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Randall P, Esmail A, Wilson L, Makambwa E, Pooran A, Tomasicchio M, Dheda K, Ntsekhe M. GeneXpert MTB/RIF Ultra vs Unstimulated Interferon γ (IRISA-TB) for the Diagnosis of Tuberculous Pericarditis in a Tuberculosis-Endemic Setting. Open Forum Infect Dis 2024; 11:ofae021. [PMID: 38510916 PMCID: PMC10953797 DOI: 10.1093/ofid/ofae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
Background Tuberculous pericarditis (TBP) is a paucibacillary disease, where host biomarkers such as unstimulated interferon γ (IRISA-TB) have high diagnostic accuracy. However, DNA-based diagnostic tests (GeneXpert Ultra), more sensitive than an earlier versions, have recently become available. Given that the diagnosis of TBP is challenging, we performed a comparative diagnostic accuracy study comparing both assays. Methods We recruited 99 consecutive patients with suspected TBP in Cape Town, South Africa. Definite TBP was defined by microbiological confirmation of tuberculosis (TB) on pericardial fluid culture or an alternative polymerase chain reaction-based test (GeneXpert MTB/RIF) or by use of sputum (polymerase chain reaction or culture). Probable TBP was defined as a high clinical suspicion of TB accompanied by anti-TB treatment, while non-TBP was defined as negative microbiological test results for TB without initiation of TB treatment and/or the presence of an alternative diagnosis. Results There were 39 patients with definite TBP, 35 with probable TBP, and 23 with non-TBP. Approximately 70% of participants who received TB treatment were HIV coinfected. Overall, IRISA-TB was more sensitive than Xpert Ultra (88.6% [95% CI, 74.1%-95.5%] vs 71.5% [55.0%-83.7%], n = 53) and significantly more sensitive in participants who were HIV uninfected (100% [95% CI, 72.3%-100.0%] vs 60% [31.3%-83.2%], P = .03). In patients with definite and probable TBP combined (n = 84), sensitivity was significantly higher with IRISA-TB (77.3% [95% CI, 65.9%-85.8%] vs 37.9 [27.2%-50.0%], P < .0001). A similar pattern was seen in persons who were HIV uninfected (88.3% vs 35.3%, P = .002). Specificity was high for both assays (>95%). Conclusions Unstimulated interferon γ (IRISA-TB) was significantly more sensitive than Xpert Ultra for the diagnosis of TB pericarditis in a TB-endemic resource-poor setting.
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Affiliation(s)
- Philippa Randall
- Division of Pulmonology, Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, Observatory, South Africa
- Antrum Biotech, Observatory, South Africa
| | - Aliasgar Esmail
- Division of Pulmonology, Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Lindsay Wilson
- Division of Pulmonology, Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Edson Makambwa
- Division of Pulmonology, Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Anil Pooran
- Division of Pulmonology, Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Michele Tomasicchio
- Division of Pulmonology, Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Keertan Dheda
- Division of Pulmonology, Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, Observatory, South Africa
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town, Observatory, South Africa
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Ren Y. The clinical value of P-wave terminal force in lead V1 in evaluating pericardial thickness in tuberculous constrictive pericarditis. J Cardiothorac Surg 2024; 19:89. [PMID: 38347560 PMCID: PMC10863288 DOI: 10.1186/s13019-024-02526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
AIM To investigate the relationship between p wave terminal force (Ptfv1) and pericardial thickness in patients with tuberculous constrictive pericarditis. METHODS From January 2018 to October 2022, 95 patients with tuberculous constrictive pericarditis who needed pericarditis dissection in a hospital were collected, and 3 patients who did not meet the criteria were excluded, a total of 92 cases. The absolute value of Ptfv1 in conventional electrocardiogram was tested before surgery, and pericardial thickness was measured by echocardiography and chest CT. Pericardial thickness was measured after pericardial dissection. Pearson correlation analysis was used, R software was used to make scatter plot, and non-parametric square test was used. The correlation of postoperative measurements with echocardiography, chest CT and absolute value of Ptfv1 was analyzed. RESULTS Pearson correlation analysis was conducted with postoperative measurements and echocardiography measurements, postoperative measurements and chest CT measurements, and postoperative measurements and absolute value of Ptfv1. Pearson correlation analysis showed that the correlation coefficients between postoperative measurements and echocardiography, chest CT and Ptfv1 values were statistically significant. Scatter plot and nonparametric Chi-square test showed that postoperative measurements were consistent with absolute values of echocardiography, chest CT and Ptfv1 (p < 0.05). And this study found that the distribution of the value of Ptfv1 ≥ 5 was higher than the value of Ptfv1 < 5 after pericardiectomy (0.95:0.05) in the absolute value of Ptfv1 ≥ 0.04 which measured before pericardiectomy. The hypothesis was statistically significant (p < 0.05). CONCLUSION The absolute value of Ptfv1 in electrocardiogram can be used as an auxiliary diagnostic index to evaluate pericardial thickness in tuberculous constrictive pericarditis.
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Affiliation(s)
- Yanhong Ren
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Bajpai J, Roy S, Shukla S, Pradhan A, Kant S, Shah S. Detection of drug-resistant Mycobacterium tuberculosis in pericardial fluid culture and its correlation with cartridge based nucleic acid amplification test and adenosine deaminase activity. Indian J Tuberc 2023; 71 Suppl 1:S59-S66. [PMID: 39067957 DOI: 10.1016/j.ijtb.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/22/2023] [Indexed: 07/30/2024]
Abstract
BACKGROUND Pericardial effusion is the accumulation of fluid in the pericardial cavity. In nations with high tuberculosis (TB) load, TB is the most common cause of pericardial effusion. 1-2% of patients with pulmonary TB develop Pericardial TB worldwide. Multi-drug-resistant (MDR) TB, including extrapulmonary TB (EPTB) cases, are rising in number. Adenosine Deaminase (ADA) is an enzyme in lymphocytes and myeloid cells, which has certain immune functions in the body. ADA levels are increased in inflammatory conditions, like pleural, pericardial, or joint effusions, of bacterial etiology, granulomatous conditions, neoplasms, and autoimmune pathologies. TB is the only lymphocytosis involving disease with increased ADA levels. MDR EPTB is rare, but cases are on the rise, and tuberculous pericardial effusion is one such example. Hence, it is important to know the percentage of cases detected by a culture that can be identified by cartridge-based nucleic acid amplification test (CBNAAT), their resistance patterns, and to identify potential markers like ADA, which can help in early identification of cases. The objectives of this study were to identify the Mycobacterium tuberculosis (MTB) bacilli in culture, and correlate them with cartridge-based nucleic acid amplification test (CBNAAT) results and their drug-resistance, in the Pericardial tubercular effusion, and to find if Adenosine Deaminase (ADA) levels can be used as a predictor of the presence of MTB in pericardial fluid. METHODOLOGY We enrolled 52 patients with moderate to large tuberculous pericardial effusion, based on pericardial fluid analysis, CBNAAT, and culture methods, between January 2021 and December 2021. RESULTS The mean age of the patients was 41.85 + 17.88 years, with a median of 38 years. Males made up 57.7% of the total patients. MTB was detected in 16 (30.8%) patients in the CBNAAT evaluations. 14 (87.5%) of the CBNAAT-positive TB patients were sensitive to Rifampicin, whereas the remaining 2 (12.5%) were resistant to Rifampicin on CBNAAT. MTB was found to be growing in 8 (15.38%) drug sensitivity test cultures. Out of these 8, 6 were sensitive to first-line drugs, whereas 2 were resistant to both Isoniazid and Rifampicin. The presence of cough was found to have a significant difference between CBNAAT-detected MTB positive and negative patients (p = 0.020), whereas an insignificant difference was found for the presence of hypertension, diabetes mellitus, obesity, dyspnea, or fever. There was also an insignificant difference between the number of patients positive for the Tuberculin skin test, between the two groups. ADA was significantly higher in the MTB-detected CBNAAT group (85.91 + 37.60U/L vs 39.78 + 24.31U/L, p = 0.005), whereas the total leukocyte count, lymphocytes, neutrophils, random blood sugar levels, and serum protein levels had no significant difference. The area under the Receiver Operator Curve (CBNAAT positive: dependent variable; ADA: test result variable) was 0.854 (null hypothesis rejected), with a standard error of 0.078. CONCLUSIONS Culture is the gold standard method to diagnose tuberculosis. Detection of MTB on pericardial fluid culture is very uncommon, though in our study, culture came out positive in 16% of patients, and 4% were resistant to rifampicin and isoniazid. Higher ADA levels in pericardial fluid are an indicator of tuberculous pericardial effusion.
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Affiliation(s)
- Jyoti Bajpai
- Department of Respiratory Medicine, Kasturba Chest Hospital, King George's Medical University, Lucknow, India
| | - Shubhajeet Roy
- Faculty of Medical Sciences, King George's Medical University, Lucknow, India
| | - Suruchi Shukla
- Department of Microbiology, King George's Medical University, Lucknow, India
| | - Akshyaya Pradhan
- Department of Cardiology, Lari Cardiology Centre, King George's Medical University, Lucknow, India.
| | - Surya Kant
- Department of Respiratory Medicine, Kasturba Chest Hospital, King George's Medical University, Lucknow, India
| | - Shobhit Shah
- Department of Cardiology, Lari Cardiology Centre, King George's Medical University, Lucknow, India
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Khatun N, Akivis Y, Ji B, Chandrakumar HP, Bukharovich I, John S. Tuberculous Pericarditis Presenting as Cardiac Tamponade: Role of Echocardiography. J Med Cases 2023; 14:271-276. [PMID: 37692365 PMCID: PMC10482598 DOI: 10.14740/jmc4119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/06/2023] [Indexed: 09/12/2023] Open
Abstract
Tuberculous pericarditis, a rare but potentially lethal manifestation of tuberculosis, poses diagnostic and therapeutic challenges in clinical practice. Its nonspecific clinical presentation often mimics other conditions, leading to delayed or missed diagnoses. We report a 25-year-old male with no past medical history, who presented with nonspecific symptoms such as fatigue, weight loss, body aches, and dyspnea. An electrocardiogram showed low voltage QRS complex with electrical alternans, and transthoracic echocardiography (TTE) showed large pericardial effusion with tamponade physiology with right ventricular diastolic collapse, the collapse of the right atrium and the inferior vena cava was dilated with a respiratory variation of less than 50%. The diagnosis of tuberculous pericarditis was made based on clinical presentation, imaging, and laboratory findings, including a positive QuantiFERON-TB gold test and pericardial fluid analysis, despite negative cultures. This case highlights the significance of considering tuberculosis in the differential diagnosis of pericardial effusion and underscores the role of imaging and laboratory investigations in diagnosis. Management of tuberculous pericarditis involves a combination of antituberculous chemotherapy, pericardiocentesis, and corticosteroids. Despite its rarity, tuberculous pericarditis carries a high mortality rate and can present as cardiac tamponade, as illustrated in our case. This underscores the need for high clinical suspicion, especially in high-risk populations, for timely diagnosis and initiation of treatment.
