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Zhang L, Yan H, Wang Y, Huang F. Case report: Sudden unexpected death due to tuberculous myocarditis involving sinus node at autopsy. Front Cardiovasc Med 2023; 10:1159292. [PMID: 37396574 PMCID: PMC10308008 DOI: 10.3389/fcvm.2023.1159292] [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] [Received: 02/05/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Tuberculous myocarditis (TM) is an extremely rare manifestation of Mycobacterium tuberculosis (TB) infection. Although TM is a critical cause of sudden cardiac death, only a few cases have been reported. We report the case of an older patient with pulmonary TB with a history of fever, chest tightness, paroxysmal palpitations, and electrocardiographic evidence of sinus node conduction abnormalities on admission. Although emergency physicians observed these unusual clinical manifestations, no timely differential diagnosis was made nor interventions were performed. A definitive diagnosis of TM and histopathological findings compatible with sinus node involvement were made based on autopsy outcomes. Herein, we describe the clinical presentation and pathological features of a rare form of Mycobacterium TB. In addition, we provide an overview of issues related to the diagnosis of myocardial TB.
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Affiliation(s)
- Le Zhang
- Forensic Science Center, Gannan Medical University, Ganzhou, China
| | - He Yan
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Yufang Wang
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Feijun Huang
- Department of Forensic Science, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
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2
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Patil SV, Toshniwal S, Acharya A, Gondhali G. Cardiac dysfunction in active pulmonary tuberculosis: Mysterious facts of TB’s pandora. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
<b>Introduction</b>: Cardiac dysfunction in pulmonary tuberculosis is relatively more common and underestimated due to lack of suspicion. We have studied prevalence of cardiac dysfunction in pulmonary tuberculosis with special emphasis on echocardiography, serum cortisol and its correlation in cases with unstable cardiorespiratory parameters.<br />
<b>Methods:</b> Prospective, observational, complete workup, and one year follow up study conducted during January 2016 to December 2020 included 800 cases of active pulmonary tuberculosis with specified inclusion criteria of disproportionate tachycardia, tachypnea with or without hypoxia and shock. Cases with known risk factor for cardiac disease and taking cardiac medicines, and cases with pericardial effusion were excluded from study. All study cases were undergone protocolized analysis such as chest radiograph, pulse oximetry, ECG, sputum examination, cardiac enzymes (CPK-MB, NT-Pro-BNP, and cardiac troponins), serum cortisol, and echocardiography at entry point, at two and six months of treatment with anti-tuberculosis medicines as per NTEP. Statistical analysis was carried out by Chi-square test.<br />
<b>Observations and analysis: </b>In a study of 800 pulmonary tuberculosis cases, 56.00% (448/800) cases were males, and 44.00% (352/800) cases were females. Cases with BMI<18 was 41.62% (333/800) and BMI>18 was 58.37% (467/800). Radiological patterns as unilateral disease in 33.62% (269/800) & bilateral disease in 66.37% (531/800). Hemoglobin less than 10 gm% were documented in 85.12% (681/800) and above 10 gm% were in 14.87% (119/800) cases. Serum albumin less than 3.5 gm% and more than 3.5 gm% were observed in 48.12% (385/800) and 51.12% (415/800) cases respectively. Hypoxia was documented 26.12% (209/800) cases and normal oxygen saturation in 73.87% (591/800) cases. cases with normal and abnormal serum cortisol were 61.37% (491/800) & 38.62% (309/800) respectively. Sputum examination for AFB observed in 30.00% (240/800) and gene Xpert MTB/RIF documented in 51.37% (411/800) cases respectively. Bronchoscopy guided techniques were used in 149 cases and BAL smear AFB in 44.96% (67/149) cases, gene Xpert MTB/RIF in 97.31% (145/149) cases and MGIT culture in four cases (positive in 100% cases subjected to MGIT culture). We have observed global hypokinesia is predominant cardiac dysfunction documented in 82.21% (171/208) cases, followed by left heart systolic dysfunction in 16.34% (34/208) cases and left heart diastolic dysfunction in 75% (156/208) cases. Right heart dysfunction as dilated right atrium and right ventricle documented in 52.88% (110/208) cases and pulmonary hypertension in 40.38% (84/208) cases. Covariates such as age, gender, hemoglobin, BMI, serum cortisol, serum albumin, oxygen saturation and radiological involvement has significant association with cardiac dysfunction. (p<0.00001) Response to treatment with antituberculosis medicines and steroids has documented as improved in 77.40% cases (161/208) cases, persistent in 13.46% (28/2028) cases and progressive in 9.13% (19/208) cases. Final outcome of cardiac dysfunction in Pulmonary tuberculosis cases has significant association with serum cortisol level (p<0.00086).<br />
<b>Conclusion:</b> Cardiac dysfunction is active pulmonary tuberculosis needs prompt workup in presence of disproportionate tachypnea, tachycardia with or without hypoxia and shock. Echocardiography is basic tool to evaluate these cases and global hypokinesis is most common abnormality. Serum cortisol abnormality documented in fair number of cases and very well correlated with left ventricular dysfunction abnormalities. Steroids with antituberculosis treatment backup is mainstay protocol during management of these cases. Cardiac dysfunction is reversible in majority of cases and proportionate number shown complete improvement in cardiac dysfunction.
