Diagnosis of tuberculous aetiology in pericardial effusions

Cherian, G

doi:10.1136/pgmj.2003.013664

Cited by 66 publications

(53 citation statements)

References 38 publications

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“…This is especially true when the diagnosis and the correct treatment of the disease is delayed 7 . Survival time without treatment is approximately four months.…”

Section: Introductionmentioning

confidence: 99%

“…The main complications of TP are: constrictive pericarditis with or without restrictive hearth failure; cardiac tamponade, a most frequent cause of death if not detected and properly managed 12 . The lack of specificity of TP symptoms makes this condition hard to diagnose 7 . The tuberculin skin test (TST) and thorax radiography are associated with a low positive predictive value of TP 25,30 .…”

Section: Introductionmentioning

confidence: 99%

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The usefulness of adenosine deaminase in the diagnosis of tuberculous pericarditis

Tuon

Silva

Almeida

et al. 2007

Rev. Inst. Med. trop. S. Paulo

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SUMMARYThe objective of this study was to evaluate the adenosine deaminase (ADA) activity usefulness in the diagnosis of tuberculous pericarditis (TP), comparing its value with pericardial effusions (PE) caused by other pericardial diseases. A retrospective casecontrol study was conducted with nine cases of TP and 39 other than TP diseases (12 neoplastic, 11 septic and 16 unknown origin). Every patient included in this study had PE samples submitted to ADA activity measures and microbiological analysis, and then had pericardial tissue samples submitted to microbiological and histopathological examination. Considering the value of 40 U/L as the cut-off for the diagnosis of TP, the specificity and sensitivity were respectively of 72% and 89%. The specificity of ADA activity for the TP was best applied in the differential diagnosis from PE of unknown origin. The present study demonstrates the clinical value of the measurement of ADA activity in PE in the diagnosis of TP.

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“…This is especially true when the diagnosis and the correct treatment of the disease is delayed 7 . Survival time without treatment is approximately four months.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The usefulness of adenosine deaminase in the diagnosis of tuberculous pericarditis

Tuon

Silva

Almeida

et al. 2007

Rev. Inst. Med. trop. S. Paulo

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“…Se ha encontrado buena correlación entre la cardiomegalia observada en la radiografía y la cantidad de líquido aspirado durante la pericardiocentesis, convirtiéndola, así, en un examen de relevancia para la identificación de grandes derrames pericárdicos en los países en desarrollo (20,21).…”

Section: Discussionunclassified

“…Incluso si se tiene en cuenta que las bandas de fibrina en el pericardio visceral son típicas pero no específicas de la tuberculosis (10,21,22), en el ecocardiograma de la pericarditis tuberculosa normalmente se detecta derrame pericárdico con engrosamiento del pericardio visceral y es posible identificar bandas de fibrina o fibrosis que cicatrizan el pericardio (23).…”

Section: Discussionunclassified

“…En la TC de tórax pueden encontrarse cambios típicos de los ganglios linfáticos del mediastino en casi el 100 % de los casos (por ejemplo, tamaño mayor de 10 mm y centros hipodensos) (21). La RM es muy sensible para valorar la estructura miocárdica, la función, la inflamación y la fibrosis; sin embargo, debido a su inaccesibilidad y costo, la TC sigue siendo una herramienta crucial en el diagnóstico de la pericarditis tuberculosa (19,24).…”

Section: Discussionunclassified

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Pericarditis tuberculosa: reporte de caso