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Affiliation(s)
- Nazima Khatun
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | - Yonatan Akivis
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | - Beisi Ji
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | - Harshith P. Chandrakumar
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | | | - Sabu John
- Kings County Hospital Center, Brooklyn, NY 11203, USA
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Ntsekhe M. Pericardial Disease in the Developing World. Can J Cardiol 2023; 39:1059-1066. [PMID: 37201721 DOI: 10.1016/j.cjca.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023] Open
Abstract
Pericardial disease in the developing world is dominated primarily by effusive and constrictive syndromes and contributes to the acute and chronic heart failure burden in many regions. The confluence of geography (location in the tropics), a significant burden of diseases of poverty and neglect, and a significant contribution of communicable diseases to the general burden of disease is reflected in the wide etiological spectrum of causes of pericardial disease. The prevalence of Mycobacterium tuberculosis in particular, is high throughout much of the developing world where it is the most frequent and important cause of pericarditis and is associated with significant morbidity and mortality. Acute viral/idiopathic pericarditis, which is the primary manifestation of pericardial disease in the developed world is believed to occur significantly less frequently in the developing world. Although diagnostic approaches and criteria to establish the diagnosis of pericardial disease are similar throughout the globe, resource constraints such as access to multimodality imaging and hemodynamic assessment are a major limitation in much of the developing world. These important considerations significantly influence the diagnostic and treatment approaches, and outcomes related to pericardial disease.
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Affiliation(s)
- Mpiko Ntsekhe
- The Division of Cardiology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
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Ebrahimzadeh A, Pagheh AS, Mousavi T, Fathi M, Moghaddam SGM. Serosal membrane tuberculosis in Iran: A comprehensive review of evidences. J Clin Tuberc Other Mycobact Dis 2023; 31:100354. [PMID: 36874623 PMCID: PMC9982686 DOI: 10.1016/j.jctube.2023.100354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Tuberculosis (TB) is among the most common cause of serositis. There are many uncertainties in diagnostic and therapeutic approach to serous membranes tuberculosis. Our aim in the present review is to discuss the regional facilities for timely diagnosis, rapid decision-making and appropriate treatment regarding to serous membranes tuberculosis; with emphasis on situation in Iran. A comprehensive literature searches about the status of serous membranes tuberculosis in Iran were performed in English databases including Google Scholar, Science Direct, Scopus, Pub Med, and Web of Sciences, Persian SID databases, between 2000 and 2021. The main findings of the present review are as follow: a) pleural tuberculosis is more common than pericardial or peritoneal tuberculosis. b) Clinical manifestations are non-specific and so non-diagnostic. c) Smear and culture, PCR and characteristic granulomatous reaction have been used for definitive TB diagnosis by physicians. d) With Adenosine Deaminase Assays and Interferon-Gamma Release Assays in mononuclear dominant fluid, a possible diagnosis of TB is proposed by experienced physicians in Iran. e) In area of endemic for tuberculosis including Iran, a possible diagnosis of TB is enough to begin empirical treatment. f) In patients with uncomplicated tuberculosis serositis, treatment is similar to pulmonary tuberculosis. First line drugs are prescribed unless evidence of MDR-TB is detected. g) The prevalence of drug resistant tuberculosis (MDR-TB) in Iran is between 1% and 6%, and are treated by empirical standardized treatment. h) It is not known whether adjuvant corticosteroids are effective in preventing long term complication. i) Surgery may be recommended for MDR-TB. Tamponade or constrictive pericarditis and intestinal obstruction. In conclusion, it is recommended to consider serosal tuberculosis in patients who have unknown mononuclear dominant effusion and prolonged constitutional symptoms. Experimental treatment with first line anti-TB drugs can be started based on possible diagnostic findings.
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Affiliation(s)
- Azadeh Ebrahimzadeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Abdol Sattar Pagheh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Tahoora Mousavi
- Molecular and Cell Biology Research Center (MCBRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Fathi
- Parasitology Department of Medical School, Tarbiat Modares University, Tehran, Iran
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Moussa C, Rouis H, Debbiche S, Khattab A, Khouaja I, Zendah I, Maȃlej S. A life-threatening pericardial tamponade revealing disseminated tuberculosis: A challenging medical care. Heliyon 2023; 9:e15174. [PMID: 37089308 PMCID: PMC10114200 DOI: 10.1016/j.heliyon.2023.e15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
Tuberculous pericarditis (TBP) is one of the most important causes of pericarditis in developing countries in which tuberculosis remains a public health problem. We report the case of a 20-year-old immunocompetent woman who presented with hypotension and tachycardia echocardiography showed a massive pericardial effusion and signs of tamponade. The patient underwent an urgent pericardiocentesis; 700 ccs of serosanguinous pericardial fluid was drained. She had a surgical biopsy of the pleuropericardial window. The pathological examination confirmed TBP. Oral anti-tuberculosis therapy was initiated. Two months after therapy started, she was admitted for dyspnea and edema of the lower limbs. Echocardiography showed paradoxical inter-ventricular septum and non-compliant dilated inferior vena cava. She has been set on diuretics associated with Akurit for another two months. Thoracic CT scan done at 4 months of tuberculosis treatment showed: thickening of the pericardial layers, with an encysted collection facing the trunk of the pulmonary artery, bilateral pleural effusion, and thickening of the peribronchovascular and interlobular septa of the right lung, due to lymphatic stasis. We then switched to dual therapy for a total of eight months. An ultrasound check at the end of treatment was performed showing the absence of pericardial effusion with diminished systolic ejection fraction (54%). This case is the witness that TBP can be life-threatening even for immunocompetent patients. The risk is the evolution towards sequelae and constrictive pericarditis. The high mortality and morbidity from TBP despite the use of anti-tuberculous drugs call for research targeting host-directed immunological determinants of treatment outcome.
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Zhang J, Bu C, Yao L, Xu K. Clinical Application of the Mycobacterium tuberculosis-RNA Assay of Pericardial Tissue Specimens in the Diagnosis of Tuberculous Pericarditis. Infect Drug Resist 2023; 16:1875-1883. [PMID: 37020795 PMCID: PMC10069483 DOI: 10.2147/idr.s405868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose To assess the accuracy of the Mycobacterium tuberculosis (MTB)-RNA assay using pericardial tissue specimens for tuberculous pericarditis (TBP) diagnosis. Methods MTB culture and MTB-RNA assay were performed for patients with suspected TBP. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of these two assays were analyzed. Results This study included 79 patients. The sensitivity, specificity, PPV, NPV, and AUC were 28.1% (18/64), 100.0% (15/15), 100.0% (18/18), 24.6% (15/61), and 0.64 for the MTB culture and 37.5% (24/64), 100.0% (15/15), 100.0% (24/24), 27.3% (15/55), and 0.69 for the MTB-RNA assay, respectively. Patients with positive pericardial tissue culture were defined as having definite TBP; in other words, culture was the gold standard for this group of patients and had a sensitivity, specificity, PPV, and NPV of 100% and an AUC of 1.00. However, these values were found to be 72.2% (13/18), 100.0% (15/15), 100.0% (13/13), 75.0% (15/20), and 0.86 for the MTB-RNA assay, respectively. Among patients with probable TBP (culture-negative patients), the sensitivity, specificity, NPV, and AUC of MTB culture were 0.0% (0/46), 100.0% (15/15), 24.6% (15/61), and 0.50, respectively, but the PPV could not be determined. These values were found to be 23.9% (11/46), 100.0% (15/15), 100.0% (11/11), 30.0% (15/50), and 0.62 for the MTB-RNA assay, respectively. Conclusion MTB-RNA assay using pericardial tissues had limited diagnostic efficacy for TBP. In culture-positive TBP, the diagnostic accuracy of MTB-RNA was good. In contrast, in culture-negative TBP, its diagnostic accuracy was unsatisfactory.
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Affiliation(s)
- Jinjuan Zhang
- Department of Nursing, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Caifang Bu
- Department of Nursing, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Liwei Yao
- Department of Nursing, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Correspondence: Liwei Yao, Department of Nursing, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, No. 208 East Huancheng Road, Hangzhou, Zhejiang, People’s Republic of China, Email
| | - Kan Xu
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Kan Xu, Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, No. 208 East Huancheng Road, Hangzhou, Zhejiang, People’s Republic of China, Email
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Marcu DTM, Adam CA, Mitu F, Cumpat C, Aursulesei Onofrei V, Zabara ML, Burlacu A, Crisan Dabija R. Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications-A Narrative Review. Diagnostics (Basel) 2023; 13:432. [PMID: 36766543 PMCID: PMC9914020 DOI: 10.3390/diagnostics13030432] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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.
