ont été opérés en France grâce à une prise en charge par l’association humanitaire Mécénat Chirurgie Cardiaque.Ainsi donc les cardiopathies infantiles sont peu fréquentes dans le service de pédiatrie du CHR de Louga. Les formes congénitales sont plus fréquentes que les formes acquises. Leur mortalité est élevée et l’accès à la chirurgie reste faible.

Densely calcified tuberculous constrictive pericarditis with concurrent active pulmonary tuberculosis infection

Though pulmonary tuberculosis is a common chronic infection in the developing countries like Nepal, the incidence of tubercular constrictive pericarditis is very low. Here we report a patient of active pulmonary tuberculosis with sputum positive for acid fast bacilli along with densely calcified constrictive pericarditis which has been reported as a very rare presentation in the literature.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12955 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 41-43

Chronic Constrictive Pericarditis: The Experience in the Philippine Heart Center and the Philippine General Hospital

BACKGROUND: Chronic constrictive pericarditis (CCP) in developing countries is usually due to tuberculous pericarditis. This study aims to determine the patient profile, clinical presentations, different diagnostic tests, procedures and outcomes of CCP at the Philippine Heart Center (PHC) and the Philippine General Hospital (PGH). METHODOLOGY: This was a retrospective study that included all adult patients who were admitted to PHC and PGH for tuberculous pericarditis between January 2010 and December 2013. Characteristics, clinical course and outcomes of patients were described. RESULTS: The study included 67 patients from PHC and 22 patients from PGH, with a mean age of 38 years. The male-to-female ratios were 2.19:1 for PHC and 3.41:1 for PGH. Dyspnea was the most common complaint, present in 93% of PHC patients and 59% from PGH. Cardiac tamponade was documented by echocardiography in 36% of PHC patients and 46% from PGH. Anti-Koch’s therapy was given to 100% at PHC and 64% at PGH. Pericardiectomy was done on 12% of patients from PHC and 55% at PGH. Perioperative mortality was 3% for PHC and 5% for PGH. CONCLUSION: CCP is common in tuberculous pericarditis. PHC and PGH varied in their CCP management. Pericardiectomy may improve the outcome of patients with CCP. KEYWORDS: chronic constrictive pericarditis, tuberculous pericarditis.

Constrictive Pericarditis: Etiologic Spectrum, Patterns of Clinical Presentation, Prognostic Factors, and Long-term Follow-up

Introduction and objectivesSome reports have described a change in the etiologic spectrum of constrictive pericarditis. In addition, data on the relationship between its clinical presentation and etiology are lacking. We sought to describe the etiologies of the disease, their relationship with its clinical presentation and surgical findings, and to identify predictors of poor outcome. MethodsWe analyzed 140 consecutive patients who underwent surgery for constrictive pericarditis over a 34-year period in a single center. ResultsThe etiology was idiopathic in 76 patients (54%), acute idiopathic pericarditis in 24 patients (17%), tuberculous pericarditis in 15 patients (11%), purulent pericarditis in 10 patients (7%), and cardiac surgery, radiation and uremia in 5, 3 and 2 patients respectively (4%, 2% and 1%). Mean duration of symptoms before pericardiectomy was 19 months (standard deviation, 44 months), the most acute presentation being for purulent pericarditis (26 days [range, 7-60 days]) and the most chronic for idiopathic cases (29 months [range, 4 days-360 months]). Perioperative mortality was 11%. There was no difference in mortality between etiologies. Median follow-up was 12 years (range, 0.1-33.0 years) in which 50 patients died. In a Cox-regression analysis, age at surgery, advanced New York Heart Association functional class (III to IV) and previous acute idiopathic pericarditis were associated with increased mortality during follow-up. ConclusionsMost cases of constrictive pericarditis are idiopathic. Cardiac surgery and radiation accounted for a minority of cases. Etiologic investigations are warranted only in acute or subacute presentations. Age, advanced functional class, and previous acute idiopathic pericarditis are associated with increased mortality.