Echeverri

Matta

2014

biomedica

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Institución donde se llevó a cabo la investigación: Corporación Comfenalco Valle-Universidad Libre La tuberculosis sigue siendo una de las principales causas de morbilidad y mortalidad en el mundo. Su forma extrapulmonar representa hasta el 20 % de los casos. Se ha estimado que el compromiso pericárdico en esta enfermedad se presenta en 1 a 4 % de los pacientes diagnosticados. Su mortalidad alcanza el 90 % si no se diagnostica y se trata adecuadamente; este porcentaje se reduce a 12 % con el diagnóstico y el tratamiento oportunos. Se presenta el caso de una paciente de 55 años, hospitalizada durante dos semanas con síntomas constitucionales, fiebre intermitente, tos seca, dolor pleurítico y algunos síntomas de falla cardiaca. En los estudios de imaginología (radiografía y ecografía de tórax) se encontró derrame pleural bilateral de 300 ml en el lado derecho y de 1.000 ml en el izquierdo, así como derrame pericárdico de 500 ml. Las baciloscopias directas de los líquidos pleural y pericárdico, así como en esputo, fueron negativas, al igual que la proteína C reactiva (PCR); sin embargo, el cultivo del líquido pericárdico en medio de Löwenstein-Jensen fue positivo para Mycobacterium tuberculosis. El resultado de la prueba de PPD (Purified Protein Derivative) fue de 23 mm; una vez iniciado el tratamiento conjugado con isoniacida, rifampicina, etambutol y pirazinamida, se presentó una mejoría rápida del cuadro clínico que persistió hasta que se le dio de alta. La pericarditis tuberculosa puede considerarse como una manifestación infrecuente de la tuberculosis, con una morbilidad elevada y una mortalidad considerable, cuya probabilidad disminuye si hay un diagnóstico oportuno y se instaura un tratamiento efectivo temprano. Aunque se han sugerido varios criterios diagnósticos para la pericarditis tuberculosa, su diagnóstico definitivo puede implicar varios desafíos técnicos. Tuberculous pericarditisTuberculosis remains a major cause of morbidity and mortality worldwide, and the extrapulmonary presentation represents up to 20% of this disease. The pericardial compromise of this disease has been estimated between 1% and 4% of diagnosed patients. This presentation may have a mortality rate as high as 90% without proper treatment and diagnosis, dropping to 12% with timely diagnosis and treatment. We present the case of a 55 year-old female patient hospitalized for two weeks with constitutional symptoms, intermittent fever, dry cough, pleuritic pain and some symptoms of heart failure. The imaging studies (chest x-rays and ultrasound), revealed bilateral pleural effusion: 300 cc on the right side, 1,000 cc on the left side, and 500 cc of pericardial effusion. Direct bacilloscopy of the pleural fluid, the pericardial fluid and the sputum were negative, as well as the C-reactive protein (CRP); however, the Löwenstein-Jensen culture of the pericardial fluid was positive for Mycobacterium tuberculosis. The result of the purified protein derivative (PPD) test showed a 23 mm swelling, and after quadruple therapy her clinical condi...

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Assessing the hazard of death, cardiac tamponade, and pericardial constriction among HIV and tuberculosis pericarditis patients using the extended Cox‐hazard model: Intervention study

Iddrisu,

Otoo,

Kwasi

et al. 2024

Health Science Reports

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Background and AimsTuberculous (TB) pericarditis (TBP), a TB of the heart, is linked to significant morbidity and mortality rates. Administering glucocorticoid therapy to individuals with TBP might enhance overall results and lower the likelihood of fatality. However, the actual clinical effectiveness of supplementary glucocorticoids remains uncertain. This study specifically evaluated the effects of prednisolone, prednisolone‐antiretroviral therapy (ART) interaction, and other potential risk factors in reducing the hazard of the composite outcome, death, cardiac tamponade, and constriction, among TBP and human immunodeficiency virus (HIV) patients.MethodsThe data used in this study were obtained from the investigation of the Management of Pericarditis trial, a multicentre international randomized double‐blind placebo‐controlled factorial study that investigated the effects of two TB treatments, prednisolone and Mycobacterium indicus pranii immunotherapy in patients with TBP in Africa. This study used a sample size of 587 TBP and HIV‐positive patients randomized into prednisolone and its corresponding placebo arm. We used the extended Cox‐proportional hazard model to evaluate the effects of the covariates on the hazard of the survival outcomes. Models fitting and parameter estimation were carried out using R version 4.3.1.ResultsPrednisolone reduces the hazard of composite outcome (hazrad ratio [HR] = 0.32, 95% confidence interval [CI] = , p < 0.001), cardiac tamponade (HR = 0.14, 95% CI = 0.05, 0.42, p < 0.001) and constriction (HR = 0.81, 95% CI = 0.41, 1.61, p = 0.55). However, prednisolone increases the hazard of death (HR = 1.58, 95% CI = 1.11, 2.24, p = 0.01). Consistent usage of ART reduces the hazard of composite outcome, death, and constriction but insignificantly increased the hazard of cardiac tamponade.ConclusionThe study offers valuable insights into how prednisolone impact the hazard of different outcomes in patients with TBP and HIV. The findings hold potential clinical significance, particularly in guiding treatment decisions and devising strategies to enhance outcomes in this specific patient group. However, there are concerns about prednisolone potentially increasing the risk of death due to HIV‐related death.

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Diagnosis of tuberculous aetiology in pericardial effusions

Cited by 66 publications

References 38 publications

The usefulness of adenosine deaminase in the diagnosis of tuberculous pericarditis

The usefulness of adenosine deaminase in the diagnosis of tuberculous pericarditis

Pericarditis tuberculosa: reporte de caso

Assessing the hazard of death, cardiac tamponade, and pericardial constriction among HIV and tuberculosis pericarditis patients using the extended Cox‐hazard model: Intervention study

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