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Affiliation(s)
- Dragos Traian Marius Marcu
- Department of Medical Specialties (I and III) and Surgical Specialties, Grigore T. Popa University of Medicine and Pharmacy, University Street No. 16, 700115 Iaşi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street no 30, 700115 Iasi, Romania
| | - Cristina Andreea Adam
- Department of Medical Specialties (I and III) and Surgical Specialties, Grigore T. Popa University of Medicine and Pharmacy, University Street No. 16, 700115 Iaşi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties (I and III) and Surgical Specialties, Grigore T. Popa University of Medicine and Pharmacy, University Street No. 16, 700115 Iaşi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Academy of Medical Sciences, Ion C. Brătianu Boulevard No 1, 030167 Bucharest, Romania
- Academy of Romanian Scientists, Dimitrie Mangeron Boulevard No. 433, 700050 Iasi, Romania
| | - Carmen Cumpat
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Department of Management, Alexandru Ioan Cuza University, Carol I Boulevard, 700506 Iasi, Romania
| | - Viviana Aursulesei Onofrei
- Department of Medical Specialties (I and III) and Surgical Specialties, Grigore T. Popa University of Medicine and Pharmacy, University Street No. 16, 700115 Iaşi, Romania
- St. Spiridon Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Mihai Lucian Zabara
- Department of Medical Specialties (I and III) and Surgical Specialties, Grigore T. Popa University of Medicine and Pharmacy, University Street No. 16, 700115 Iaşi, Romania
| | - Alexandru Burlacu
- Department of Medical Specialties (I and III) and Surgical Specialties, Grigore T. Popa University of Medicine and Pharmacy, University Street No. 16, 700115 Iaşi, Romania
- Institute of Cardiovascular Diseases George I.M. Georgescu, 700503 Iasi, Romania
| | - Radu Crisan Dabija
- Department of Medical Specialties (I and III) and Surgical Specialties, Grigore T. Popa University of Medicine and Pharmacy, University Street No. 16, 700115 Iaşi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street no 30, 700115 Iasi, Romania
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Schaberg T, Brinkmann F, Feiterna-Sperling C, Geerdes-Fenge H, Hartmann P, Häcker B, Hauer B, Haas W, Heyckendorf J, Lange C, Maurer FP, Nienhaus A, Otto-Knapp R, Priwitzer M, Richter E, Salzer HJ, Schoch O, Schönfeld N, Stahlmann R, Bauer T. Tuberkulose im Erwachsenenalter. Pneumologie 2022; 76:727-819. [DOI: 10.1055/a-1934-8303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ZusammenfassungDie Tuberkulose ist in Deutschland eine seltene, überwiegend gut behandelbare Erkrankung. Weltweit ist sie eine der häufigsten Infektionserkrankungen mit ca. 10 Millionen Neuerkrankungen/Jahr. Auch bei einer niedrigen Inzidenz in Deutschland bleibt Tuberkulose insbesondere aufgrund der internationalen Entwicklungen und Migrationsbewegungen eine wichtige Differenzialdiagnose. In Deutschland besteht, aufgrund der niedrigen Prävalenz der Erkrankung und der damit verbundenen abnehmenden klinischen Erfahrung, ein Informationsbedarf zu allen Aspekten der Tuberkulose und ihrer Kontrolle. Diese Leitlinie umfasst die mikrobiologische Diagnostik, die Grundprinzipien der Standardtherapie, die Behandlung verschiedener Organmanifestationen, den Umgang mit typischen unerwünschten Arzneimittelwirkungen, die Besonderheiten in der Diagnostik und Therapie resistenter Tuberkulose sowie die Behandlung bei TB-HIV-Koinfektion. Sie geht darüber hinaus auf Versorgungsaspekte und gesetzliche Regelungen wie auch auf die Diagnosestellung und präventive Therapie einer latenten tuberkulösen Infektion ein. Es wird ausgeführt, wann es der Behandlung durch spezialisierte Zentren bedarf.Die Aktualisierung der S2k-Leitlinie „Tuberkulose im Erwachsenenalter“ soll allen in der Tuberkuloseversorgung Tätigen als Richtschnur für die Prävention, die Diagnose und die Therapie der Tuberkulose dienen und helfen, den heutigen Herausforderungen im Umgang mit Tuberkulose in Deutschland gewachsen zu sein.
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Affiliation(s)
- Tom Schaberg
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | - Folke Brinkmann
- Abteilung für pädiatrische Pneumologie/CF-Zentrum, Universitätskinderklinik der Ruhr-Universität Bochum, Bochum
| | - Cornelia Feiterna-Sperling
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin
| | | | - Pia Hartmann
- Labor Dr. Wisplinghoff Köln, Klinische Infektiologie, Köln
- Department für Klinische Infektiologie, St. Vinzenz-Hospital, Köln
| | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | - Jan Heyckendorf
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Christoph Lange
- Klinische Infektiologie, Forschungszentrum Borstel
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Hamburg-Lübeck-Borstel-Riems
- Respiratory Medicine and International Health, Universität zu Lübeck, Lübeck
- Baylor College of Medicine and Texas Childrenʼs Hospital, Global TB Program, Houston, TX, USA
| | - Florian P. Maurer
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Borstel
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Albert Nienhaus
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg
| | - Ralf Otto-Knapp
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | | | | | | | - Ralf Stahlmann
- Institut für klinische Pharmakologie und Toxikologie, Charité Universitätsmedizin, Berlin
| | - Torsten Bauer
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
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11
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Head-to-head comparison of the diagnostic value of five tests for constrictive tuberculous pericarditis. Int J Infect Dis 2022; 120:25-32. [DOI: 10.1016/j.ijid.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/20/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022] Open
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12
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Armstrong SM, Thavendiranathan P, Butany J. The pericardium and its diseases. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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13
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Fang L, Yu G, Ye B, Zhong F, Chen G. The optimal duration of anti-tuberculous therapy before pericardiectomy in constrictive tuberculous pericarditis. J Cardiothorac Surg 2021; 16:313. [PMID: 34702309 PMCID: PMC8549194 DOI: 10.1186/s13019-021-01691-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/09/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It is unclear about the duration of anti-tuberculous therapy before pericardiectomy (DATT) in the patients with constrictive tuberculous pericarditis. This study aims to explore the optimal DATT and its impact on surgical outcomes in these patients. METHODS We retrospectively enrolled 93 patients with constrictive tuberculous pericarditis undergoing pericardiectomy and divided them into two groups according to the optimal cutoff value of DATT which was determined by the receiver operating characteristic (ROC) curve and Youden Index. Postoperative and survival outcomes were compared between the two groups. RESULTS The optimal cutoff value of DATT was 1.05 (months). The enrolled patients were divided into the DATT ≤ 1.05 group and the DATT > 1.05 group, with 24 (25.8%) and 69 (74.2%) cases, respectively. Comparing with the DATT ≤ 1.05 group, the DATT > 1.05 group had shorter postoperative ICU stay (P = 0.023), duration of chest drainage (P = 0.002), postoperative hospital stay (P = 0.001) and lower incidence of postoperative complications (P < 0.001). There were no statistical differences between the two groups in recurrence and survival outcomes. CONCLUSIONS It would be of potential benefit to enhance recovery after pericardiectomy if DATT lasted for at least 1 month in the patients with constrictive tuberculous pericarditis.
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Affiliation(s)
- Likui Fang
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, China
| | - Guocan Yu
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, China
| | - Bo Ye
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, China
| | - Fangming Zhong
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, China
| | - Gang Chen
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, China.
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14
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Yu G, Zhong F, Shen Y, Zheng H. Diagnostic accuracy of the Xpert MTB/RIF assay for tuberculous pericarditis: A systematic review and meta-analysis. PLoS One 2021; 16:e0257220. [PMID: 34506587 PMCID: PMC8432788 DOI: 10.1371/journal.pone.0257220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/18/2021] [Indexed: 02/01/2023] Open
Abstract
Objective The purpose of this study was to evaluate the diagnostic efficacy of Xpert MTB/RIF for tuberculous pericarditis (TBP). Methods We searched relevant databases for Xpert MTB/RIF for TBP diagnosis until April 2021 and screened eligible studies for study inclusion. We evaluated the effectiveness of Xpert MTB/RIF when the composite reference standard (CRS) and mycobacterial culture were the gold standards, respectively. We performed meta-analyses using a bivariate random-effects model, and when the heterogeneity was obvious, the source of heterogeneity was further discussed. Results We included seven independent studies comparing Xpert MTB/RIF with the CRS and six studies comparing it with culture. The pooled sensitivity, specificity, and area under the curve of Xpert MTB/RIF were 65% (95% confidence interval, 59–72%), 99% (97–100%), and 0.99 (0.97–0.99) as compared with the CRS, respectively, and 75% (53–88%), 99% (90–100%), and 0.94 (0.92–0.96) as compared with culture, respectively. There was no significant heterogeneity between studies when CRS was the gold standard, whereas heterogeneity was evident when culture was the gold standard. Conclusions The sensitivity of Xpert MTB/RIF for diagnosing TBP was moderate and the specificity was good; thus, Xpert MTB/RIF can be used in the initial diagnosis of TBP.
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Affiliation(s)
- Guocan Yu
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, China
| | - Fangming Zhong
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, China
| | - Yanqin Shen
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, China
| | - Hong Zheng
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, China
- * E-mail:
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15
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Yu G, Zhong F, Shen Y, Zheng H. Diagnostic accuracy of the Xpert MTB/RIF assay for tuberculous pericarditis: A protocol of systematic review and meta-analysis. PLoS One 2021; 16:e0252109. [PMID: 34038477 PMCID: PMC8153464 DOI: 10.1371/journal.pone.0252109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 04/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Tuberculous pericarditis (TBP) can lead to serious consequences. Early diagnosis and treatment are very important for TBP, but early diagnosis is still very challenging. This study aims to evaluate the diagnostic accuracy of Xpert MTB/RIF for TBP using meta-analysis method. METHODS We will search Embase, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and the Wanfang database for researches assessing the diagnostic accuracy of Xpert MTB/RIF for TBP until April 2021. Any types of study design with full text will be selected and included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool will be used to assess the risk of bias. We will use version 15.0 of the STATA software with the midas command packages to carry out meta-analyses. RESULTS Evidence for diagnostic accuracy of Xpert MTB/RIF for TBP will be provided through the study, and this protocol will be submitted to a peer-reviewed journal for publication. CONCLUSION This study will provide evidence of Xpert MTB/RIF for TBP.
