1
|
Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications-A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13030432. [PMID: 36766543 PMCID: PMC9914020 DOI: 10.3390/diagnostics13030432] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Although primarily a lung disease, extra-pulmonary tuberculosis (TB) can affect any organ or system. Of these, cardiovascular complications associated with disease or drug toxicity significantly worsen the prognosis. Approximately 60% of patients with TB have a cardiovascular disease, the most common associated pathological entities being pericarditis, myocarditis, and coronary artery disease. We searched the electronic databases PubMed, MEDLINE, and EMBASE for studies that evaluated the impact of TB on the cardiovascular system, from pathophysiological mechanisms to clinical and paraclinical diagnosis of cardiovascular involvement as well as the management of cardiotoxicity associated with antituberculosis medication. The occurrence of pericarditis in all its forms and the possibility of developing constrictive pericarditis, the association of concomitant myocarditis with severe systolic dysfunction and complication with acute heart failure phenomena, and the long-term development of aortic aneurysms with risk of complications, as well as drug-induced toxicity, pose complex additional problems in the management of patients with TB. In the era of multidisciplinarity and polymedication, evidence-based medicine provides various tools that facilitate an integrative management that allows early diagnosis and treatment of cardiac pathologies associated with TB.
Collapse
|
2
|
Tuberculosis of the Heart: A Diagnostic Challenge. Tomography 2022; 8:1649-1665. [PMID: 35894002 PMCID: PMC9326682 DOI: 10.3390/tomography8040137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis of the heart is relatively rare and presents a significant diagnostic difficulty for physicians. It is the leading cause of death from infectious illness. It is one of the top 10 leading causes of death worldwide, with a disproportionate impact in low- and middle-income nations. The radiologist plays a pivotal role as CMR is a non-invasive radiological method that can aid in identifying potential overlap and differential diagnosis between tuberculosis, mass lesions, pericarditis, and myocarditis. Regardless of similarities or overlap in observations, the combination of clinical and certain particular radiological features, which are also detected by comparison to earlier and follow-up CMR scans, may aid in the differential diagnosis. CMR offers a significant advantage over echocardiography for detecting, characterizing, and assessing cardiovascular abnormalities. In conjunction with clinical presentation, knowledge of LGE, feature tracking, and parametric imaging in CMR may help in the early detection of tuberculous myopericarditis and serve as a surrogate for endomyocardial biopsy resulting in a quicker diagnosis and therapy. This article aims to explain the current state of cardiac tuberculosis, the diagnostic utility of CMR in tuberculosis (TB) patients, and offer an overview of the various imaging and laboratory procedures used to detect cardiac tuberculosis.
Collapse
|
3
|
Dulin M, Pasi N, Benali K, Ducrocq G, Roriz M, Pellenc Q, Para M, Chauveheid MP, Goulenok T, van Gysel D, Dossier A, Papo T, Sacre K. Management of patients with myocardial tuberculosis: A case series. Int J Cardiol 2020; 327:132-137. [PMID: 33166586 DOI: 10.1016/j.ijcard.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Myocardial Tuberculosis (MT) is exceedingly rare. We aimed to report on myocardial involvement in tuberculosis (TB). METHODS All 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. RESULTS Six 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. CONCLUSION Our 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.
Collapse
Affiliation(s)
- Marie Dulin
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicoletta Pasi
- Département de Radiologie, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Khadija Benali
- Département de Médecine Nucléaire, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Gregory Ducrocq
- Département de Cardiologie, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Mélanie Roriz
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Quentin Pellenc
- Département de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marylou Para
- Département de Chirurgie Cardio-vasculaire, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie-Paule Chauveheid
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Damien van Gysel
- Département d'Information Médicale, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Antoine Dossier
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France.