Pericarditis constrictiva: espectro etiológico, presentaciones clínicas, factores pronósticos y seguimiento a largo plazo

Introduction and objectivesSome reports have described a change in the etiologic spectrum of constrictive pericarditis. In addition, data on the relationship between its clinical presentation and etiology are lacking. We sought to describe the etiologies of the disease, their relationship with its clinical presentation and surgical findings, and to identify predictors of poor outcome. MethodsWe analyzed 140 consecutive patients who underwent surgery for constrictive pericarditis over a 34-year period in a single center. ResultsThe etiology was idiopathic in 76 patients (54%), acute idiopathic pericarditis in 24 patients (17%), tuberculous pericarditis in 15 patients (11%), purulent pericarditis in 10 patients (7%), and cardiac surgery, radiation and uremia in 5, 3 and 2 patients respectively (4%, 2% and 1%). Mean duration of symptoms before pericardiectomy was 19 months (standard deviation=44 months), the most acute presentation being for purulent pericarditis (26 days [range, 7-60 days]) and the most chronic for idiopathic cases (29 months [range, 4 days-360 months]). Perioperative mortality was 11%. There was no difference in mortality between etiologies. Median follow-up was 12 years (range, 0.1-33.0 years) in which 50 patients died. In a Cox-regression analysis, age at surgery, advanced New York Heart Association functional class (III to IV) and previous acute idiopathic pericarditis were associated with increased mortality during follow-up. ConclusionsMost cases of constrictive pericarditis are idiopathic. Cardiac surgery and radiation accounted for a minority of cases. Etiologic investigations are warranted only in acute or subacute presentations. Age, advanced functional class, and previous acute idiopathic pericarditis are associated with increased mortality.Full English text available from:www.revespcardiol.org/en

TUBERCULOUS PERICARDITIS WITH DISSEMINATED TUBERCULOSIS IN AN ADULT WITH SICKLE CELL DISEASE AND MASSIVE SPLENOMEGALY

Tuberculous pericarditis with disseminated tuberculosis (TB) is fatal if not treated. Clinical manifestations are often non-specific. Antituberculosis treatment is lifesaving. A 53-year-old man with sickle cell disease (SCD) presented with a 1 year history of weight loss and paradoxical

Host-directed therapies for tuberculous pericarditis

TB Pericarditis is associated with significant inflammatory and immune responses which can paradoxically cause injury to the pericardium and myocardium. Management with anti-TB therapy alone does not prevent complications or reduce mortality. Thus the prevailing view is that adjunct host-directed therapies such as use of glucocorticoid treatment could attenuate destructive inflammatory responses and improve morbidity and mortality rates. A recent trial showed no advantage of using adjunct corticosteroid treatment on the combined endpoint of death, cardiac tamponade or constriction. The current lack of effective medical treatment for reducing the significant morbidity and mortality associated with TB pericarditis, highlights the urgent need for newer approaches to treating the disease. Newer treatment options for pericarditis using adjunct host-directed therapies, including autologous bone-marrow-derived Mesenchymal Stromal Cells (MSCs) therapy, now require evaluation in randomized placebo-controlled controlled trials.

Cardiac tamponade caused by tuberculous pericarditis: A case report

Pericarditis is a rare but potentially serious comp lication of tuberculosis. The clinical features of Tuberculous pericarditis are often subtle and nonspecific, leading to delayed or missed diagnosis. As a result, patients of Tuberculous pericarditis often present with late complications and have increased mortality. We present a 51-year-old male who was admitted to our hospital for pericardial effusion investigation which was found to be of tuberculosis etiology based on polymerase chain reaction and pericardi al effusion culture. Clinicians should keep in mind tuberculosis as an important cause of peri cardial effusion, as it may reflect increasing tuberculosis endemic and to consider using polymerase chain reaction to aid in reaching the diagnosis.

