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Tuberculous Pericarditis

Pericarditides Tuberculous


Presentation

  • The SROC curve presented an area with a tendency towards 1 (value of 0.9539) and corroborates the diagnostic value of ADA activity.[ncbi.nlm.nih.gov]
Fever
  • The persistent fever and anemia were controlled after pericardiostomy. This is the report of a unique manifestation of Tb pericarditis as free floating masses in the effusion with impending tamponade.[ncbi.nlm.nih.gov]
  • The Tygerberg scoring system helps the clinician to decide whether pericarditis is due to tuberculosis or whether it is due to another cause: night sweats (1 point), weight loss (1 point), fever (2 point), serum globulin 40g/l (3 points), blood total[en.wikipedia.org]
Fatigue
  • ., and Antonio Freitas, M.D. 1 Citing Article A 29-year-old woman presented to the emergency department with a 1-month history of worsening fatigue and weakness and a 2-week history of fever and dyspnea.[nejm.org]
  • The signs and symptoms of chronic tuberculous pericarditis may include: A sharp chest pain A stabbing pain in the left side of the chest A persistent cough Fever Night sweats Fatigue and feelings of weakness Unexplained weight loss Breathing difficulty[home-remedies-for-you.com]
  • Tuberculous pericarditis manifests with fatigue, shortness of breath, and swelling of the body, and can cause death.[doi.org]
  • […] variable clinical presentation and should be considered in the evaluation of all cases of pericarditis without a rapidly self-limiting course. [6] Tuberculous pericardial effusion develops insidiously, presenting with symptoms such as fever, night sweats, fatigue[ijmm.org]
  • […] immmuno suppression therapy. 3 It remains a serious condition as there is a high incidence of progression to constrictive pericarditis with a high mortality rate. 5 TB pericarditis has varying clinical presentations; usually with fever, night sweats, fatigue[jpma.org.pk]
Italian
  • […] tuberculose; pericard , pericarditis tuberculeus , Pericarditis tuberculosa Portuguese Pericardite tuberculosa , Pericardite Tuberculosa German tuberkuloese Perikarditis , Perikarditis, tuberkulöse , Tuberkulöse Perikarditis French Péricardite tuberculeuse Italian[fpnotebook.com]
Sepsis
  • Merx MW, Weber C (2007) Sepsis and the heart. Circulation 116(7):793–802 PubMed CrossRef Google Scholar 40. Ntsekhe M, Mayosi BM (2009) Cardiac manifestations of HIV infection: an African perspective.[springerlink.com]
  • The aetiological causes for the non-tuberculous group included malignancy ( n 6), sepsis ( n 2), uraemia ( n 2), post-trauma ( n 2), rheumatoid arthritis ( n 1), scleroderma ( n 1) and systemic lupus erythematosus ( n 1).[doi.org]
Burkina Faso
  • Niakara A, Kambire Y, Drabo YJ (2001) Pericarditis in HIV infected patients: retrospective study of 40 cases in Ouagadougou, Burkina Faso. Sante 11(3):167–172 PubMed Google Scholar 37.[springerlink.com]
Painful Cough
  • , cough, breathlessness, although severe pericardial pain of acute onset of idiopathic pericarditis is unusual.[ijmm.org]
  • , cough, and breathlessness are common, 22–24 although severe pericardial pain of acute onset characteristic of idiopathic pericarditis is unusual. 21,22,25 Right upper abdominal aching owing to liver congestion has also been described. 22,23,26 In African[circ.ahajournals.org]
Hoarseness
  • Abstract A 16-years-old Egyptian girl presented with massive pericardial effusion, fever, weight loss and hoarseness of voice. Laryngoscopy showed left vocal cord paralysis.[ncbi.nlm.nih.gov]
Tachycardia
  • An electrocardiogram showed sinus tachycardia and low-voltage complexes in the limb and precordial leads. Transthoracic echocardiography revealed a large pericardial effusion with evidence of tamponade (Panel A [arrow] and Video 1 ).[nejm.org]
  • Wide QRS tachycardias, catheter ablation and cardiac resynchronization therapy are also prominently detailed. The use of intracardiac echocardiography in various interventions.[books.google.com]
  • The most frequent signs are cardiomegaly, pericardial friction and tachycardia. Paradoxical pulse, hepatomegaly, jugular stasis and pleural effusion may still be included [ 3 ].[omicsonline.org]
  • Weight loss 64% 94% 79% 44% Cough 87% 93% 0.32 90% 69% 0.0002 Dyspnoea 80% 93% 0.25 86% 73% 0.03 Orthopnoea 44% 32% 0.08 38% 41% 0.71 Chest pain 30% 23% 0.22 27% 51% 0.001 Lymphadenopathy 22% 51% 36% 20% 0.009 Pleural effusion 42% 34% 0.25 38% 41% 0.71 Tachycardia[doi.org]
  • As for signs, the most frequent are cardiomegaly, pericardial rub, fever, and tachycardia. Other findings may include pulsus paradoxicus, hepatomegaly, distended neck veins, pleural effusion, and distant heart tones [ 1–8 ].[academic.oup.com]
Pericardial Friction Rub
  • It is called a pericardial friction rub. It sounds like a grating noise. This does not occur in all cases. Other conditions can cause similar symptoms to pericarditis.[patient.info]
  • A pericardial friction rub may be heard at the left sternal border but this disappears when fluid accumulates.[southsudanmedicaljournal.com]
  • The fully expressed syndrome consists of pleuritic chest pain, fever, leukocytosis, and a pericardial friction rub.[clevelandclinicmeded.com]
  • friction rub 16 (18) … Hepatomegaly 84 (95) 67 (100) Ascites 64 (73) 60 (89) Edema 22 (25) 63 (94) Diagnosis of Pericardial Effusion The advent of echocardiography has made it possible to achieve an accurate, noninvasive method of diagnosing the presence[circ.ahajournals.org]
Retrosternal Chest Pain