| |
Collapse
|
4
|
Hashmani S, Tipoo Sultan FA, Masood MQ. Unusual presentation of a young man with disseminated tuberculosis and right ventricular mass. BMJ Case Rep 2016; 2016:bcr-2016-216964. [PMID: 27797798 DOI: 10.1136/bcr-2016-216964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a 22-year-old man who presented to the emergency department with worsening shortness of breath and chronic fever for 2 months. Physical examination was unremarkable except for raised jugular venous pressure and palpable liver. Echocardiogram showed a large right ventricular mass causing obstruction at tricuspid valve. A subsequent chest CT scan confirmed the presence of a large mass in the right ventricle. There were multiple enlarged lymph nodes and consolidation in the right upper lobe. Diagnosis of disseminated tuberculosis (TB) was made and later confirmed by histopathology of lymph node biopsy along with positive sputum culture for acid-fast bacilli. Remarkable recovery was observed on antituberculous therapy, with complete disappearance of the cardiac mass on echocardiogram, at 1-year follow-up. Although unusual and rare, myocardial involvement as a large mass should be kept in mind while treating patients with disseminated TB.
Collapse
Affiliation(s)
- Shahrukh Hashmani
- Department of Cardiology, Aga Khan University Hospital, Karachi, Pakistan
| | | | | |
Collapse
|
5
|
Kemaloğlu Öz T, Elsayed M, Nanda NC, Kalenderoğlu K, Akyüz Ş, Atasoy I, Ösken A, Onuk T, Eren M. Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of a tuberculoma involving the left atrium and appendage. Echocardiography 2016; 33:1409-12. [PMID: 27565608 DOI: 10.1111/echo.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Intracardiac tuberculomas are extremely rare, and cardiac involvement in tuberculosis accounts for only 0.5% of extrapulmonary tuberculosis. We report for the first time incremental value of live/real time three-dimensional transesophageal echocardiography over two-dimensional transesophageal echocardiography in the assessment of a tuberculoma involving the left atrium and left atrial appendage.
Collapse
Affiliation(s)
- Tuğba Kemaloğlu Öz
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul, Turkey
| | - Mahmoud Elsayed
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Navin C Nanda
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Koray Kalenderoğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul, Turkey
| | - Şükrü Akyüz
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul, Turkey
| | - Işıl Atasoy
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul, Turkey
| | - Altuğ Ösken
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul, Turkey
| | - Tolga Onuk
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul, Turkey
| | - Mehmet Eren
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul, Turkey
| |
Collapse
|
6
|
Cardiac tuberculoma presenting as thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Heart Lung 2013; 43:158-60. [PMID: 24314749 DOI: 10.1016/j.hrtlng.2013.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/03/2013] [Accepted: 11/03/2013] [Indexed: 11/22/2022]
Abstract
Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) is a unique multisystem syndrome. It can present with either chronic or subacute infections. Tuberculosis (TB) is a chronic infection that has been reported to present with TTP-HUS as tuberculous endocarditis in the presence of immunodeficiency and implanted medical devices in regions where TB is endemic. Tuberculomas are space occupying lesions most commonly found in the brain in immunocompromised individuals. Herein, we present a rare association of tuberculosis with endocarditis manifesting as a tuberculoma and presenting as TTP-HUS in an immunocompetent patient and resident of the United States.
Collapse
|
8
|
Cantinotti M, De Gaudio M, de Martino M, Assanta N, Moschetti R, Veneruso G, Crocetti M, Murzi B, Chiappini E, Galli L. Intracardiac left atrial tuberculoma in an eleven-month-old infant: case report. BMC Infect Dis 2011; 11:359. [PMID: 22208878 PMCID: PMC3268750 DOI: 10.1186/1471-2334-11-359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 12/30/2011] [Indexed: 11/19/2022] Open
Abstract
Background Cardiac 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 presentation We 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. Conclusion Although unusual, involvement of endocardium in disseminated tuberculosis should be kept in mind.
Collapse
Affiliation(s)
- M Cantinotti
- Department of Sciences for Woman and Child's Health, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|