A case of the tuberculous pericarditis with cardiac tamponade in the patient on maintenance dialysis

A case of the tuberculous pericarditis with cardiac tamponade in the patient on maintenance dialysis

Prednisolone and Mycobacterium indicus pranii in Tuberculous Pericarditis

BackgroundTuberculous pericarditis is associated with high morbidity and mortality even if antituberculosis therapy is administered. We evaluated the effects of adjunctive glucocorticoid therapy and Mycobacterium indicus pranii immunotherapy in patients with tuberculous pericarditis.MethodsUsing a 2-by-2 factorial design, we randomly assigned 1400 adults with definite or probable tuberculous pericarditis to either prednisolone or placebo for 6 weeks and to either M. indicus pranii or placebo, administered in five injections over the course of 3 months. Two thirds of the participants had concomitant human immunodeficiency virus (HIV) infection. The primary efficacy outcome was a composite of death, cardiac tamponade requiring pericardiocentesis, or constrictive pericarditis.ResultsThere was no significant difference in the primary outcome between patients who received prednisolone and those who received placebo (23.8% and 24.5%, respectively; hazard ratio, 0.95; 95% confidence interval [CI], 0.77 to 1.18; P=0.66) or between those who received M. indicus pranii immunotherapy and those who received placebo (25.0% and 24.3%, respectively; hazard ratio, 1.03; 95% CI, 0.82 to 1.29; P=0.81). Prednisolone therapy, as compared with placebo, was associated with significant reductions in the incidence of constrictive pericarditis (4.4% vs. 7.8%; hazard ratio, 0.56; 95% CI, 0.36 to 0.87; P=0.009) and hospitalization (20.7% vs. 25.2%; hazard ratio, 0.79; 95% CI, 0.63 to 0.99; P=0.04). Both prednisolone and M. indicus pranii, each as compared with placebo, were associated with a significant increase in the incidence of cancer (1.8% vs. 0.6%; hazard ratio, 3.27; 95% CI, 1.07 to 10.03; P=0.03, and 1.8% vs. 0.5%; hazard ratio, 3.69; 95% CI, 1.03 to 13.24; P=0.03, respectively), owing mainly to an increase in HIV-associated cancer.ConclusionsIn patients with tuberculous pericarditis, neither prednisolone nor M. indicus pranii had a significant effect on the composite of death, cardiac tamponade requiring pericardiocentesis, or constrictive pericarditis. (Funded by the Canadian Institutes of Health Research and others; IMPI ClinicalTrials.gov number, NCT00810849.)

Neither glucocorticoid therapy nor immunotherapy improves outcomes in patients with tuberculous pericarditis

Neither glucocorticoid therapy nor immunotherapy improves outcomes in patients with tuberculous pericarditis

Adjunctive Therapy in Tuberculous Pericarditis

Tuberculosis remains a tremendous global health burden. Tuberculous pericarditis is a common complication of this disease in sub-Saharan Africa and

PM474 Tuberculous Pericarditis in an 87 year old male presenting with difficulty of breathing

Introduction: RHD which is more prevalent in underdeveloped countries, is one of the common cause of morbidity and mortality among school age children, in Nepal. Objectives: To evaluate the prevalence and pattern of Rheumatic heart disease in School going children aged 5-15 years from eastern Nepal. Methods: It was a cross-sectional observational study conducted in 2006-2007.School children aged 5-15 years were screened using stethoscope as a tool for presence of valvular heart disease. Clinically suspected cases were evaluated with echocardiography to confirm the presence of RHD. Results: A total of 2043 children aged 5-15 years were screened. 23(1.12%) were clinically suspected to have RHD. Out of them 5(21.74%) found to have RHD, one congenital heart disease. Commonest valve involved was mitral valve (100%) and commonest lesion found was Mitral stenosis. Pure mitral stenosis found in 40% cases, Pure Mitral regurgitation in 20%. Mixed involvement of valves seen in 40% cases, MS with MR (20%) and MS with AR (20%) cases. Commonest and only congenital heart disease was ASD. Conclusion: In eastern part of Nepal prevalence of RHD was found to be 2.5/1000 schoolchildrenwithpredominant valve involvedasmitral valve andpredominant lesionMitral stenosis. Disclosure of Interest: None Declared