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Affiliation(s)
- Shital Vishnu Patil
- MIMSR Medical College, Latur, INDIA
- Venkatesh Chest Hospital and Critical Care Center, Latur, INDIA
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Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications-A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13030432. [PMID: 36766543 PMCID: PMC9914020 DOI: 10.3390/diagnostics13030432] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Although primarily a lung disease, extra-pulmonary tuberculosis (TB) can affect any organ or system. Of these, cardiovascular complications associated with disease or drug toxicity significantly worsen the prognosis. Approximately 60% of patients with TB have a cardiovascular disease, the most common associated pathological entities being pericarditis, myocarditis, and coronary artery disease. We searched the electronic databases PubMed, MEDLINE, and EMBASE for studies that evaluated the impact of TB on the cardiovascular system, from pathophysiological mechanisms to clinical and paraclinical diagnosis of cardiovascular involvement as well as the management of cardiotoxicity associated with antituberculosis medication. The occurrence of pericarditis in all its forms and the possibility of developing constrictive pericarditis, the association of concomitant myocarditis with severe systolic dysfunction and complication with acute heart failure phenomena, and the long-term development of aortic aneurysms with risk of complications, as well as drug-induced toxicity, pose complex additional problems in the management of patients with TB. In the era of multidisciplinarity and polymedication, evidence-based medicine provides various tools that facilitate an integrative management that allows early diagnosis and treatment of cardiac pathologies associated with TB.
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Saggu DK, Yalagudri SD, Subramanian M, Atreya AR, Narasimhan C. Ventricular Tachycardia in Granulomatous Myocarditis: Role of Catheter Ablation. Card Electrophysiol Clin 2022; 14:701-707. [PMID: 36396187 DOI: 10.1016/j.ccep.2022.08.001] [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] [Indexed: 06/16/2023]
Abstract
Granulomatous myocarditis is an inflammatory disease of the myocardium, characterized by lymphocytic infiltration with characteristic granuloma formation. Although a host of disease processes can elicit myocardial granulomas, two common entities are cardiac sarcoidosis and cardiac tuberculosis. Cardiac arrhythmias in this condition are frequent and management of ventricular arrhythmias can be challenging, especially in those with drug-refractory ventricular tachycardia and electrical storm. In this review, we highlight the role of catheter ablation for ventricular tachycardia and optimal patient selection for catheter ablation, based on cardiac imaging.
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Affiliation(s)
- Daljeet Kaur Saggu
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Sachin D Yalagudri
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Muthiah Subramanian
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Auras R Atreya
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India; Division of Cardiovascular Medicine, Electrophysiology Section, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Calambur Narasimhan
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India.
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Adefuye MA, Manjunatha N, Ganduri V, Rajasekaran K, Duraiyarasan S, Adefuye BO. Tuberculosis and Cardiovascular Complications: An Overview. Cureus 2022; 14:e28268. [PMID: 36158349 PMCID: PMC9491794 DOI: 10.7759/cureus.28268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis (TB) is a dominant cause of mortality from a single infectious disease agent. It is a global health issue that has been tagged as a public health emergency for decades. The disease process, which is caused by Mycobacterium tuberculosis (MTB), affects the respiratory system as well as many other organ systems in the body, such as the lymphatic system, central nervous system (CNS), gastrointestinal system, and cardiovascular system (CVS). Generally, cardiovascular diseases are the leading cause of death worldwide, with most of the mortality in low and middle-income countries. Also, the high mortality rate of TB is skewed to these regions, making the mortality of TB with CVS involvement exceptionally high. The multisystemic involvement of TB impacts the cardiovascular system in various forms. While pericarditis caused by TB is quite common, other complications like myocarditis, coronary artery disease, and aortitis are rarer, necessitating a high index of suspicion and holistic management. This article reviews the pathophysiology of cardiovascular complications in TB, highlighting mechanisms of occurrence, common complications, management protocols, and prognostic factors. Our review highlights some of the gaps in understanding cardiovascular complications in TB, necessitating further research to investigate causal mechanisms and treatment.
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Abstract
ABSTRACT Mycobacterium infection remains a leading cause of morbidity and mortality worldwide. Although rare, thoracic cardiovascular complications are associated with devastating consequences if not promptly diagnosed using computed tomography. Intrapulmonary complications include tuberculous aortitis, Rasmussen aneurysms, involvement of bronchial and nonbronchial systemic arteries, and thromboembolic events. Extrapulmonary complications include pericarditis, myocarditis, endocarditis, involvement of coronary arteries, annular-subvalvular left ventricle aneurysms and mediastinal fibrosis. This article will review these complications and their computed tomography features.
