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Cotugno S, Guido G, Manco Cesari G, Ictho J, Lochoro P, Amone J, Segala FV, De Vita E, Lattanzio R, Okori S, De Iaco G, Girma A, Sura A, Hessebo ET, Balsemin F, Putoto G, Ronga L, Manenti F, Facci E, Saracino A, Di Gennaro F. Cardiac Tuberculosis: A Case Series from Ethiopia, Italy, and Uganda and a Literature Review. Am J Trop Med Hyg 2024; 110:795-804. [PMID: 38412542 PMCID: PMC10993843 DOI: 10.4269/ajtmh.23-0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/19/2023] [Indexed: 02/29/2024] Open
Abstract
Extrapulmonary tuberculosis (TB) is estimated to account for up to 20% of active cases of TB disease, but its prevalence is difficult to ascertain because of the difficulty of diagnosis. Involvement of the heart is uncommon, with constrictive pericarditis being the most common cardiac manifestation. Diagnostic research for cardiac disease is frequently lacking, resulting in a high mortality rate. In addition to direct cardiac involvement, instances of cardiac events during antitubercular therapy are described. This case series describes five cases of TB affecting the heart (cardiac TB) from Italy and high-burden, low-income countries (Ethiopia and Uganda), including a case of Loeffler syndrome manifesting as myocarditis in a patient receiving antitubercular therapy. Our study emphasizes how cardiac TB, rare but important in high-burden areas, is a leading cause of pericardial effusion or pericarditis. Timely diagnosis and a comprehensive approach, including imaging and microbiological tools, are crucial. Implementing high-sensitivity methods and investigating alternative samples, such as detection of tuberculosis lipoarabinomannan or use of the GeneXpert assay with stool, is recommended in TB control programs.
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Affiliation(s)
- Sergio Cotugno
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Giacomo Guido
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Giorgia Manco Cesari
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | | | | | - James Amone
- St. John’s XXIII Hospital Aber, Jaber, Uganda
| | - Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Elda De Vita
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Rossana Lattanzio
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | | | - Giuseppina De Iaco
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Adisu Girma
- Doctors with Africa CUAMM, Wolisso, Ethiopia
| | - Abata Sura
- Doctors with Africa CUAMM, Wolisso, Ethiopia
| | | | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Luigi Ronga
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | | | - Enzo Facci
- Doctors with Africa CUAMM, Wolisso, Ethiopia
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
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