The role of histopathology in establishing the diagnosis of tuberculous pericardial effusions in the presence of HIV

Reuter, Helmuth; Schneider, Johann; Vuuren, W Van; Doubell, Anton

doi:10.1111/j.1365-2559.2005.02320.x

Cited by 34 publications

(20 citation statements)

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“…This question is relevant because IL-13-secreting CD4 + T H 2 cells, which are reduced by HIV, regulate fibrogenesis directly, through stimulating collagen synthesis by fibroblasts and indirectly by promoting TGF-β1 production by macrophages [6]. Furthermore, fewer granulomata have been observed in HIV infected tuberculous pericarditis patients with severely depleted CD4 lymphocytes, suggesting that there may be less propensity to develop pericardial fibrosis in HIV-infected individuals with tuberculous pericardial effusion [7].…”

Section: Introductionmentioning

confidence: 99%

HIV Infection Is Associated with a Lower Incidence of Constriction in Presumed Tuberculous Pericarditis: A Prospective Observational Study

et al. 2008

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BackgroundPericardial constriction is a serious complication of tuberculous pericardial effusion that occurs in up to a quarter of patients despite anti-tuberculosis chemotherapy. The impact of human immunodeficiency virus (HIV) infection on the incidence of constrictive pericarditis following tuberculous pericardial effusion is unknown.Methods and ResultsWe conducted a prospective observational study to determine the association between HIV infection and the incidence of constrictive pericarditis among 185 patients (median age 33 years) with suspected tuberculous pericardial effusion. These patients were recruited consecutively between March and October 2004 on commencement of anti-tuberculosis treatment, from 15 hospitals in Cameroon, Nigeria and South Africa. Surviving patients (N = 119) were assessed for clinical evidence of constrictive pericarditis at 3 and 6 months of follow-up. Clinical features of HIV infection were present in 42 (35.2%) of the 119 patients at enrolment into the study. 66 of the 119 (56.9%) patients consented to HIV testing at enrolment. During the 6 months of follow-up, a clinical diagnosis of constrictive pericarditis was made in 13 of the 119 patients (10.9 %, 95% confidence interval [CI] 5.9–18%). Patients with clinical features of HIV infection appear less likely to develop constriction than those without (4.8% versus 14.3%; P = 0.08). None of the 33 HIV seropositive patients developed constriction, but 8 (24.2%, 95%CI 11.1–42.3%) of the 33 HIV seronegative patients did (P = 0.005). In a multivariate logistic regression model adjusting simultaneously for several baseline characteristics, only clinical signs of HIV infection were significantly associated with a lower risk of constriction (odd ratio 0.14, 95% CI 0.02–0.87, P = 0.035).ConclusionsThese data suggest that HIV infection is associated with a lower incidence of pericardial constriction in patients with presumed tuberculous pericarditis.

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Section: Introductionmentioning

confidence: 99%

HIV Infection Is Associated with a Lower Incidence of Constriction in Presumed Tuberculous Pericarditis: A Prospective Observational Study

et al. 2008

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“…16 Recent data suggest that the histological pattern is affected by the immune status of the patient, with fewer granulomas being observed in HIV-infected patients with severely depleted CD4 lymphocytes. 17 The lymphatic drainage of the pericardium is primarily to the anterior and posterior mediastinal and tracheobronchial lymph nodes and is reflected by the pattern of lymphadenopathy seen in tuberculous pericarditis. 18 The mediastinal node enlargement of tuberculous pericardial effusion is not visible on a routine chest radiograph but can be seen on CT or MRI.…”

Section: Pathogenesis Of Tuberculous Pericarditismentioning

confidence: 99%

Tuberculous Pericarditis

2005

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Background-The incidence of tuberculous pericarditis is increasing in Africa as a result of the human immunodeficiency virus (HIV) epidemic. The primary objective of this article was to review and summarize the literature on the pathogenesis, diagnosis, and management of tuberculous pericarditis. Methods and Results-We searched MEDLINE (January 1966 to May 2005 and the Cochrane Library (Issue 1, 2005) for information on relevant references. A "definite" diagnosis of tuberculous pericarditis is based on the demonstration of tubercle bacilli in pericardial fluid or on a histological section of the pericardium; "probable" tuberculous pericarditis is based on the proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis, a lymphocytic pericardial exudate with elevated adenosine deaminase levels, and/or appropriate response to a trial of antituberculosis chemotherapy. Treatment consists of the standard 4-drug antituberculosis regimen for 6 months. It is uncertain whether adjunctive corticosteroids are effective in reducing mortality or progression to constriction. Surgical resection of the pericardium remains the appropriate treatment for constrictive pericarditis. The timing of surgical intervention is controversial, but many experts recommend a trial of medical therapy for noncalcific pericardial constriction, and pericardiectomy in nonresponders after 4 to 8 weeks of antituberculosis chemotherapy.

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“…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. With the high morbidity and mortality associated with tuberculous pericarditis, especially in persons living with HIV/AIDS, current efforts towards the development of a highly sensitive and/or specific test are solicited.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of pericardial diseases in Africa: a systematic scoping review

Noubiap

Agbor

Ndoadoumgue

et al. 2018

Heart

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ObjectivesThis scoping review sought to summarise available data on the prevalence, aetiology, diagnosis, treatment and outcome of pericardial disease in Africa.MethodsWe searched PubMed, Scopus and African Journals Online from 1 January 1967 to 30 July 2017 to identify all studies published on the prevalence, aetiologies, diagnosis, treatment and outcomes of pericardial diseases in adults residing in Africa.Results36 studies were included. The prevalence of pericardial diseases varies widely according to the population of interest: about 1.1% among people with cardiac complaints, between 3.3% and 6.8% among two large cohorts of patients with heart failure and up to 46.5% in an HIV-infected population with cardiac symptoms. Tuberculosis is the most frequent cause of pericardial diseases in both HIV-uninfected and HIV-infected populations. Patients with tuberculous pericarditis present mostly with effusive pericarditis (79.5%), effusive constrictive pericarditis (15.1%) and myopericarditis (13%); a large proportion of them (up to 20%) present in cardiac tamponade. The aetiological diagnosis of pericardial diseases is challenging in African resource-limited settings, especially for tuberculous pericarditis for which the diagnosis is not definite in many cases. The outcome of these diseases remains poor, with mortality rates between 18% and 25% despite seemingly appropriate treatment approaches. Mortality is highest among patients with tuberculous pericarditis especially those coinfected with HIV.ConclusionPericardial diseases are a significant cause of morbidity and mortality in Africa, especially in HIV-infected individuals. Tuberculosis is the most frequent cause of pericardial diseases, and it is associated with poor outcomes.

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The role of histopathology in establishing the diagnosis of tuberculous pericardial effusions in the presence of HIV

Cited by 34 publications

References 34 publications

HIV Infection Is Associated with a Lower Incidence of Constriction in Presumed Tuberculous Pericarditis: A Prospective Observational Study

HIV Infection Is Associated with a Lower Incidence of Constriction in Presumed Tuberculous Pericarditis: A Prospective Observational Study

Tuberculous Pericarditis

Epidemiology of pericardial diseases in Africa: a systematic scoping review

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