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Dulin M, Pasi N, Benali K, Ducrocq G, Roriz M, Pellenc Q, Para M, Chauveheid MP, Goulenok T, van Gysel D, Dossier A, Papo T, Sacre K. Management of patients with myocardial tuberculosis: A case series. Int J Cardiol 2020; 327:132-137. [PMID: 33166586 DOI: 10.1016/j.ijcard.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Myocardial Tuberculosis (MT) is exceedingly rare. We aimed to report on myocardial involvement in tuberculosis (TB). METHODS All adult patients admitted in a department of Internal Medicine over an 8-year period with microbiologically proven MT were retrospectively reviewed. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records. RESULTS Six patients (4 women, 37.6 [21.3-62.1] years) with MT were identified. MT included cardiac mass (n = 1), coronaritis (n = 1), left ventricle spontaneous rupture (n = 1) and myocarditis (n = 3). Pericardial effusion was associated with myocardial involvement in 2 cases. Four patients presented with acute heart failure. CRP serum level was high in all cases. The mean delay between the first symptoms and TB diagnosis was of 6 [1-44] months. The time from admission to diagnosis was of 18 (9-28) days. No patient had human immunodeficiency virus infection. Fluorodeoxyglucose - positron emission tomography (FDG-PET) detected extra-cardiac asymptomatic Mycobacterium tuberculosis infection localization and guided biopsy in 5 cases. As compared to TB patients without cardiac involvement, patients with MT were younger and more frequently women. All patients received antituberculosis therapy for 7.5 to 12 months associated with steroids for at least 6 weeks. Cardiac surgery was required in all but one patient. No patient died over a median follow-up of 1.2 [0.2-4.4] years. CONCLUSION Our study emphasizes the clinical spectrum of life-threatening MT. Early diagnosis using FDG-PET imaging to target biopsy in extra-cardiac tissues and combined treatment strategy associating antituberculosis therapy, corticosteroids and surgery prevent complications and death.
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Affiliation(s)
- Marie Dulin
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicoletta Pasi
- Département de Radiologie, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Khadija Benali
- Département de Médecine Nucléaire, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Gregory Ducrocq
- Département de Cardiologie, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Mélanie Roriz
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Quentin Pellenc
- Département de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marylou Para
- Département de Chirurgie Cardio-vasculaire, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie-Paule Chauveheid
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Damien van Gysel
- Département d'Information Médicale, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Antoine Dossier
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France.
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8
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Beijer E, Bakker A, Kraaijvanger R, Meek B, Post M, Grutters J, Veltkamp M. Latent tuberculosis infection associates with cardiac involvement in patients with sarcoidosis. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2020; 37:e2020005. [PMID: 33264382 PMCID: PMC7690062 DOI: 10.36141/svdld.v37i3.9926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/14/2020] [Indexed: 11/02/2022]
Abstract
BACKGROUND Sarcoidosis is a systemic disease characterized by formation of non-caseating granulomas. About 5% of patients have symptoms of cardiac sarcoidosis. Identification of cardiac involvement is important since it is a major cause of death. Mycobacterial antigens have been linked to sarcoidosis pathogenesis. Previous findings suggest that a latent tuberculosis infection (LTBI) might associate with development of cardiac involvement in patients with sarcoidosis. The aim of the present study was to further evaluate these findings in another cohort of cardiac sarcoidosis patients. METHODS Interferon release assays (IGRAs) or tuberculin skin tests (TST) were analysed in a cohort of cardiac sarcoidosis patients (n=103) and compared to non-cardiac sarcoidosis patients (n=153). RESULTS In the cohort of patients with cardiac sarcoidosis, 7 could be diagnosed with a LTBI (6.8%) compared to only one of the non-cardiac patients (0.7%), p = 0.008. CONCLUSIONS To conclude, we were able to show an association between a LTBI and cardiac involvement in patients with sarcoidosis. Future research is however required to unravel the mechanism involved in this association. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (3): e2020005).
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Affiliation(s)
- Els Beijer
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Annelies Bakker
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Raisa Kraaijvanger
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Bob Meek
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marco Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan Grutters
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Pulmonology, University Medical Center, Utrecht, The Netherlands
| | - Marcel Veltkamp
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Pulmonology, University Medical Center, Utrecht, The Netherlands
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9
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Chinen K, Ito K. Sudden death caused by pulmonary fat embolism in a patient with miliary tuberculosis. AUTOPSY AND CASE REPORTS 2019; 9:e2018059. [PMID: 30863732 PMCID: PMC6394360 DOI: 10.4322/acr.2018.059] [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: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 12/26/2022] Open
Abstract
An 84-year-old Japanese woman with myelodysplastic syndrome was admitted with pyrexia and dyspnea, but died suddenly during diagnostic evaluation. The autopsy revealed miliary tuberculosis in addition to myelodysplastic syndrome in the bone marrow. The immediate cause of the patient’s sudden death was pulmonary fat embolism derived from bone marrow necrosis. This case shows that the infiltration of the myelodysplastic bone marrow by tuberculosis and consequent bone marrow necrosis and fat embolism can be the cause of sudden death. In this article, we report the autopsy results of this unusual cause of sudden death, and discuss tuberculosis-related sudden death with a review of the literature.