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Affiliation(s)
- Guocan Yu
- Department of Thoracic Surgery, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Zhejiang, China
| | - Fangming Zhong
- Department of Thoracic Surgery, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Zhejiang, China
| | - Yanqin Shen
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Zhejiang, China
| | - Hong Zheng
- Department of Thoracic Surgery, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Zhejiang, China
- * E-mail:
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16
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López-López JP, Posada-Martínez EL, Saldarriaga C, Wyss F, Ponte-Negretti CI, Alexander B, Miranda-Arboleda AF, Martínez-Sellés M, Baranchuk A. Tuberculosis and the Heart. J Am Heart Assoc 2021; 10:e019435. [PMID: 33733808 PMCID: PMC8174360 DOI: 10.1161/jaha.120.019435] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Acquired tuberculosis continues to be a challenge worldwide. Although tuberculosis has been considered a global public health emergency, it remains poorly controlled in many countries. Despite being primarily a pulmonary disease, tuberculosis could involve the heart. This systematic review is part of the "Neglected Tropical Diseases and Other Infectious Diseases Involving the Heart" (the NET-Heart Project) initiative from the Interamerican Society of Cardiology. This project aims to review the cardiovascular involvement of these heterogeneous diseases, advancing original algorithms to help healthcare providers diagnose and manage cardiovascular complications. In tuberculosis, pericardium involvement is relatively common, especially in AIDS, and tuberculosis is the most common cause of constrictive pericarditis in endemic countries. Myocarditis and aortitis by tuberculosis are rare. Clinical manifestations of cardiovascular involvement by tuberculosis differ from those typically found for bacteria or viruses. Prevailing systemic symptoms and the pericarditis diagnostic index should be taken into account. An echocardiogram is the first step for diagnosing cardiovascular involvement; however, several image modalities can be used, depending on the suspected site of infection. Adenosine deaminase levels, gamma interferon, or polymerase chain reaction testing could be used to confirm tuberculosis infection; each has a high diagnostic performance. Antituberculosis chemotherapy and corticosteroids are treatment mainstays that significantly reduce mortality, constriction, and hospitalizations, especially in patients with HIV. In conclusion, tuberculosis cardiac involvement is frequent and could lead to heart failure, constrictive pericarditis, or death. Early detection of complications should be a cornerstone of overall management.
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Affiliation(s)
- José Patricio López-López
- Department of Medicine Fundación Oftalmológica de Santander (FOSCAL) Bucaramanga Colombia.,Instituto de Investigaciones Masira Universidad de Santander (UDES) Bucaramanga Colombia
| | | | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic Clínica Cardiovascular Santa MariaUniversidad of Antioquia Medellín Colombia
| | - Fernando Wyss
- Technology and Cardiovascular Service of Guatemala - Cardiosolutions Guatemala City Guatemala
| | | | - Bryce Alexander
- Division of Cardiology Kingston Health Science CenterQueen's University Kingston Canada
| | | | - Manuel Martínez-Sellés
- Servicio de Cardiología Hospital Universitario Gregorio MarañónCIBERCVUniversidad EuropeaUniversidad Complutense Madrid Spain
| | - Adrian Baranchuk
- Division of Cardiology Kingston Health Science CenterQueen's University Kingston Canada
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Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- . Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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18
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Huang YS, Zhang JX, Sun Y. Chronic massive pericardial effusion: a case report and literature review. J Int Med Res 2020; 48:300060520973091. [PMID: 33233991 PMCID: PMC7705390 DOI: 10.1177/0300060520973091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic massive pericardial effusion without cardiac tamponade is relatively rare. Nearly half of all patients with chronic large pericardial effusion are asymptomatic. We report a case of a 77-year-old man who presented with an asymptomatic chronic massive pericardial effusion, with no evidence of cardiac tamponade or pericardial constriction during a 10-year follow-up. The patient had a complex history of lymph node tuberculosis, hypertension, hypothyroidism, and polycythemia vera, as well as high-dose 31P radiation exposure 45 years ago. There was no evidence of tuberculosis infection, hypothyroidism, malignant tumor, severe heart failure, uremia, trauma, severe bacterial or fungal infection, chronic myeloid leukemia, or bone marrow fibrosis after admission. The patient underwent pericardiocentesis twice. The pericardial effusion comprised exudate fluid with a high proportion of monocytes. The patient refused indwelling catheter drainage or pericardiectomy. The likely final diagnosis was recurrent chronic large idiopathic pericardial effusion.
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Affiliation(s)
- Ying-Shuo Huang
- Department of Research Ward, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jian-Xiong Zhang
- Department of Research Ward, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ying Sun
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Hajsadeghi S, Iranpour A, Kalantari S, Dashti F. A rare manifestation of extrapulmonary tuberculosis: left ventricular cardiac tuberculoma in an HIV infected male "case report". Cardiovasc Diagn Ther 2020; 10:1341-1344. [PMID: 33224758 DOI: 10.21037/cdt-20-446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac tuberculosis (TB) is rare and most commonly manifests itself as tuberculous pericarditis. Involvement of other parts of the heart is unusual and descriptions in the literature are confined to case reports regarding mainly pericardial TB and very few cases of cardiac tuberculoma. Tuberculomas are space occupying lesions most commonly found in the brain of immunocompromised individuals. These space occupying lesions previously described only after autopsies are now more diagnosed with the use of advanced imaging techniques. Herein, we describe a first case of pericardial TB manifesting as left ventricular (LV) cardiac tuberculoma in a 34-year-old human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infected male. Upon presentation the patient complained mainly of progressive dyspnoea over the past month. Primary investigations including chest computed tomography (CT) scan and transthoracic echocardiography (TTE) suggested probable diagnosis of cardiac and pericardial TB which was later confirmed by histopathological modalities. The patient received anti-TB therapy along with surgical subtotal pericardiotomy which resulted in improvement of symptoms, complete resolution of the mass and reduction in the size of pericardial thickening. Although very rare it is crucial to bear in mind the importance of having cardiac tuberculoma as differential diagnosis in patients with a cardiac mass and implement the optimum diagnostic and therapeutic courses.
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Affiliation(s)
- Shokoufeh Hajsadeghi
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Aida Iranpour
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Kalantari
- Research Center for Antimicrobial Resistance, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Dashti
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
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Kushwaha S, Bogoch II, Mak S, Rogalla P, Detsky AS. In the Absence of Proof. N Engl J Med 2020; 383:1878-1884. [PMID: 33211934 DOI: 10.1056/nejmcps2002083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sameer Kushwaha
- From the Department of Medicine (S.K., I.I.B., S.M., A.S.D.), the Joint Department of Medical Imaging (P.R.), and the Institute for Health Policy, Management, and Evaluation (A.S.D.), University of Toronto, and the Department of Medicine, Mount Sinai Hospital and University Health Network (I.I.B., S.M., A.S.D.), Toronto
| | - Isaac I Bogoch
- From the Department of Medicine (S.K., I.I.B., S.M., A.S.D.), the Joint Department of Medical Imaging (P.R.), and the Institute for Health Policy, Management, and Evaluation (A.S.D.), University of Toronto, and the Department of Medicine, Mount Sinai Hospital and University Health Network (I.I.B., S.M., A.S.D.), Toronto
| | - Susanna Mak
- From the Department of Medicine (S.K., I.I.B., S.M., A.S.D.), the Joint Department of Medical Imaging (P.R.), and the Institute for Health Policy, Management, and Evaluation (A.S.D.), University of Toronto, and the Department of Medicine, Mount Sinai Hospital and University Health Network (I.I.B., S.M., A.S.D.), Toronto
| | - Patrik Rogalla
- From the Department of Medicine (S.K., I.I.B., S.M., A.S.D.), the Joint Department of Medical Imaging (P.R.), and the Institute for Health Policy, Management, and Evaluation (A.S.D.), University of Toronto, and the Department of Medicine, Mount Sinai Hospital and University Health Network (I.I.B., S.M., A.S.D.), Toronto
| | - Allan S Detsky
- From the Department of Medicine (S.K., I.I.B., S.M., A.S.D.), the Joint Department of Medical Imaging (P.R.), and the Institute for Health Policy, Management, and Evaluation (A.S.D.), University of Toronto, and the Department of Medicine, Mount Sinai Hospital and University Health Network (I.I.B., S.M., A.S.D.), Toronto
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21
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Diagnostic values of Xpert MTB/RIF, T-SPOT.TB and adenosine deaminase for HIV-negative tuberculous pericarditis in a high burden setting: a prospective observational study. Sci Rep 2020; 10:16325. [PMID: 33004934 PMCID: PMC7530650 DOI: 10.1038/s41598-020-73220-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
The diagnosis of tuberculous pericarditis (TBP) remains challenging. This prospective study evaluated the diagnostic value of Xpert MTB/RIF (Xpert) and T-SPOT.TB and adenosine deaminase (ADA) for TBP in a high burden setting. A total of 123 HIV-negative patients with suspected TBP were enrolled at a tertiary referral hospital in China. Pericardial fluids were collected and subjected to the three rapid tests, and the results were compared with the final confirmed diagnosis. Of 105 patients in the final analysis, 39 (37.1%) were microbiologically, histopathologically or clinically diagnosed with TBP. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio (DOR) for Xpert were 66.7%, 98.5%, 96.3%, 83.3%, 44.0, 0.338, and 130.0, respectively, compared to 92.3%, 87.9%, 81.8%, 95.1%, 7.6, 0.088, and 87.0, respectively, for T-SPOT.TB, and 82.1%, 92.4%, 86.5%, 89.7%, 10.8, 0.194, and 55.8, respectively, for ADA (≥ 40 U/L). ROC curve analysis revealed a cut-off point of 48.5 spot-forming cells per million pericardial effusion mononuclear cells for T-SPOT.TB, which had a DOR value of 183.8, while a cut-off point of 41.5 U/L for ADA had a DOR value of 70.9. Xpert (Step 1: rule-in) followed by T-SPOT.TB [cut-off point] (Step 2: rule-out) showed the highest DOR value of 252.0, with only 5.7% (6/105) of patients misdiagnosed. The two-step algorithm consisting of Xpert and T-SPOT.TB could offer rapid and accurate diagnosis of TBP.
