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Venuti L, Condemi A, Albano C, Boncori G, Garbo V, Bagarello S, Cascio A, Colomba C. Tuberculous Pericarditis in Childhood: A Case Report and a Systematic Literature Review. Pathogens 2024; 13:110. [PMID: 38392848 PMCID: PMC10892678 DOI: 10.3390/pathogens13020110] [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: 12/28/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Tuberculous pericarditis (TBP) is an important cause of pericarditis worldwide while being infrequent in childhood, especially in low-TB-incidence countries. We report a case of TBP and provide a systematic review of the literature, conducted by searching PubMed, Scopus, and Cochrane to find cases of TBP in pediatric age published in the English language between the year 1990 and the time of the search. Of the 587 search results obtained, after screening and a backward citation search, 45 studies were selected to be included in this review, accounting for a total of 125 patients. The main signs and symptoms were fever, cough, weight loss, hepatomegaly, dyspnea, and increased jugular venous pressure or jugular vein turgor. A definitive diagnosis of TBP was made in 36 patients, either thanks to microbiological investigations, histological analysis, or both. First-line antitubercular treatment (ATT) was administered in nearly all cases, and 69 children underwent surgical procedures. Only six patients died, and only two died of TBP. TBP in childhood is relatively uncommon, even in high-TB-prevalence countries. Clinical manifestations, often suggestive of right-sided cardiac failure, are subtle, and diagnosis is challenging. TBP has an excellent prognosis in childhood; however, in a significant proportion of cases, invasive surgical procedures are necessary.
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Affiliation(s)
- Laura Venuti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (A.C.); (C.A.); (G.B.); (V.G.); (S.B.); (C.C.)
| | - Anna Condemi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (A.C.); (C.A.); (G.B.); (V.G.); (S.B.); (C.C.)
| | - Chiara Albano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (A.C.); (C.A.); (G.B.); (V.G.); (S.B.); (C.C.)
| | - Giovanni Boncori
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (A.C.); (C.A.); (G.B.); (V.G.); (S.B.); (C.C.)
| | - Valeria Garbo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (A.C.); (C.A.); (G.B.); (V.G.); (S.B.); (C.C.)
| | - Sara Bagarello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (A.C.); (C.A.); (G.B.); (V.G.); (S.B.); (C.C.)
| | - Antonio Cascio
- Infectious and Tropical Disease Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy;
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (A.C.); (C.A.); (G.B.); (V.G.); (S.B.); (C.C.)
- Division of Paediatric Infectious Disease, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy
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Abstract
OBJECTIVES The primary objective of this study was to describe the frequency of the most common presenting signs and symptoms of pericardial effusions, particularly with relation to the size of the effusion. The secondary objective was to review the final etiology of the pericardial effusion in those patients who had presented to a tertiary care pediatric emergency department. METHODS This was a retrospective chart review of patients younger than 17 years who presented and were evaluated at the pediatric emergency department and subsequently diagnosed with a pericardial effusion during a period of 10 years. RESULTS A total of 23 patients matched the inclusion criteria. The most common symptom was shortness of breath (65%), followed by fever (52%), fatigue (44%), and chest pain (44%). Shortness of breath (60%) and chest pain (60%) were the most frequent symptoms among patients with a small pericardial effusion. Fever (86%), cough (71%), and shortness of breath (71%) were the most frequent symptoms among patients with moderate pericardial effusion. In patients with large pericardial effusions, the most frequent symptoms were shortness of breath (63%) and abdominal pain (63%). Tachycardia (52%) and tachypnea (52%) were the most common abnormal vital signs. The most common etiology was cardiac (44%) and autoimmune disease (26%). CONCLUSIONS This study suggests that the presence of certain symptoms should be associated with a high index of suspicion for pericardial effusion for the pediatric emergency care physician.
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Abstract
Despite the infectious and connective tissue diseases are most encountered, etiological factors, pericardial effusions, can also rarely emerge because of malign disease in childhood and it often develops during the course of chemotherapy and radiotherapy. Unfortunately, pericardial involvement is one of the frequently encountered symptoms of pediatric malignancies. Herein, we present a rare case who was admitted with pericardial effusion and whose disease was diagnosed as pre-T cell acute lymphoblastic leukemia without peripheral blood involvement.
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