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Affiliation(s)
- Katsuya Chinen
- a Nerima General Hospital, Department of Pathology. Tokyo, Japan.,b Tokyo Healthcare Foundation, Institute for Health Care Quality Improvement. Tokyo, Japan.,c Nerima General Hospital, Department of Cardiology. Tokyo, Japan
| | - Kashima Ito
- a Nerima General Hospital, Department of Pathology. Tokyo, Japan.,b Tokyo Healthcare Foundation, Institute for Health Care Quality Improvement. Tokyo, Japan.,c Nerima General Hospital, Department of Cardiology. Tokyo, Japan
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Cowley A, Dobson L, Kurian J, Saunderson C. Acute myocarditis secondary to cardiac tuberculosis: a case report. Echo Res Pract 2017; 4:K25-K29. [PMID: 28814447 PMCID: PMC5592778 DOI: 10.1530/erp-17-0024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/16/2017] [Indexed: 12/28/2022] Open
Abstract
Isolated myocardial involvement in tuberculosis is exceedingly rare but there are reports it can present with sudden cardiac death, atrioventricular block, ventricular arrhythmias or congestive cardiac failure. We report the case of a 33-year-old male, of South Asian descent, who presented with chest pain, shortness of breath and an abnormal ECG. The patient had no significant past medical history and coronary angiogram showed no evidence of coronary artery disease. Of note, the patient had recently been discharged from a local district hospital with an episode of myocarditis. The patient was found to be severely hypoxic with evidence of severe biventricular failure on echocardiography. Computed tomography of the chest demonstrated hilar lymphadenopathy, and the differential diagnosis was thought to be tuberculosis or sarcoidosis. A TB Quantiferon gold test performed at the district hospital was positive; however, fine needle aspiration was negative for acid-fast bacilli. Despite aggressive diuresis, the patient became increasingly hypoxic and suffered a cardiac arrest. Post-mortem confirmed a diagnosis of myocardial tuberculosis – a rare case of acute decompensated heart failure.
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Affiliation(s)
- Alice Cowley
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Laura Dobson
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - John Kurian
- Department of Cardiology, Bradford Royal Infirmary, Bradford, UK
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11
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Lambatten D, Hammi S, Rhofir Y, Bourkadi JE. [Myocardial tuberculoma: unusual location of tuberculosis: a new observation and review of the literature]. Pan Afr Med J 2016; 24:32. [PMID: 27583096 PMCID: PMC4992366 DOI: 10.11604/pamj.2016.24.32.9361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/03/2016] [Indexed: 11/18/2022] Open
Abstract
Nous rapportons l'observation d'un patient de 50 ans présentant une masse tumorale du ventricule gauche évoluant dans un contexte d'altération de l’état général et de fièvre. Cette masse a été objectivée par l’échocardiographie réalisée pour l'exploration d'une cardiomégalie radiologique. L'aspect en imagerie par résonance magnétique était évocateur d'un tuberculome intra myocardique. A travers notre observation, nous proposons une revue de la littérature sur cette localisation inhabituelle de la tuberculose.
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Affiliation(s)
- Dalal Lambatten
- Service de Pneumo-Phtisiologie, Hospital Moulay Youssef, CHU Rabat, Akkari, 10000, Maroc; Faculté de Médecine et de Pharmacie de Rabat, Maroc
| | - Sanaa Hammi
- Faculté de Médecine et de Pharmacie de Tanger, Maroc
| | - Yasmina Rhofir
- Service de Pneumo-Phtisiologie, Hospital Moulay Youssef, CHU Rabat, Akkari, 10000, Maroc; Faculté de Médecine et de Pharmacie de Rabat, Maroc
| | - Jamal Eddine Bourkadi
- Service de Pneumo-Phtisiologie, Hospital Moulay Youssef, CHU Rabat, Akkari, 10000, Maroc; Faculté de Médecine et de Pharmacie de Rabat, Maroc
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12
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du Toit-Prinsloo L, Saayman G. “Death at the wheel” due to tuberculosis of the myocardium: a case report. Cardiovasc Pathol 2016; 25:271-274. [DOI: 10.1016/j.carpath.2016.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 11/26/2022] Open
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13
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Sharma SK, Mohan A, Sharma A. Miliary tuberculosis: A new look at an old foe. J Clin Tuberc Other Mycobact Dis 2016; 3:13-27. [PMID: 31723681 PMCID: PMC6850233 DOI: 10.1016/j.jctube.2016.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 11/03/2022] Open
Abstract
Miliary tuberculosis (TB), is a fatal form of disseminated TB characterized by tiny tubercles evident on gross pathology similar to innumerable millet seeds in size and appearance. Global HIV/AIDS pandemic and increasing use of immunosuppressive drugs have altered the epidemiology of miliary TB. Keeping in mind its protean manifestations, clinicians should have a low threshold for suspecting miliary TB. Careful physical examination should focus on identifying organ system involvement early, particularly TB meningitis, as this has therapeutic significance. Fundus examination for detecting choroid tubercles can help in early diagnosis as their presence is pathognomonic of miliary TB. Imaging modalities help in recognizing the miliary pattern, define the extent of organ system involvement and facilitate image guided fine-needle aspiration cytology or biopsy from various organ sites. Sputum or BAL fluid examination, pleural, pericardial, peritoneal fluid and cerebrospinal fluid studies, fine needle aspiration cytology or biopsy of the lymph nodes, needle biopsy of the liver, bone marrow aspiration and biopsy, testing of body fluids must be carried out. GeneXpert MTB/RIF, line probe assay, mycobacterial culture and drug-susceptibility testing must be carried out as appropriate and feasible. Treatment of miliary TB should be started at the earliest as this can be life saving. Response to first-line anti-TB drugs is good. Screening and monitoring for complications like acute respiratory distress syndrome (ARDS), adverse drug reactions like drug-induced liver injury, drug-drug interactions, especially in patients co-infected with HIV/AIDS, are warranted. Sparse data are available from randomized controlled trials regarding optimum regimen and duration of anti-TB treatment.