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Barua S, Phua B, Orr Y, Skinner M. Bulky granulomatous disease resulting in constrictive tuberculous pericarditis requiring pericardiectomy: a case report. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33204984 PMCID: PMC7649499 DOI: 10.1093/ehjcr/ytaa208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/17/2020] [Accepted: 06/05/2020] [Indexed: 11/24/2022]
Abstract
Background We present a 23-year-old Nepalese migrant with mycobacterial tuberculosis (TB) pericarditis manifesting as effusive constrictive disease and subsequent rapid progression to constrictive pericarditis resulting from bulky granulomatous disease. Case summary Following initial presumptive diagnosis of TB pericarditis based on presence of moderate pericardial effusion and positive polymerase chain reaction on concurrent pleural aspirate, the patient was managed with standard empiric therapy. Despite treatment, he developed progressive heart failure with New York Heart Association (NYHA) class III symptoms and had confirmation of constrictive physiology on simultaneous left and right heart catheterization. He underwent pericardiectomy 4 months after his initial diagnosis, with debridement of large necrotizing granulomas and an associated immediate improvement clinical improvement. He remains well at 6-month follow-up with no residual heart failure symptoms off diuretic therapy. Discussion Tuberculous pericarditis accounts for 1–2% of presentations with TB infection, with progression to constrictive pericarditis in between 17 and 40% of cases. To date, pericardiectomy remains mainstay of treatment for constriction, albeit with high perioperative risk. In combination with anti-tuberculous therapy, prednisone and pericardiocentesis may reduce risk of progression to constriction, however, neither have shown mortality benefit. Our patient continued to progress, despite medical therapy and proceeded to pericardiectomy only 4 months after his initial diagnosis, with rapid improvement in symptoms, demonstrating the importance of close monitoring and revision of management strategy in these patients.
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Affiliation(s)
- Sumita Barua
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead NSW 2145, Australia
- Faculty of Medicine, University of New South Wales, UNSW Sydney, NSW 2052, Australia
| | - Bernadette Phua
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead NSW 2145, Australia
| | - Yishay Orr
- Department of Cardiothoracics, Westmead Hospital, Hawkesbury Road, Westmead NSW 2145, Australia
| | - Michael Skinner
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead NSW 2145, Australia
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Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis. J Cardiothorac Surg 2020; 15:148. [PMID: 32560663 PMCID: PMC7304169 DOI: 10.1186/s13019-020-01198-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/15/2020] [Indexed: 12/28/2022] Open
Abstract
Background The risk factors of postoperative outcomes after pericardiectomy in tuberculous constrictive pericarditis have still been unclear. This study aimed to investigate the predictors of postoperative complication and prolonged intensive care unit (ICU) stay in the patients with tuberculous constrictive pericarditis undergoing pericardiectomy. Methods A total of 88 patients with tuberculous constrictive pericarditis undergoing pericardiectomy were retrospectively enrolled. Logistic regression and Cox regression analysis were performed to identify the predictors of postoperative complication and prolonged ICU stay, respectively. Results All patients underwent complete pericardiectomy and 35 (39.8%) had postoperative complication with no mortality within 30 days after surgery and no in-hospital deaths. Postoperative complication prolonged postoperative ICU stay (P < 0.001), duration of chest drainage (P < 0.001) and postoperative hospital stay (P < 0.001). Preoperative NYHA functional class (P = 0.004, OR 4.051, 95%CI 1.558–10.533) and preoperative central venous pressure (CVP) (P = 0.031, OR 1.151, 95%CI 1.013–1.309) were independent risk factors of postoperative complication. Postoperative complication (P < 0.001, HR 4.132, 95%CI 2.217–7.692) was the independent risk factor for prolonged ICU stay. Conclusion Complete pericardiectomy was associated with high risk of postoperative complication in tuberculous constrictive pericarditis. Poor preoperative NYHA functional class and high preoperative CVP were shown to predict postoperative complication which was the predictor of prolonged ICU stay.
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Swaminathan A, du Cros P, Achar J, Kliescikova J, Mirgayosieva S, Pirmahmadzoda B. A case report of a child with probable drug resistant tuberculous pericarditis with a review of challenges involved in diagnosis, treatment and follow up of children with DR-TB pericarditis. BMC Infect Dis 2020; 20:298. [PMID: 32321429 PMCID: PMC7178721 DOI: 10.1186/s12879-020-05027-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 04/12/2020] [Indexed: 01/23/2023] Open
Abstract
Background There are unique challenges in the diagnosis and management of multi drug resistant tuberculosis (MDR-TB) in children. It is difficult to obtain confirmatory microbiological diagnosis in TB pericarditis. It is essential to differentiate between drug sensitive and drug resistant forms of TB as it has a major bearing on the regimen used, and inappropriate TB treatment combined with steroid use for pericarditis can lead to deterioration. With lack of samples, the treatment decision relies on the drug resistance pattern of the close contact if available. Therapeutic challenges of MDR-TB management in a child involve use of toxic drugs that need to be judiciously handled. We report a 2 years 4 months old male child who was diagnosed with TB pericarditis and treated based on the resistance pattern of his mother who was on treatment for pulmonary MDR-TB. Case presentation This 2 years 4 months old male child was diagnosed with TB involving his pericardium. Getting him started on an appropriate regimen was delayed due to the difficulty in establishing microbiological confirmation and drug susceptibility. He was commenced on a regimen based on his mother’s drug resistance pattern and required surgery due to cardiac failure during the course of his treatment. He successfully completed 2 years of therapy. Conclusions This child’s case demonstrates that despite unique challenges in diagnosis and management of drug resistant extra pulmonary tuberculosis in children, treatment of even complex forms can be successful. The need for high suspicion of MDR-TB, especially when there is close contact with pulmonary TB, careful design of an effective regimen that is tolerated by the child, indications for invasive surgical management of pericarditis, appropriate follow-up and management of adverse effects are emphasised.
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Affiliation(s)
- Aravind Swaminathan
- Médecins Sans Frontières (MSF), Dushanbe, Tajikistan. .,Clinical Fellow, Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK.
| | | | - Jay Achar
- Médecins Sans Frontières (MSF), Manson Unit, London, UK
| | | | | | - Bobojon Pirmahmadzoda
- National Tuberculosis Programme, Ministry of Health and Social Protection of the Republic of Tajikistan, Dushanbe, Tajikistan
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Naicker K, Ntsekhe M. Tuberculous pericardial disease: a focused update on diagnosis, therapy and prevention of complications. Cardiovasc Diagn Ther 2020; 10:289-295. [PMID: 32420111 DOI: 10.21037/cdt.2019.09.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tuberculous pericarditis (TBP) is the most important manifestation of tuberculous heart disease and is still associated with a significant morbidity and mortality in TB endemic areas. The high prevalence of the disorder over the last 3 decades has been fueled by the human immunodeficiency virus/AIDS (HIV/AIDS) pandemic in these areas. The objective of this review is to provide a focused update on developments in the diagnosis and therapy of this condition, prevention of its complications, as well as future novel therapies. The definitive diagnosis of a tuberculous etiology in patients with suspected TBP continues to pose a challenge for clinicians. Clinical prediction scores, although never formally validated have been used with some success. However, they may be prone to both over and underdiagnosis due to lack of pericardial fluid analysis. Recent studies evaluating Xpert MTB/RIF, suggest that this advanced polymerase chain reaction (PCR) based technology does not provide increased accuracy compared to earlier iterations. However a combined two test approach starting with Xpert MTB/RIF followed by either adenosine deaminase (ADA) or interferon gamma (IFN-γ) may provide for significantly enhanced specificity and sensitivity cost permitting. Pericardiocentesis remains the gold standard for managing the compressive pericardial fluid and its adverse hemodynamic sequelae. A four drug anti-TB drug regimen at standard doses and duration is recommended. However recent evidence suggests that these drugs penetrate the pericardium very poorly potentially explaining the high mortality observed particularly in those who are culture positive with a high bacillary load. Constrictive pericarditis is the main long-term complication of TBP and is still a significant cause of heart failure in Sub-Saharan Africa. This is important because access to definitive surgical therapy where TBP is prevalent continues to be low, highlighting the need to develop strategies or interventions to prevent fibrosis and constriction. Recent detailed advanced studies of pericardial fluid in TBP have revealed a strong profibrotic transcriptomic profile, with high amounts of pro-inflammatory cytokines and low levels of the anti-fibrotic tetrapeptide N-Acetyl-Seryl-Aspartyl-Lysyl-Proline (Ac-SDKP). These new insights may explain in part the high propensity to fibrosis associated with the condition and offer hope for the future use of targeted therapy to interrupt pathways and mediators of tissue damage and subsequent maladaptive healing and fibrosis. The value of effective pericardiocentesis in reducing these pro-inflammatory and pro-fibrotic cytokines and peptides in an attempt to prevent pericardial constriction has yet to be established but has generated hypotheses for ongoing and future research.
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Affiliation(s)
- Kishendree Naicker
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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Howlett P, Du Bruyn E, Morrison H, Godsent IC, Wilkinson KA, Ntsekhe M, Wilkinson RJ. The immunopathogenesis of tuberculous pericarditis. Microbes Infect 2020; 22:172-181. [PMID: 32092538 DOI: 10.1016/j.micinf.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
Tuberculous pericarditis is a severe form of extrapulmonary tuberculosis and is the commonest cause of pericardial effusion in high incidence settings. Mortality ranges between 8 and 34%, and it is the leading cause of pericardial constriction in Africa and Asia. Current understanding of the disease is based on models derived from studies performed in the 1940-50s. This review summarises recent advances in the histology, microbiology and immunology of tuberculous pericarditis, with special focus on the effect of Human Immunodeficiency Virus (HIV) and the determinants of constriction.