Workup

  • The appropriate diagnostic workup and optimal therapeutic management are not well defined. We present 10 new cases of tuberculous pericarditis and review the relevant literature.[ncbi.nlm.nih.gov]
  • Close follow-up should be assured so that, if there is an inadequate response to therapy, alternative diagnoses can be considered and a more exhaustive diagnostic workup can be undertaken.[hivinsite.ucsf.edu]
  • In an attempt to improve the yield and shorten the time of the diagnostic workup, recent studies have utilized molecular biology techniques.[academic.oup.com]
  • Multimodality cardiovascular imaging and diagnostic work-up 4.1 Multimodality imaging 4.1.1 Chest X-ray 4.1.2 Echocardiography 4.1.6 Cardiac catheterization 4.1.7 Multimodality imaging 4.2 Proposal for a general diagnostic workup 5.[escardio.org]
  • […] is made when there is proof of TB elsewhere in a patient with unexplained pericarditis, a lymphocytic pericardial exudate with elevated ADA levels, and/or a good response to antituberculosis chemotherapy. 3,57 An integrated approach to the diagnostic workup[circ.ahajournals.org]
Pericardial Effusion
  • Tuberculous pericardial effusions were diagnosed according to predetermined criteria. RESULTS: The diagnosis of tuberculous pericarditis was made in 53% (n 90) of patients with pericardial effusions.[ncbi.nlm.nih.gov]
  • In our study, ADA activity was significantly elevated in tuberculous pericardial effusions compared to non-tuberculous pericardial effusions.[doi.org]
Streptococcus Pneumoniae
  • Louw A, Tikly M (2007) Purulent pericarditis due to co-infection with Streptococcus pneumoniae and Mycobacterium tuberculosis in a patient with features of advanced HIV infection. BMC Infect Dis 7:12 PubMed CrossRef Google Scholar 50.[springerlink.com]
Colitis
  • Clostridium difficile can cause pseudomembranous colitis (PMC). Antimicrobial agent exposure is a risk factor for Clostridium difficile-associated disease, whereas the use of antituberculous (anti-TB) agents is not.[ncbi.nlm.nih.gov]

