Myopericarditis in tuberculous pericardial effusion: prevalence, predictors and outcome

Abstract

Myopericarditis is common in TB pericardial effusion and associated with HIV-related immunosuppression. It can be identified by electrocardiographic ST-elevation, particularly when peripheral CD4 count is low. There was no significant difference in case fatality rate in those with or without myopericarditis.

Diagnosis and treatment of pericarditis

“…1–6 In developed countries with a low prevalence of tuberculosis (TB), more common causes include viral infections, systemic inflammatory diseases and cancer (especially lung and breast cancer or lymphomas and leukaemia) 5 11. In developing countries with a high prevalence of TB, TB, often with concomitant HIV-infection, is the more common cause of the disease (about two of three cases in Sub-Saharan Africa) 15 16. On this basis, the epidemiological background has to be considered when evaluating a patient with pericarditis 17…”

Epidemiology of pericardial diseases in Africa: a systematic scoping review

“…At 6-month follow-up, those with HIV-infection had a lower incidence of constriction 33. In another South African study of patients with TB pericarditis that looked more closely for evidence of myocardial injury, the proportion of patients with tuberculous myopericarditis was much higher at 53.1% 34. In a study of pericarditis in HIV-infected patients from Mali, the majority of participants presented with effusive pericarditis (55.1%) and 20.4% had evidence of cardiac tamponade 16…”

“…With regards to mortality, in those studies with the shortest follow-up (6 months), the mortality ranged from 18% in a single-centre South African experience34 to 27.6% in the multinational IMPI registry 35. A longer follow-up (12 months) did not appear to change the mortality rates that remained between 17%25 and 23.8% 36.…”

“…The low availability and affordability of microbiological tests and other relevant investigations in resource-poor settings make an accurate diagnosis very challenging. This is illustrated in the IMPI registry34 35 that reported that across the continent, the diagnosis of tuberculous pericarditis was made at the clinical discretion of the attending physician in the majority of cases34 with few centres adopting a standardised diagnostic approach to establishing a definitive diagnosis. In addition, the performances of culture-based and smear-based tests for tuberculous pericarditis are compromised due to a paucibacillary pericardial fluid (even though it may be multibacillary in advanced HIV48) in a greater majority of the patients,50 while the accuracy of histological diagnostic are reduced in the context of HIV infection as fewer granulomas are observed in those with severe immunosuppression 51.…”

Global health and cardiovascular disease

“…HIV infection also seems to be associated with sudden cardiac death and its burden is increased by the common association with Mycobacterium tuberculosis infection. In HIV-infected patients in sub-Saharan Africa, close to 100% of pericardial effusions are due to tuberculosis; the association with myopericarditis is common and an important part of it (40%) evolves with decreased LVEF 37. A factor of major relevance is that HIV-related cardiomyopathy is more common with increased immunosuppression and viraemia, whereas adequate antiretroviral therapy lowers its prevalence,38 implying that controlling this disease may reduce its CVD consequences.…”