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Affiliation(s)
- Patrick Howlett
- National Heart & Lung Institute, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY, United Kingdom; Department of Medicine, University of Cape Town, Observatory 7925, South Africa.
| | - Elsa Du Bruyn
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
| | - Hazel Morrison
- The Jenner Institute, University of Oxford, Old Road Campus Research Build, Roosevelt Dr, Oxford OX3 7DQ, United Kingdom
| | - Isiguzo C Godsent
- National Heart & Lung Institute, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY, United Kingdom; Department of Medicine, Federal Teaching Hospital Abakaliki, Nigeria
| | - Katalin A Wilkinson
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa; Francis Crick Institute, 1 Midland Rd, London NW1 1AT, United Kingdom
| | - Mpiko Ntsekhe
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
| | - Robert J Wilkinson
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa; Francis Crick Institute, 1 Midland Rd, London NW1 1AT, United Kingdom; Department of Infectious Diseases, Imperial College London, W2 1PG, United Kingdom
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Abstract
PURPOSE OF REVIEW This review provides an update on the immunopathogenesis of tuberculous pericarditis (TBP), investigations to confirm tuberculous etiology, the limitations of anti-tuberculous therapy (ATT), and recent efficacy trials. RECENT FINDINGS A profibrotic immune response characterizes TBP, with low levels of AcSDKP, high levels of γ-interferon and IL-10 in the pericardium, and high levels of TGF-β and IL-10 in the blood. These findings may have implications for future therapeutic targets. Despite advances in nucleic acid amplification approaches, these tests remain disappointing for TBP. Trials of corticosteroids and colchicine have had mixed results, with no impact on mortality, evidence of a reduction in rates of constrictive pericarditis and potential harm in those with advanced HIV. Small studies suggest that ATT penetrates the pericardium poorly. Given that there is a close association between high bacillary burden and mortality, a rethink about the optimal drug doses and duration may be required. The high mortality and morbidity from TBP despite use of anti-tuberculous drugs call for researches targeting host-directed immunological determinants of treatment outcome. There is also a need for the identification of steps in clinical management where interventions are needed to improve outcomes.
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Affiliation(s)
- Godsent Isiguzo
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Federal Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Elsa Du Bruyn
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, 7925 Republic of South Africa
| | - Patrick Howlett
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, 7925 Republic of South Africa
- Department of Medicine, Imperial College, Kensington, London, SW7 2DD UK
| | - Mpiko Ntsekhe
- Division of Cardiology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town South Africa, Cape Town, South Africa
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Lima NDA, Stancic C, Vos D, Carmen Diaz Insua MMD, Lima CCDV, de Castro RL, Maravelas R, Melgar TA. Hospital admissions for tuberculous pericarditis in the United States 2002-2014. Int J Mycobacteriol 2019; 8:347-350. [PMID: 31793504 DOI: 10.4103/ijmy.ijmy_150_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Extra pulmonary manifestations of tuberculosis (TB) are rare in developed countries. TB is the main etiology of chronic pericarditis in developing countries, but it's epidemiology is not unknown in the United States. Methods This retrospective study used the Healthcare Utilization Projects/Nationwide Inpatient Sample (HCUPS/NIS) database from 2002-2014 to evaluate the characteristics, risk factors, trends over time and region of tuberculous pericarditis in the United States. Results The data during the study period consists of 100,790,900 discharges accounting for 482,872,274 weighted discharges. The data showed 744 weighted discharges with indication of both tuberculosis and pericarditis. A co-ocurrence of TB pericarditis and malignancy or chronic kidney disease was more common than in patients without TB pericarditis. The frequency of co-ocurrence of TB pericarditis and HIV infection, obesity, alcohol abuse and organ transplant was not elevated. Conclusion TB pericarditis is rare disease in the USA and the classical risk factors for lung tuberculosis may not be associated with TB pericarditis. CKD and malignancy appear to be associated with TB pericarditis, further studies are required to determine causality.
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Affiliation(s)
- Neiberg de Alcantara Lima
- Department of Internal Medicine, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Christopher Stancic
- Department of Internal Medicine, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Duncan Vos
- Statistics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | | | | | - Ricardo Lessa de Castro
- Department of Internal Medicine, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Rheanne Maravelas
- Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Thomas A Melgar
- Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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Mathiasen VD, Frederiksen CA, Wejse C, Poulsen SH. A clinical case of tuberculosis with transient constrictive pericarditis and perimyocarditis. Echo Res Pract 2019; 6:K7-K12. [PMID: 31413861 PMCID: PMC6689120 DOI: 10.1530/erp-19-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 12/30/2022] Open
Abstract
Tuberculous pericarditis is a rare diagnosis seen among as few as 1% of tuberculosis (TB) patients in developed countries. We present a case of a 60-year-old male suffering from a transient constrictive pericarditis and subclinical involvement of the myocardium in a clinical case of tuberculous pericarditis with corresponding improvement after the initiation of anti-tuberculous treatment. We suggest monitoring of myocardial function using global longitudinal strain by myocardial speckle tracking strain analysis as supplement to routine left ventricular ejection fraction to assess clinical improvement in patients at risk of developing constrictive pericarditis. LEARNING POINTS Tuberculous pericarditis is rare and a diagnostic challenge in low-incidence countries.Patients with tuberculosis and involvement of the heart are at high risk of developing constrictive pericarditis.Novel imaging techniques, such as estimation of global longitudinal strain using myocardial speckle tracking analysis, may be useful in assessing cardiac involvement in tuberculosis patients.
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Affiliation(s)
- V D Mathiasen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Kobenhavn, Denmark
| | - C A Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - C Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Center for Global Health, Aarhus University, Aarhus, Denmark
| | - S H Poulsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
A 65-year-old Vietnamese man with hypertension, type 2 diabetes mellitus, and chronic hepatitis B with cirrhosis presented with a 2-week history of shortness of breath at rest, orthopnea, and lower extremity edema. He reported a 4-month history of nonproductive cough, 5-kg weight loss, and fatigue. He immigrated to the United States as an adult more than 20 years before presentation. His temperature was 37°C, heart rate was 78/min, respiratory rate was 17/min, and blood pressure was 158/95 mm Hg. A chest radiographic image suggested cardiomegaly and a computed tomographic scan demonstrated a moderate to large pericardial effusion. A pericardial drain was placed and pericardial fluid was sent to the laboratory for evaluation. Initial pericardial fluid study results are presented in the Table. Empirical treatment for tuberculosis was initiated. Three days later, an adenosine deaminase (ADA) level of 118.1 U/L (normal range, 0.0-11.3 U/L) from pericardial fluid was reported from the laboratory.
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Affiliation(s)
- Edward Chau
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California
| | - Minoo Sarkarati
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California
| | - Brad Spellberg
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California
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Skripka AI, Buchneva AV, Vankhin VV, Lisyanskaya NV, Babyre VV, Senchikhin PV, Sokolova AA, Napalkov DA, Fomin VV. Clinical Case: Tuberculous Myopericarditis in the Cardiology Practice. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-5-691-698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A. I. Skripka
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. V. Buchneva
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - V. V. Vankhin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N. V. Lisyanskaya
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - V. V. Babyre
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - P. V. Senchikhin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. A. Sokolova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - D. A. Napalkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - V. V. Fomin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Schutz C, Davis AG, Sossen B, Lai RPJ, Ntsekhe M, Harley YXR, Wilkinson RJ. Corticosteroids as an adjunct to tuberculosis therapy. Expert Rev Respir Med 2018; 12:881-891. [PMID: 30138039 PMCID: PMC6293474 DOI: 10.1080/17476348.2018.1515628] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Inflammation, or the prolonged resolution of inflammation, contributes to death from tuberculosis. Interest in inflammatory mechanisms and the prospect of beneficial immune modulation as an adjunct to antibacterial therapy has revived and the concept of host directed therapies has been advanced. Such renewed attention has however, overlooked the experience of such therapy with corticosteroids. Areas covered: The authors conducted literature searches and evaluated randomized clinical trials, systematic reviews and current guidelines and summarize these findings. They found evidence of benefit in meningeal and pericardial tuberculosis in HIV-1 uninfected persons, but less so in those HIV-1 coinfected and evidence of harm in the form of opportunist malignancy in those not prescribed antiretroviral therapy. Adjunctive corticosteroids are however of benefit in the treatment and prevention of paradoxical HIV-tuberculosis immune reconstitution inflammatory syndrome. Expert commentary: Further high-quality clinical trials and experimental medicine studies are warranted and analysis of materials arising from such studies could illuminate ways to improve corticosteroid efficacy or identify novel pathways for more specific intervention.
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Affiliation(s)
- Charlotte Schutz
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Angharad G Davis
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
- The Francis Crick Institute, Midland Road, London, NW1 1AT, United Kingdom
- University College London, United Kingdom
| | - Bianca Sossen
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Rachel P-J Lai
- The Francis Crick Institute, Midland Road, London, NW1 1AT, United Kingdom
- Department of Medicine, Imperial College London W2 1PG, United Kingdom
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Yolande XR Harley
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory 7925, Republic of South Africa
- The Francis Crick Institute, Midland Road, London, NW1 1AT, United Kingdom
- University College London, United Kingdom
- Department of Medicine, Imperial College London W2 1PG, United Kingdom
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Ramasamy V, Mayosi BM, Sturrock ED, Ntsekhe M. Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis. World J Cardiol 2018; 10:87-96. [PMID: 30344956 PMCID: PMC6189073 DOI: 10.4330/wjc.v10.i9.87] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/06/2018] [Accepted: 04/22/2018] [Indexed: 02/06/2023] Open
Abstract
This review article aims to: (1) discern from the literature the immune and inflammatory processes occurring in the pericardium following injury; and (2) to delve into the molecular mechanisms which may play a role in the progression to constrictive pericarditis. Pericarditis arises as a result of a wide spectrum of pathologies of both infectious and non-infectious aetiology, which lead to various degrees of fibrogenesis. Current understanding of the sequence of molecular events leading to pathological manifestations of constrictive pericarditis is poor. The identification of key mechanisms and pathways common to most fibrotic events in the pericardium can aid in the design and development of novel interventions for the prevention and management of constriction. We have identified through this review various cellular events and signalling cascades which are likely to contribute to the pathological fibrotic phenotype. An initial classical pattern of inflammation arises as a result of insult to the pericardium and can exacerbate into an exaggerated or prolonged inflammatory state. Whilst the implication of major drivers of inflammation and fibrosis such as tumour necrosis factor and transforming growth factor β were foreseeable, the identification of pericardial deregulation of other mediators (basic fibroblast growth factor, galectin-3 and the tetrapeptide Ac-SDKP) provides important avenues for further research.