Treatment

  • Prompt and effective treatment is essential to reduce morbidity and mortality.[ncbi.nlm.nih.gov]
  • There are no randomized trials which evaluate the length of anti-tuberculosis treatment required for tuberculous pericarditis. There is a small but not conclusive benefit for treatment with a schedule of steroids with anti-tuberculosis drugs.[en.wikipedia.org]

Prognosis

  • Diagnosis is often challenging, while proper treatment has a major impact on prognosis.[ncbi.nlm.nih.gov]
  • The prognosis depends on the complications of pericarditis, the underlying etiology, and the associated co-morbidities. Pericarditis secondary to malignancy, MI, autoimmune disease and renal failure carries a poor prognosis.[wikidoc.org]
  • Pericardial syndromes 3.1 Acute pericarditis 3.1.1 Clinical management and therapy 3.1.2 Prognosis 3.2 Incessant and chronic pericarditis 3.3 Recurrent pericarditis 3.3.1 Therapy 3.3.2 Prognosis 3.4 Pericarditis associated with myocardial involvement[escardio.org]

Etiology

  • Opportunistic infections and neoplastic processes represent the most common etiology of pericardial disease. Pericardial tuberculosis is an uncommon condition, especially in developed countries.[ncbi.nlm.nih.gov]
  • ) , pericardium; tuberculous (manifestation) , tuberculosis; pericardium (etiology) , tuberculosis; pericardium (manifestation) Swedish Hjärtsäcksinflammation, tuberkulös Japanese ケッカクセイシンマクエン , 結核性心膜炎 , 心膜炎-結核性 Finnish Tuberkuloottinen sydänpussitulehdus[fpnotebook.com]

Epidemiology

  • Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, E-17 New Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa. mpiko.ntsekhe@uct.ac.za Abstract The human immunodeficiency virus (HIV) has altered the epidemiology[ncbi.nlm.nih.gov]
  • […] incidence of TB pericarditis in patients with HIV infection and pericardial disease.(3,4) HIV testing often is readily available, even in resource-limited countries, and can increase the pretest probability of TB pericarditis significantly based on epidemiological[hivinsite.ucsf.edu]
  • McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, ON, Canada 5. University of Cape Town, Department of Statistical Sciences, Cape Town, South Africa 6.[evidence4health.org]
  • Reuter H, Burgess LJ, Doubell AF (2005) Epidemiology of pericardial effusions at a large academic hospital in South Africa. Epidemiol Infect 133(3):393–399 PubMed CrossRef Google Scholar 2.[springerlink.com]
  • Epidemiology, aetiology and classification of pericardial diseases 2.1 Epidemiology 2.2 Aetiology 3.[escardio.org]
Sex distribution
Age distribution

Pathophysiology

  • Myers RB, Spodick DH (1999) Constrictive pericarditis: clinical and pathophysiologic characteristics. Am Heart J 138(2 Pt 1):219–232 PubMed CrossRef Google Scholar 27. Little WC, Freeman GL (2006) Pericardial disease.[springerlink.com]
  • Pathophysiology of the Pericardium. Progress in cardiovascular diseases. 2016. Tse G, Ali A, Alpendurada F, et al. Tuberculous Constrictive Pericarditis. Res Cardiovasc Med. 2015;4:e29614. Syed FF, Mayosi BM.[alliedacademies.org]
  • Pathophysiology The initiating event results in a chronic inflammatory pericardial process, resulting in fibrinous scarring and occasionally calcification of the pericardium ( Figure 10 ).[clevelandclinicmeded.com]

Prevention

  • Corticosteroids probably offer some benefit in preventing fluid reaccumulation as well. The data are inconclusive regarding whether open drainage or corticosteroid use prevents progression to constrictive pericarditis.[ncbi.nlm.nih.gov]
  • Open surgical drainage of fluid though effective in preventing cardiac tamponade was associated with more deaths.[en.wikipedia.org]

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