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Affiliation(s)
- Surendra K Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Alladi Mohan
- Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, India
| | - Animesh Sharma
- Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110 060, India
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Huaman MA, Henson D, Ticona E, Sterling TR, Garvy BA. Tuberculosis and Cardiovascular Disease: Linking the Epidemics. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2015; 1. [PMID: 26835156 PMCID: PMC4729377 DOI: 10.1186/s40794-015-0014-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The burden of tuberculosis and cardiovascular disease (CVD) is enormous worldwide. CVD rates are rapidly increasing in low- and middle-income countries. Public health programs have been challenged with the overlapping tuberculosis and CVD epidemics. Monocyte/macrophages, lymphocytes and cytokines involved in cellular mediated immune responses against Mycobacterium tuberculosis are also main drivers of atherogenesis, suggesting a potential pathogenic role of tuberculosis in CVD via mechanisms that have been described for other pathogens that establish chronic infection and latency. Studies have shown a pro-atherogenic effect of antibody-mediated responses against mycobacterial heat shock protein-65 through cross reaction with self-antigens in human vessels. Furthermore, subsets of mycobacteria actively replicate during latent tuberculosis infection (LTBI), and recent studies suggest that LTBI is associated with persistent chronic inflammation that may lead to CVD. Recent epidemiologic work has shown that the risk of CVD in persons who develop tuberculosis is higher than in persons without a history of tuberculosis, even several years after recovery from tuberculosis. Together, these data suggest that tuberculosis may play a role in the pathogenesis of CVD. Further research to investigate a potential link between tuberculosis and CVD is warranted.
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Affiliation(s)
- Moises A Huaman
- Division of Infectious Diseases, Department of Medicine, University of Kentucky, Lexington, KY, USA
| | - David Henson
- Division of Infectious Diseases, Department of Medicine, University of Kentucky, Lexington, KY, USA
| | - Eduardo Ticona
- Infectious Diseases & Tropical Medicine Research Unit, Hospital Nacional Dos de Mayo, Lima, Peru
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Beth A Garvy
- Division of Infectious Diseases, Department of Medicine, University of Kentucky, Lexington, KY, USA; Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, KY, USA
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Michira BN, Alkizim FO, Matheka DM. Patterns and clinical manifestations of tuberculous myocarditis: a systematic review of cases. Pan Afr Med J 2015; 21:118. [PMID: 26327955 PMCID: PMC4546727 DOI: 10.11604/pamj.2015.21.118.4282] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 02/03/2015] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis is a rare cause of myocarditis. It is however associated with a high mortality when it occurs and is often diagnosed at post-mortem. Tuberculous myocarditis prevalence in males is twice that in females. Most of the reported cases of tuberculous myocarditis are predominantly in immunocompetent patients. Out of the reported fatalities (sudden cardiac deaths), eighty one percent (81%) occur in the ‘young’ patients (below 45years). Antituberculosis drug therapy does not appear to offer mortality benefit against sudden cardiac deaths.
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Affiliation(s)
| | - Faraj Omar Alkizim
- School of Medicine, University of Nairobi, Nairobi 00100, Kenya ; Department of Medical Physiology, University of Nairobi, Nairobi 00100, Kenya
| | - Duncan Mwangangi Matheka
- School of Medicine, University of Nairobi, Nairobi 00100, Kenya ; Department of Medical Physiology, University of Nairobi, Nairobi 00100, Kenya
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16
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Langara B, Georgieva S, Khan WA, Bhatia P, Abdelaziz M. Case report: Sudden cardiac death in a young man. Breathe (Sheff) 2015; 11:67-70. [PMID: 26306105 PMCID: PMC4487387 DOI: 10.1183/20734735.009014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 35-year-old man presented to the accident and emergency department with history of productive cough, breathlessness and some weight loss over several weeks. He had a past medical history of asthma and eczema. He mentioned that, at times, he had been expectorating sputum with some haemoptysis over the past few months. He was of Bangladeshi origin, but had been resident in the UK since 1986 and last visited Bangladesh a year ago. He was a smoker of 10-15 cigarettes per day. He also admitted to smoking heroin. In addition to his respiratory symptoms he also complained of vomiting, which was precipitated by eating. He denied bowel or urinary symptoms.