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Affiliation(s)
- Vinasha Ramasamy
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Integrative Biomedical Sciences, University of Cape Town, Observatory 7925, South Africa
| | - Bongani M Mayosi
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Division of Cardiology, University of Cape Town, Observatory 7925, South Africa
| | - Edward D Sturrock
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Integrative Biomedical Sciences, University of Cape Town, Observatory 7925, South Africa
| | - Mpiko Ntsekhe
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Division of Cardiology, University of Cape Town, Observatory 7925, South Africa
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A 63-Year-Old Man With Recurrent Dyspnea. Chest 2018; 154:e55-e59. [DOI: 10.1016/j.chest.2018.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/02/2017] [Accepted: 01/06/2018] [Indexed: 11/23/2022] Open
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Features of cardiovascular disease in low-income and middle-income countries in adults and children living with HIV. Curr Opin HIV AIDS 2018; 12:579-584. [PMID: 28799999 DOI: 10.1097/coh.0000000000000415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The current article addresses crucial issues in identifying risk of cardiovascular disease (CVD) in people living with HIV in low-income and middle-income countries (LMICs). These issues are in need of urgent attention to advance our knowledge and inform actions to mitigate CVD in this population. We address CVDs in adults living with HIV as well as the unique aspects pertaining to children living with HIV (CLHIV), a group sorely under-represented in this field. RECENT FINDINGS CVDs affecting adults such as hypertension, dyslipidemia, coronary artery disease, and heart failure, in addition to myocardial dysfunction, vascular diseases, and autoimmune phenomena are also being reported in CLHIV. In addition to the background disparity in prevalence of traditional CVD risk factors, it is also likely that differential access to antiretroviral treatment, the younger age of the HIV-infected population, and types of antiretroviral treatment commonly used in LMICs contribute to the observed differences. SUMMARY Overall, the state of evidence for CVD in LMICs is limited and at times contradictory. We summarize the evidence with suggestions for high priorities for further scientific investigation. Now is the crucial time to intervene in modifying CVD risk in LMICs.
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Liu C, Cui YL, Ding CM, Wu YH, Li HL, Liu XF, Hu ZD. Diagnostic accuracy of interferon-gamma in pericardial effusions for tuberculous pericarditis: a meta-analysis. J Thorac Dis 2018; 10:854-860. [PMID: 29607157 DOI: 10.21037/jtd.2017.12.107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background 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. Methods 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. Results 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. Conclusion Testing for interferon-gamma in cases of pericardial effusion is adequate for identifying or ruling out tuberculous pericarditis.
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Affiliation(s)
- Chao Liu
- Department of Blood Transfusion, General Hospital of Ji'nan Military Region of PLA, Ji'nan 250031, China
| | - Yun-Liang Cui
- Department of Critical Care Medicine, General Hospital of Ji'nan Military Region of PLA, Ji'nan 250031, China
| | - Chun-Mei Ding
- Department of Laboratory Medicine, General Hospital of Ji'nan Military Region of PLA, Ji'nan 250031, China
| | - Yan-Hua Wu
- Department of Laboratory Medicine, General Hospital of Ji'nan Military Region of PLA, Ji'nan 250031, China
| | - Hui-Li Li
- Department of Critical Care Medicine, General Hospital of Ji'nan Military Region of PLA, Ji'nan 250031, China
| | - Xiao-Fei Liu
- Department of Laboratory Medicine, General Hospital of Ji'nan Military Region of PLA, Ji'nan 250031, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, General Hospital of Ji'nan Military Region of PLA, Ji'nan 250031, China
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Yu G, Ye B, Chen D, Zhong F, Chen G, Yang J, Xu L, Xu X. Comparison between the diagnostic validities of Xpert MTB/RIF and interferon-γ release assays for tuberculous pericarditis using pericardial tissue. PLoS One 2017; 12:e0188704. [PMID: 29211755 PMCID: PMC5718425 DOI: 10.1371/journal.pone.0188704] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/10/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study aimed to assess the diagnostic performance of Xpert MTB/RIF for tuberculous pericarditis (TBP) using pericardial tissues. METHODS The study involved 30 patients admitted with suspected TBP from January-December 2016; three patients were later excluded. The interferon-γ release assay (T-SPOT.TB) and the Xpert MTB/RIF test were performed using peripheral blood and pericardial tissues, respectively. TBP was confirmed using pericardial histopathology and a composite reference standard (CRS). We analyzed the sensitivity, specificity, predictive value (PV), likelihood ratio (LR), and area under curve (AUC) of both assays. RESULTS Fourteen patients were confirmed as TBP, 10 as non-TBP, and 3 as probable TBP. The sensitivity, specificity, positive PV (PPV), negative PV (NPV), PLR, NLR, and AUC (95% confidence interval [CI]) of the Xpert MTB/RIF assay were 78.6% (49.2-95.3%) and 70.6% (44.0-89.7%); 92.3% (64.0-99.8%) and 100% (69.2-100%); 91.7% (61.5-99.8%) and 100% (73.5-100%); 80.0% (51.9-95.7%) and 66.7% (38.4-88.2%); 10.21 (1.52-68.49) and the PLR value was undefined with CRS as the reference; 0.23 (0.08-0.64) and 0.29(0.14-0.61); and 0.854 (0.666-0.959) and 0.853 (0.664-0.959), against histopathology and CRS, respectively. The sensitivity, specificity, PPV, NPV, PLR, NLR, and AUC values (95% CI) of T-SPOT.TB were 92.9% (66.1-99.8%) and 94.1% (71.3-99.9%); 15.4% (1.9-45.5%) and 20.0% (2.5-55.6%); 54.2% (32.8-74.5%) and 66.7% (44.7-84.4%); 66.7% (9.4-99.2%) and 66.7% (9.4-99.2%); 1.10 (0.83-1.44) and 1.18 (0.84-1.6); 0.46 (0.05-4.53) and 0.29 (0.03-2.85); and 0.541(0.340-0.733) and 0.571(0.367-0.758), against histopathology and CRS, respectively. The differences in sensitivity, PPV, and AUC of Xpert MTB/RIF and T-SPOT.TB were not statistically significant (P > 0.05), compared to those of histopathology and CRS. However, the differences in specificity and NPV of the two assays were significant (P < 0.05), compared to those of histopathology and CRS. CONCLUSIONS Xpert MTB/RIF test is a valid diagnostic technique for TBP with higher sensitivity and specificity than T-SPOT.TB.
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Affiliation(s)
- Guocan Yu
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Bo Ye
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Da Chen
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Fangming Zhong
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Gang Chen
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Jun Yang
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Liliang Xu
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Xudong Xu
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
- * E-mail:
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Wiysonge CS, Ntsekhe M, Thabane L, Volmink J, Majombozi D, Gumedze F, Pandie S, Mayosi BM. Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev 2017; 9:CD000526. [PMID: 28902412 PMCID: PMC5618454 DOI: 10.1002/14651858.cd000526.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tuberculous 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. OBJECTIVES To assess the effects of treatments for tuberculous pericarditis. SEARCH METHODS We 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 CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs. DATA COLLECTION AND ANALYSIS Two 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 RESULTS Seven 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' CONCLUSIONS For 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.
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Affiliation(s)
- Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Mpiko Ntsekhe
- Groote Schuur HospitalDivision of CardiologyObservatory 7925Cape TownSouth Africa
| | - Lehana Thabane
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics50 Charlton Ave ERoom H325, St. Joseph's HealthcareHamiltonONCanadaL8N 4A6
| | - Jimmy Volmink
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Dumisani Majombozi
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Freedom Gumedze
- University of Cape TownDepartment of Statistical SciencesCape TownSouth Africa
| | - Shaheen Pandie
- University of Cape TownDepartment of MedicineCape TownSouth Africa
| | - Bongani M Mayosi
- University of Cape TownDepartment of MedicineCape TownSouth Africa
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Ohsawa N, Nakaoka Y, Kubokawa SI, Kubo T, Yamasaki N, Kitaoka H, Kawai K, Hamashige N, Doi Y. Subacute effusive-constrictive pericarditis: Echocardiography-guided diagnosis and management. J Cardiol Cases 2017; 16:14-17. [PMID: 30279787 DOI: 10.1016/j.jccase.2017.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/03/2017] [Accepted: 03/14/2017] [Indexed: 12/28/2022] Open
Abstract
A 49-year-old man presented with flu-like symptoms of two weeks. Electrocardiogram showed diffuse ST elevation. Blood samples revealed severe renal failure and moderate inflammatory results. Echocardiogram showed large pericardial effusion, dilated inferior vena cava, but no right ventricular collapse. The patient underwent hemodialysis, after which he developed clinical signs of cardiac tamponade with echocardiographic features of collapse of the right ventricle. Pericardial drainage was then performed revealing purulent fluid of 800 ml. Streptococcus agalactiae was found in the cultures of urine, blood, and pericardial fluid. Despite removal of the pericardial fluid, echocardiogram failed to show any improvement in dilated inferior vena cava and estimated right atrial pressure remained elevated. Thus, a diagnosis of subacute effusive-constrictive pericarditis was made. Following antibiotic treatment for purulent pericarditis, early pericardiectomy was performed under transesophageal echocardiographic monitoring which successfully guided surgeons to careful removal of thick and adhesive visceral pericardium as well as an additional Waffle procedure resulting in significant clinical and hemodynamic improvement. Echo-guided approach is most practical in establishing the diagnosis of effusive-constrictive pericarditis and also most helpful in obtaining successful surgical results. <Learning objective: Diagnosis of effusive-constrictive pericarditis is difficult and is not often made because of mixtures of clinical findings associated with effusion/tamponade and constriction. Echo-guided approach is most practical in establishing the diagnosis by detecting absence of normalization in dilatation of the inferior vena cava after pericardial drainage. Also, since careful removal of visceral pericardium is mandatory, transesophageal echocardiographic monitoring during pericardiectomy plays an essential role in obtaining successful surgical results.>.
