Tuberculous Pericarditis

Abstract

Tuberculosis is responsible for approximately 4% of cases of acute pericarditis, 7% of cases of cardiac tamponade, and, in older studies, 6% of instances of constrictive pericarditis. However, in some nonindustrialized countries, tuberculosis is a leading cause of pericarditis. The diagnosis is based on demonstration of tubercle bacilli in pericardial fluid or on histologic section of the pericardium, or proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis. Treatment consists of triple drug therapy for at least 9 months (isoniazid, rifampin, and streptomycin or ethambutol). Pyrazinamide can be used for the first 2 months, and the total therapeutic period can then be shortened to 6 months after culture conversion. Three months of corticosteroid therapy may be useful in patients in whom pericardial effusion persists or recurs despite the use of antituberculous drugs. Surgical resection of the pericardium is indicated for recurrent or life-threatening tamponade, or when there is persistent elevation of systemic venous pressure unrelieved by pericardiocentesis. As many as one third to one half of patients will eventually require pericardiectomy despite adequate drug therapy.

Effects of pericardiectomy on early diastolic mitral annular velocity in patients with constrictive pericarditis

“…CP is a disease with an inflammatory process that involves the pericardium, leading to the encasement of the heart with pericardial thickening and calcification [17,18]. Pericardiectomy is a proven treatment for constrictive pericarditis, and the evaluation of effective pericardiectomy is important [1][2][3][4][5].…”

Acute tuberculous myopericarditis mimicking acute myocardial infarction: A case report and literature review

“…Among bacterial causes, tuberculosis is possibly the most important cause worldwide due to the high number of cases in developing countries, particularly in the setting of HIV coinfection (19,20). Tuberculous pericarditis caused by M. tuberculosis is found in ~1% of all autopsied cases of tuberculosis and in 1-2% of cases with pulmonary tuberculosis (21). In the present case, tubercle bacilli detected in a sputum smear and culture demonstrated indirectly the diagnosis of tuberculous myopericarditis based on the exclusion of viral infection, other bacterial infections and autoimmune disease.…”

Cardiogenic shock following cesarean delivery due to undiagnosed tuberculous constrictive pericarditis

“…4 Caused by mycobacterium tuberculosis, TB pericarditis is found in approximately 1% of all autopsies of TB cases and in 1-2% of cases with pulmonary TB. 5 TB pericarditis develops secondary to retrograde lymphatic spread from peritracheal, peribronchial, or mediastinal lymph nodes or by hema- togenous spread, and can result in cardiac tamponade. [6][7][8] Clinical signs are non-specific and include fever, night sweats, fatigue, chest pain, cough, and breathlessness.…”

“…14,15 Pericardial biopsies are often non-diagnostic. 5,16 Polymerase chain reaction testing is frequently unavailable and has only moderate sensitivity of 81%. 17 Serum antibody tests directed against specific tuberculoprotein epitopes have not offered significant diagnostic advantages.…”