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Affiliation(s)
- Beatrix Langara
- Dept of Respiratory Medicine, Tameside General Hospital, Ashton Under Lyne, UK
| | | | - Waseem A. Khan
- Dept of Respiratory Medicine, Tameside General Hospital, Ashton Under Lyne, UK
| | - Praveen Bhatia
- Respiratory and General Medicine, Tameside General Hospital, Ashton Under Lyne, UK
| | - Muntasir Abdelaziz
- Respiratory and General Medicine, Tameside General Hospital, Ashton Under Lyne, UK
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17
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Ray S, Talukdar A, Kundu S, Khanra D, Sonthalia N. Diagnosis and management of miliary tuberculosis: current state and future perspectives. Ther Clin Risk Manag 2013; 9:9-26. [PMID: 23326198 PMCID: PMC3544391 DOI: 10.2147/tcrm.s29179] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Tuberculosis (TB) remains one of the most important causes of death from an infectious disease, and it poses formidable challenges to global health at the public health, scientific, and political level. Miliary TB is a potentially fatal form of TB that results from massive lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli. The epidemiology of miliary TB has been altered by the emergence of the human immunodeficiency virus (HIV) infection and widespread use of immunosuppressive drugs. Diagnosis of miliary TB is a challenge that can perplex even the most experienced clinicians. There are nonspecific clinical symptoms, and the chest radiographs do not always reveal classical miliary changes. Atypical presentations like cryptic miliary TB and acute respiratory distress syndrome often lead to delayed diagnosis. High-resolution computed tomography (HRCT) is relatively more sensitive and shows randomly distributed miliary nodules. In extrapulmonary locations, ultrasonography, CT, and magnetic resonance imaging are useful in discerning the extent of organ involvement by lesions of miliary TB. Recently, positron-emission tomographic CT has been investigated as a promising tool for evaluation of suspected TB. Fundus examination for choroid tubercles, histopathological examination of tissue biopsy specimens, and rapid culture methods for isolation of M. tuberculosis in sputum, body fluids, and other body tissues aid in confirming the diagnosis. Several novel diagnostic tests have recently become available for detecting active TB disease, screening for latent M. tuberculosis infection, and identifying drug-resistant strains of M. tuberculosis. However, progress toward a robust point-of-care test has been limited, and novel biomarker discovery remains challenging. A high index of clinical suspicion and early diagnosis and timely institution of antituberculosis treatment can be lifesaving. Response to first-line antituberculosis drugs is good, but drug-induced hepatotoxicity and drug-drug interactions in HIV/TB coinfected patients create significant problems during treatment. Data available from randomized controlled trials are insufficient to define the optimum regimen and duration of treatment in patients with drug-sensitive as well as drug-resistant miliary TB, including those with HIV/AIDS, and the role of adjunctive corticosteroid treatment has not been properly studied. Research is going on worldwide in an attempt to provide a more effective vaccine than bacille Calmette-Guérin. This review highlights the epidemiology and clinical manifestation of miliary TB, challenges, recent advances, needs, and opportunities related to TB diagnostics and treatment.
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Affiliation(s)
- Sayantan Ray
- Department of Medicine, Medical College and Hospital, Kolkata, West Bengal, India
| | - Arunansu Talukdar
- Department of Medicine, Medical College and Hospital, Kolkata, West Bengal, India
| | - Supratip Kundu
- Department of Medicine, Medical College and Hospital, Kolkata, West Bengal, India
| | - Dibbendhu Khanra
- Department of Medicine, Medical College and Hospital, Kolkata, West Bengal, India
| | - Nikhil Sonthalia
- Department of Medicine, Medical College and Hospital, Kolkata, West Bengal, India
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Bansal M, Mehrotra R, Kasliwal RR. Loss of left ventricular torsion as the predominant mechanism of left ventricular systolic dysfunction in a patient with tubercular cardiomyopathy. Echocardiography 2012; 29:E221-5. [PMID: 22748130 DOI: 10.1111/j.1540-8175.2012.01768.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Pericarditis is the commonest form of cardiac involvement in tuberculosis whereas myocardial involvement is exceedingly rare. We hereby report a patient who presented with cardiac tuberculosis manifesting as predominantly right-sided cardiomyopathy. In addition to being a very rare clinical presentation, this case provided an interesting insight into the left ventricular (LV) myocardial mechanics. The patient had nearly preserved contractile function of the LV myocardium (except for segmental abnormalities in circumferential strain) but had marked impairment of torsion resulting in LV systolic dysfunction. Such disproportionate loss of LV torsion leading to LV systolic dysfunction has not been previously described on echocardiography. These myocardial mechanical abnormalities almost completely recovered with adequate antitubercular treatment. Thus, this case proved to be a unique demonstration of the significant, independent role played by torsion in maintenance of normal LV systolic function.
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Affiliation(s)
- Manish Bansal
- Department of Cardiology, Medanta, The Medicity, Gurgaon, Haryana, India.
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19
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Liu A, Hu Y, Coates A. Sudden cardiac death and tuberculosis – How much do we know? Tuberculosis (Edinb) 2012; 92:307-13. [DOI: 10.1016/j.tube.2012.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/07/2012] [Indexed: 12/13/2022]
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20
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Sharma SK, Mohan A, Sharma A. Challenges in the diagnosis & treatment of miliary tuberculosis. Indian J Med Res 2012; 135:703-30. [PMID: 22771605 PMCID: PMC3401706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2011] [Indexed: 11/08/2022] Open
Abstract
Miliary tuberculosis (TB) is a potentially lethal disease if not diagnosed and treated early. Diagnosing miliary TB can be a challenge that can perplex even the most experienced clinicians. Clinical manifestations are nonspecific, typical chest radiograph findings may not be evident till late in the disease, high resolution computed tomography (HRCT) shows randomly distributed miliary nodules and is relatively more sensitive. Ultrasonography, CT and magnetic resonance imaging (MRI) are useful in discerning the extent of organ involvement by lesions of miliary TB in extra-pulmonary locations. Fundus examination for choroid tubercles, histopathological examination of tissue biopsy specimens, conventional and rapid culture methods for isolation of Mycobacterium tuberculosis, drug-susceptibility testing, along with use of molecular biology tools in sputum, body fluids, other body tissues are useful in confirming the diagnosis. Although several prognostic markers have been described which predict mortality, yet untreated miliary TB has a fatal outcome within one year. A high index of clinical suspicion and early diagnosis and timely institution of anti-tuberculosis treatment can be life-saving. Response to first-line anti-tuberculosis drugs is good but drug-induced hepatotoxicity and drug-drug interactions in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients pose significant problems during treatment. However, sparse data are available from randomized controlled trials to define the optimum regimen and duration of treatment in patients with drug-sensitive as well as drug-resistant miliary TB, including those with HIV/AIDS.