Management of Rheumatic Heart Disease in Uganda

Management of Rheumatic Heart Disease in Uganda

Tuberculous Effusive-Constrictive Pericarditis

Introduction: Tuberculosis (TB) is a serious disease in developing countries. Tuberculous pericarditis is a rare but life-threatening condition and may lead to cardiac tamponade and constrictive pericarditis. Case Presentation: An 82-year-old man was referred for cardiac consultation. He was suffering from dyspnea, malaise, weight loss, night sweat, and fever for four months duration. Discussion: Transthoracic echocardiography disclosed massive pericardial effusion, respiratory variation in mitral and tricuspid inflow E velocity, increased diastolic flow reversal with expiration in the hepatic vein, septum deviation in inspiration toward the left ventricle (LV), preserved LV function, and inferior vena caval (IVC) dilation without any collapse in inspiration. Chest computed tomography (CT) revealed a large amount of pericardial effusion and bilateral pleural effusion.

Surgery for Aneurysmal Right Coronary Fistula and Constrictive Pericarditis in an Adult: Case Report

Coronary artery fistula (CAF) is a direct communication between a coronary artery and the lumen of any of the cardiac chambers, i.e. the coronary sinus, the pulmonary artery, the superior vena cava or the proximal pulmonary veins. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. Congenital CAF is a rare anomaly and aneurysmal formation in the fistula is even rarer. Majority of CAFs are isolated lesions, however, congenital or acquired heart diseases may co-exist. Herein, we report a case of huge congenital aneurysmal right CAF connected to the right atrium in an Iraqi man of 62 associated with tuberculous effusive-constrictive pericarditis to whom off pump pericardiectomy was performed followed by ligation of right coronary artery and vein graft implantation to its posterior descending branch under cardiopulmonary bypass. To the best of our knowledge, such association was not previously reported. CAF can be repaired surgically with minimum risk and excellent outcome. Surgery is advised whenever coronary fistula is diagnosed unless it is very small to avoid the potential complications.

Isolated tuberculous pericarditis, an unusual presentation of tuberculosis – a case report

Background Although during the past years a constant decreasing trend of extrapulmonary tuberculosis (TB) was registered in Romania, the number of reported cases of pericardial effusion TB remained steady at 40-50 cases annually, most of them in association with pleural effusion. Pericardial TB is a potentially lethal complication of TB and it is associated with high rates of morbidity and mortality.

Myopericarditis in tuberculous pericardial effusion: prevalence, predictors and outcome

ObjectiveThe prevalence, predictors and outcome of myopericarditis in patients with tuberculous (TB) pericarditis are unknown.MethodsEighty-one patients (mean age±SD, 36.1±13.3 years; 54 (66.7%) men; 58 (71.6%) HIV seropositive) with TB pericarditis...

Corticosteroids for prevention of tuberculosis mortality

www.thelancet.com/infection Vol 13 November 2013 915 patients with pulmonary tuberculosis recover uneventfully without major complications with multidrug treatment. The most important fi nding is that not one patient died in four of the fi ve trials that assessed the eff ects of steroids in pulmonary tuberculosis in the era of multidrug treatment. The only trial that did report deaths included only patients with HIV who received high doses of glucocorticoids. Predictors of mortality in patients with HIV and tuberculosis diff er from those in patients with tuberculosis without HIV. Moreover, the biological mechanisms of benefi cial eff ect of corticosteroids in tuberculous meningitis and pericarditis are poorly understood. The possibility of increased risks of emergence of drug resistance in the era of multidrugresistant tuberculosis, coexistent HIV infection, and immunosuppression leading to disease progression with coadministration of steroids to patients with pulmonary tuberculosis need to be carefully considered before doing further research.