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Affiliation(s)
- Naoto Ohsawa
- The Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan.,Department of Cardiology and Aging Sciences, Kochi Medical School, Nankoku, Japan
| | - Yoko Nakaoka
- The Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Sho-Ichi Kubokawa
- The Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Aging Sciences, Kochi Medical School, Nankoku, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Aging Sciences, Kochi Medical School, Nankoku, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Sciences, Kochi Medical School, Nankoku, Japan
| | - Kazuya Kawai
- The Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Naohisa Hamashige
- The Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Yoshinori Doi
- The Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
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Abstract
Over the last 2 decades human immunodeficiency virus (HIV) infection has become a chronic disease requiring long-term management. Aging, antiretroviral therapy, chronic inflammation, and several other factors contribute to the increased risk of cardiovascular disease in patients infected with HIV. In low-income and middle-income countries where antiretroviral therapy access is limited, cardiac disease is most commonly related to opportunistic infections and end-stage manifestations of HIV/acquired immunodeficiency syndrome, including HIV-associated cardiomyopathy, pericarditis, and pulmonary arterial hypertension. Cardiovascular screening, prevention, and risk factor management are important factors in the management of patients infected with HIV worldwide.
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Affiliation(s)
- Gerald S Bloomfield
- Division of Cardiology, Duke Global Health Institute, Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC 27705, USA.
| | - Claudia Leung
- Feinberg School of Medicine, Northwestern University, 420 East Superior Street, Chicago, IL 60611, USA
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Abstract
Owing to the high prevalence of tuberculosis (TB) and human immunodeficiency virus/AIDS, tuberculous heart disease remains an important problem in TB endemic areas. In this review, we reiterate salient aspects of the traditional understanding and approach to its management, and provide important updates on the pathophysiology, diagnosis, and treatment garnered over the past decade of focused clinical and basic science research. We emphasize that, if implemented widely, these improved evidence-based approaches to the disease can build on the early progress made in treating tuberculous heart disease and help further the goal of significantly reducing its historically high morbidity and mortality.
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Affiliation(s)
- Arthur K Mutyaba
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, E17 Cardiac Clinic, New Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, E17 Cardiac Clinic, New Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa.
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Taponamiento cardiaco secundario a pericarditis tuberculosa aguda en un paciente joven, no asociado a inmunosupresión. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Liebenberg JJ, Dold CJ, Olivier LR. A prospective investigation into the effect of colchicine on tuberculous pericarditis. Cardiovasc J Afr 2017; 27:350-355. [PMID: 27965998 PMCID: PMC5412665 DOI: 10.5830/cvja-2016-035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/16/2016] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Tuberculous (TB) pericarditis carries significant mortality and morbidity rates, not only during the primary infection, but also as part of the granulomatous scar-forming fibrocalcific constrictive pericarditis so commonly associated with this disease. Numerous therapies have previously been investigated as adjuvant strategies in the prevention of pericardial constriction. Colchicine is well described in the treatment of various aetiologies of pericarditis. The aim of this research was to investigate the merit for the use of colchicine in the management of tuberculous pericarditis, specifically to prevent constrictive pericarditis. METHODS This pilot study was designed as a prospective, double-blinded, randomised, control cohort study and was conducted at a secondary level hospital in the Northern Cape of South Africa between August 2013 and December 2015. Patients with a probable or definite diagnosis of TB pericarditis were included (n = 33). Study participants with pericardial effusions amenable to pericardiocentesis underwent aspiration until dryness. All patients were treated with standard TB treatment and corticosteroids in accordance with the South African Tuberculosis Treatment Guidelines. Patients were randomised to an intervention and control group using a web-based computer system that ensured assignment concealment. The intervention group received colchicine 1.0 mg per day for six weeks and the control group received a placebo for the same period. Patients were followed up with serial echocardiography for 16 weeks. The primary outcome assessed was the development of pericardial constriction. Upon completion of the research period, the blinding was unveiled and data were presented for statistical analysis. RESULTS TB pericarditis was found exclusively in HIV-positive individuals. The incidence of pericardial constriction in our cohort was 23.8%. No demonstrable benefit with the use of colchicine was found in terms of prevention of pericardial constriction (p = 0.88, relative risk 1.07, 95% CI: 0.46-2.46). Interestingly, pericardiocentesis appeared to decrease the incidence of pericardial constriction. CONCLUSION Based on this research, the use of colchicine in TB pericarditis cannot be advised. Adjuvant therapy in the prevention of pericardial constriction is still being investigated and routine pericardiocentesis may prove to be beneficial in this regard.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Anti-Inflammatory Agents/therapeutic use
- Antitubercular Agents/therapeutic use
- Coinfection
- Colchicine/therapeutic use
- Double-Blind Method
- Echocardiography, Doppler, Color
- Echocardiography, Doppler, Pulsed
- Female
- HIV Infections/diagnosis
- HIV Infections/epidemiology
- Humans
- Incidence
- Male
- Pericardial Effusion/microbiology
- Pericardial Effusion/therapy
- Pericardiocentesis
- Pericarditis, Constrictive/diagnostic imaging
- Pericarditis, Constrictive/epidemiology
- Pericarditis, Constrictive/microbiology
- Pericarditis, Constrictive/prevention & control
- Pericarditis, Tuberculous/diagnostic imaging
- Pericarditis, Tuberculous/drug therapy
- Pericarditis, Tuberculous/epidemiology
- Pericarditis, Tuberculous/microbiology
- Pilot Projects
- Prospective Studies
- Risk Factors
- South Africa/epidemiology
- Time Factors
- Treatment Outcome
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Imazio M, Gaido L, Battaglia A, Gaita F. Contemporary management of pericardial effusion: practical aspects for clinical practice. Postgrad Med 2017; 129:178-186. [PMID: 28135875 DOI: 10.1080/00325481.2017.1285676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A pericardial effusion (PE) is a relatively common finding in clinical practice. It may be either isolated or associated with pericarditis with or without an underlying disease. The aetiology is varied and may be either infectious (especially tuberculosis as the most common cause in developing countries) or non-infectious (cancer, systemic inflammatory diseases). The management is essentially guided by the hemodynamic effect (presence or absence of cardiac tamponade), the presence of concomitant pericarditis or underlying disease, and its size and duration. The present paper reviews the current knowledge on the aetiology, classification, diagnosis, management, therapy, and prognosis of PE in clinical practice.
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Affiliation(s)
- Massimo Imazio
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Luca Gaido
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Alberto Battaglia
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Fiorenzo Gaita
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
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Gouriet F, Levy PY. Management of Pericardial Effusion. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lawal I, Sathekge M. F-18 FDG PET/CT imaging of cardiac and vascular inflammation and infection. Br Med Bull 2016; 120:55-74. [PMID: 27613996 DOI: 10.1093/bmb/ldw035] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Inflammation forms an important core of the aetiopathogenic process involved in many diseases affecting the heart and the blood vessels. These diseases include infections as well as inflammatory non-infectious cardiovascular conditions. The common feature of this is invasion of the heart or blood vessel by inflammatory cells. F-18 2-fluoro 2-deoxy-D glucose (FDG) is an analogue of glucose and like glucose it is taken up by activated inflammatory cells that accumulate at the site of infection. This has formed the basis of the use of F-18 FDG PET/CT in the non-invasive evaluation of human inflammatory diseases. SOURCES OF DATA This review is based on the published academic articles as well as our clinical experience. AREAS OF AGREEMENT F-18 FDG PET/CT is a useful imaging modality in the evaluation of cardiovascular inflammatory disorders. Accumulation and distribution of F-18 FDG at the site of inflammation/infection corresponds to severity of the inflammation/infection and extent of involvement. AREAS OF CONTROVERSY Most studies evaluating utility of F-18 FDG PET/CT in imaging cardiovascular inflammation are small observational studies hence are potentially prone to bias. GROWING POINTS Being a hybrid metabolic and morphologic imaging technique, F-18 FDG PET/CT offers combined advantage of complementary anatomic and metabolic information in disease process. This makes it a useful modality in the diagnosis, determination of extent of disease, prognostication as well as treatment monitoring. AREAS TIMELY FOR DEVELOPING RESEARCH Larger prospective studies are needed to validate the superiority of F-18 FDG PET/CT imaging over conventional anatomic imaging modalities.
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Affiliation(s)
- Ismaheel Lawal
- Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Private Bag X169, Pretoria 0001, South Africa
| | - Mike Sathekge
- Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Private Bag X169, Pretoria 0001, South Africa
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Fry DE. Extra-Pulmonary Tuberculosis and Its Surgical Treatment. Surg Infect (Larchmt) 2016; 17:394-401. [DOI: 10.1089/sur.2016.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Donald E. Fry
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and the Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
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49
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The Pericardium and Its Diseases. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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50
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Whitehall J, Sgarlata J, Edwards M, Bent G, Allgood C. A warning about tuberculosis. J Paediatr Child Health 2015; 51:1033-5. [PMID: 26040786 DOI: 10.1111/jpc.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- John Whitehall
- Paediatrics, University of Western Sydney, Sydney, New South Wales, Australia
| | - Julia Sgarlata
- Paediatrics, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Matthew Edwards
- Paediatrics, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Geoffery Bent
- Paediatrics, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Catherine Allgood
- Paediatrics, Campbelltown Hospital, Sydney, New South Wales, Australia
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