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Affiliation(s)
- Surendra K Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
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21
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Abstract
We present the cardiac magnetic resonance images of an unusual form of cardiac tuberculosis. Nodular masses in a sheet-like distribution were seen to infiltrate the outer myocardium and pericardium along most of the cardiac chambers. The lesions showed significant resolution on antitubercular therapy.
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Affiliation(s)
- Gurpreet S Gulati
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi - 110 029, India
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22
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Abstract
Granulomatous inflammation of the myocardium may occur in a number of systemic disease processes including those with infectious etiologies such as fungal, mycobacterial and parasitic infections, as well as hypersensitivity reactions, and rarely autoimmune disorders. In many of these disorders, giant cells are components of the inflammatory infiltrate. Systemic granulomatous processes of unknown pathogenesis, most notably sarcoidosis, may also be associated with involvement of the myocardium. Occasionally, these disorders are associated with sudden death due to pathologic involvement of the heart. In contrast, giant cell myocarditis, also known as idiopathic myocarditis, a rare, frequently fulminant and fatal disorder of unknown etiology, is isolated to the heart and lacks systemic involvement. This disorder is most commonly diagnosed at autopsy. We present two cases in which sudden death resulted from a giant cell inflammatory process affecting the myocardium. Both individuals lacked antemortem diagnoses and collapsed at their respective places of employment. These cases compare and contrast the clinical and pathologic issues involved in the differential diagnoses of the subgroup of sudden cardiac deaths resulting from giant cell inflammatory processes that affect the myocardium, as well as the value of histologic examination and immunohistochemical studies.
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Affiliation(s)
- Rebecca A Hamilton
- Office of the District 21 Medical Examiner, 70 Danley Drive, Fort Myers, FL 33907, USA.
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Abstract
Tuberculous myocarditis is a rare finding. We present the case of a 33-year-old woman who was in good health and who died suddenly at home. Autopsy and histopathologic examinations revealed granulamatous lesions in the myocardium, lungs, lymph nodes, liver, and spleen. No fast acid bacilli were demonstrated on histological examination. The presence of a Mycobacterium tuberculosis DNA complex was identified using a polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded histological samples. An HIV test carried out on the blood obtained during the autopsy was negative according to the DNA amplification technique (PCR) and enzyme-linked immunosorbent assay serological test. We hypothesize that the mechanism of death was severe ventricular arrhythmia due to granulomatous proliferation in the structures of the interventricular septum.
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Affiliation(s)
- Enrico Silingardi
- Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy.
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Sharma SK, Mohan A, Sharma A, Mitra DK. Miliary tuberculosis: new insights into an old disease. THE LANCET. INFECTIOUS DISEASES 2005; 5:415-30. [PMID: 15978528 DOI: 10.1016/s1473-3099(05)70163-8] [Citation(s) in RCA: 217] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Miliary tuberculosis is a potentially lethal form of tuberculosis resulting from massive lymphohaematogeneous dissemination of Mycobacterium tuberculosis bacilli. The emergence of the HIV/AIDS pandemic and widespread use of immunosuppressive drugs has changed the epidemiology of miliary tuberculosis. Impaired cell-mediated immunity underlies the disease's development. Clinical manifestations are non-specific and typical chest radiographic findings may not be seen until late in the course of the disease. Atypical presentations--eg, cryptic miliary tuberculosis and acute respiratory distress syndrome--often delay the diagnosis. Several laboratory abnormalities with prognostic and therapeutic implications have been described, including pulmonary function and gas exchange impairment. Isolation of M tuberculosis from sputum, body fluids, or biopsy specimens, application of molecular methods such as PCR, and histopathological examination of tissue biopsy specimens are useful for the confirmation of diagnosis. Although response to first-line antituberculosis drugs is good, evidence regarding optimum duration of treatment is lacking and the role of adjunctive corticosteroid treatment is unclear.
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Affiliation(s)
- Surendra Kumar Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
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Agarwal R, Malhotra P, Awasthi A, Kakkar N, Gupta D. Tuberculous dilated cardiomyopathy: an under-recognized entity? BMC Infect Dis 2005; 5:29. [PMID: 15857515 PMCID: PMC1090580 DOI: 10.1186/1471-2334-5-29] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 04/27/2005] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a common public health problem in many parts of the world. TB is generally believed to spare these four organs-heart, skeletal muscle, thyroid and pancreas. We describe a rare case of myocardial TB diagnosed on a post-mortem cardiac biopsy. CASE PRESENTATION Patient presented with history suggestive of congestive heart failure. We describe the clinical presentation, investigations and outcome of this case, and review the literature on the involvement of myocardium by TB. CONCLUSION Involvement of myocardium by TB is rare. However it should be suspected as a cause of congestive heart failure in any patient with features suggestive of TB. Increasing recognition of the entity and the use of endomyocardial biopsy may help us detect more cases of this "curable" form of cardiomyopathy.
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Affiliation(s)
- Ritesh Agarwal
- Department of Pulmonary Medicine, Post-Graduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India
| | - Puneet Malhotra
- Department of Pulmonary Medicine, Post-Graduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India
| | - Anshu Awasthi
- Department of Histopathology, Post-Graduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India
| | - Nandita Kakkar
- Department of Histopathology, Post-Graduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India
| | - Dheeraj Gupta
- Department of Pulmonary Medicine, Post-Graduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India
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Abstract
INTRODUCTION Tuberculosis can be responsible for myocardial damage, the frequency of which is probably underestimated because of the difficulty in its diagnosis. We studied the contribution of cardiac magnetic resonance imaging (MRI) in three patients. OBSERVATIONS Three patients were treated for disseminated tuberculosis. They had moderate cardiac abnormalities (tachycardia, dyspnoea on effort). The electrocardiogram was normal in 2 patients and the echocardiography showed localized hyperkinesias. Cardiac MRI revealed intra-myocardial nodular gadolinium enhancement and hyperkinesias. The clinical outcome in the 3 patients was favourable following anti-tuberculosis therapy; one patient was also administered corticosteroids. DISCUSSION Cardiac MRI is a non-invasive examination that brought important arguments for the diagnosis of tubercular myocarditis in the 3 patients.
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Affiliation(s)
- Guillaume Breton
- Service des maladies infectieuses et tropicales, Hôpital Bichat-Claude Bernard, 46, rue Henri Huchard, 75018 Paris, France
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Ozer N, Aytemir K, Sade E, Oto A, Aksoy S, Engin H, Tokgözoğlu L, Oto A. Cardiac tuberculosis with multiple intracardiac masses: a case report. J Am Soc Echocardiogr 2002; 15:756-8. [PMID: 12094179 DOI: 10.1067/mje.2002.119846] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this report, clinical, echocardiographic, and pathologic findings of a patient with multiple masses caused by tuberculosis both in the left and right side of the heart are presented. After antituberculosis treatment some of the masses disappeared and some became smaller. Although an intracardiac mass caused by tuberculosis is very rare, it should be considered in the list of masses detected by echocardiography.
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Affiliation(s)
- Necla Ozer
- Department of Cardiology, Hacettepe University, School of Medicine, Ankara, Turkey.
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28
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Abstract
Although deaths from tuberculosis (TB) are increasing, TB-related sudden death (TBRSD) is rarely reported in the literature. We present a case report of fatal pulmonary TB with extrapulmonary extension in a patient infected with the human immunodeficiency virus (HIV) and a review of published reports of TBRSD in MEDLINE (1966 to October 2000). Forty-six cases of TBRSD were reported. The most common cause of TBRSD was tuberculous bronchopneumonia in 30 (64%) patients, followed by hemoptysis in 14 (30%) patients. Tuberculous myocarditis and isolated TB of the adrenal glands are seldom causes of TBRSD. The early detection of TB, use of directly observed therapy, and individualization of treatment can be helpful in decreasing the incidence of TBRSD.
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Affiliation(s)
- S Alkhuja
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, St. Barnabas Hospital, Weill Medical College of Cornell University, Bronx, NY 10457-2594, USA
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Dada MA, Lazarus NG, Kharsany AB, Sturm AW. Sudden death caused by myocardial tuberculosis: case report and review of the literature. Am J Forensic Med Pathol 2000; 21:385-8. [PMID: 11111803 DOI: 10.1097/00000433-200012000-00018] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 25-year-old fit man died suddenly while playing social soccer. Autopsy revealed an infiltrative lesion involving the left ventricle with overlying pericarditis. No other significant pathologic changes were observed. Histologic examination showed necrotizing granulomatous inflammation. No acid-fast bacilli were demonstrated in the pericardial fluid or on histologic examination. The presence of Mycobacterium tuberculosis DNA complex was confirmed by use of the ligase chain reaction technique. The differential diagnosis of myocardial tuberculosis includes sarcoidosis, rheumatic fever, rheumatoid arthritis, giant-cell-containing tumors, idiopathic (giant-cell) myocarditis, and bacterial infections such as tularemia and brucellosis. This case illustrates the protean manifestations of tuberculosis and highlights the use of molecular biologic techniques in arriving at a definitive diagnosis in cases of suspected tuberculosis.
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Affiliation(s)
- M A Dada
- Department of Forensic Medicine, School of Pathology and Laboratory Science, University of Natal, Durban, South Africa
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30
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Doherty JG, Rankin R, Kerr F. Miliary tuberculosis presenting as infection of a pacemaker pulse-generator pocket. Scott Med J 1996; 41:20-1. [PMID: 8658118 DOI: 10.1177/003693309604100108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A seventy year old woman had a permanent VVI pacemaker inserted in 1983 for complete heart block and presented ten years later with purulent discharge from the generator pocket. During a prolonged pyrexial illness, she developed renal and respiratory failure and her illness was complicated by recurrent ventricular fibrillation. The patient died on her 31st hospital day. Subsequent histological and microbiological investigation revealed widespread miliary tuberculosis which included involvement of myocardial tissue, great vessels and the pacemaker pocket. To our knowledge, this is the first reported occurrence of miliary tuberculosis involving a permanent pacemaker system. Furthermore, the granulomatous myocarditis which occurred as part of the miliary picture is a rare occurrence and possibly explains the recurrent ventricular fibrillation.
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Affiliation(s)
- J G Doherty
- Department of Cardiology, Raigmore Hospital, Inverness, Scotland
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31
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 16-1995. A 35-year-old man with dilated cardiomyopathy, repeated ventricular tachycardia, and pulmonary lesions. N Engl J Med 1995; 332:1432-8. [PMID: 7723801 DOI: 10.1056/nejm199505253322108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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