Tuberculous Pericarditis—Own Experiences and Recent Recommendations

Dybowska, Małgorzata; Błasińska, Katarzyna; Gątarek, Juliusz; Klatt, Magdalena; Augustynowicz–Kopeć, Ewa; Tomkowski, Witold; Szturmowicz, Monika

doi:10.3390/diagnostics12030619

Cited by 9 publications

(5 citation statements)

References 52 publications

(95 reference statements)

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“…In endemic areas, 60% of LPE may be caused by tuberculosis, but it is rare in non-endemic areas [ 21 , 22 ]. In our study group, tuberculous pericarditis was recognized in only one patient [ 23 ]. Prognosis in patients with tuberculous pericarditis depends on early recognition and initiation of treatment [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Large Pericardial Effusion—Diagnostic and Therapeutic Options, with a Special Attention to the Role of Prolonged Pericardial Fluid Drainage

Dybowska¹,

Szturmowicz²,

Błasińska³

et al. 2022

Diagnostics

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Background: Large pericardial effusion (LPE) is associated with high mortality. In patients with cardiac tamponade or with suspected bacterial etiology of pericardial effusion, urgent pericardial decompression is necessary. Aim: The aim of the present retrospective study was to assess the short-term results of pericardial decompression combined with prolonged drainage in LPE. Material: This study included consecutive patients with LPE who had been treated with pericardial fluid drainage between 2007 and 2017 in the National Tuberculosis and Lung Diseases Research Institute. Methods: Echocardiographic examination was used to confirm LPE and the signs of cardiac tamponade. Pericardiocentesis or surgical decompression were combined with pericardial fluid (PF) drainage. Short-term effectiveness of therapy was defined as less than 5 mm of fluid behind the left ventricular posterior wall in echocardiography. Results: The analysis included 74 patients treated with pericardial fluid drainage (33 female and 41 male), mean age 58 years, who underwent pericardial decompression. Out of 74 patients, 26 presented with cardiac tamponade symptoms. Pericardiocentesis was performed in 18 patients and pericardiotomy in 56 patients. Median PF drainage duration was 13 days. In 17 out of 25 patients with neoplastic PF, intrapericardial cisplatin therapy was implemented. In 4 out of 49 patients with non-malignant PF, purulent pericarditis was recognized and intrapericardial fibrinolysis was used. Short-term effectiveness of the therapy was obtained in all of patients. Non-infective complications were noted in 16% of patients and infective ones in 10%. Conclusion: Pericardial decompression combined with prolonged PF drainage was safe and efficient method of LPE treatment.

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Section: Discussionmentioning

confidence: 99%

Large Pericardial Effusion—Diagnostic and Therapeutic Options, with a Special Attention to the Role of Prolonged Pericardial Fluid Drainage

Dybowska¹,

Szturmowicz²,

Błasińska³

et al. 2022

Diagnostics

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“…In a 2019 report of annual trends of patients admitted to US hospitals with constrictive pericarditis from 2005 to 2014, investigators found a stable prevalence of 9-10 cases per million [7]. Tuberculous pericarditis accounts for 1% of all forms of tuberculosis and 1-2% of extrapulmonary tuberculosis [8]. Most data regarding TBP come from developing countries with a high tuberculosis burden and frequent coinfection with M. tuberculosis and HIV.…”

Section: Epidemiologymentioning

confidence: 99%

“…Most data regarding TBP come from developing countries with a high tuberculosis burden and frequent coinfection with M. tuberculosis and HIV. In these geographic regions, TBP accounts for 50-70% of effusive pericarditis in HIV-negative patients and more than 90% in HIV-positive patients [8]. In industrialized countries, tuberculosis accounts for only 4% of cases of pericardial effusion and an even smaller proportion of constrictive pericarditis.…”

Section: Epidemiologymentioning

confidence: 99%

Constrictive Pericarditis Secondary to Tuberculosis Infection: Literature Review

Coral

2022

JOCCT

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Tuberculous pericarditis is produced by Mycobacterium tuberculosis, accounting for 1% of all forms of tuberculosis. Its prevalence varies according to coinfection with HIV. Mortality varies between 17 and 40%. In the US, the prevalence is low compared to developing countries. This article aims to review the literature on pericarditis caused by tuberculosis (TBP), its prevalence in the US, clinical manifestations, diagnosis, and treatment. Among the most frequent clinical manifestations are dyspnea, fever, chest pain, and cough. TBP should be suspected in patients at high risk of exposure to tuberculosis. There are multiple lab tests for diagnosis, and its primary treatment is triple therapy with isoniazid, rifampin, and streptomycin or ethambutol. In case of persistent elevation of systemic venous pressure, surgical intervention is indicated. The clinical presentation was found to be variable.

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“…Even if pericardial fluid is obtained, conventional acid-fast bacilli (AFB) smear and culture of the fluid have limited diagnostic accuracy. 12 …”

Section: Introductionmentioning

confidence: 99%

“…Even if pericardial fluid is obtained, conventional acid-fast bacilli (AFB) smear and culture of the fluid have limited diagnostic accuracy. 12 Nucleic acid amplification tests (NAATs) are a mainstay in the diagnosis of infectious diseases, greatly improving the rate and shortening the time required for the establishment of infectious disease etiology, including TB. 13,14 NAATs are also useful in TBP as they improve its diagnostic rate.…”

Section: Introductionmentioning

confidence: 99%

Clinical Application of the Mycobacterium tuberculosis-RNA Assay of Pericardial Tissue Specimens in the Diagnosis of Tuberculous Pericarditis

Zhang¹,

Bu²,

Yao³

et al. 2023

IDR

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Purpose To assess the accuracy of the Mycobacterium tuberculosis (MTB)-RNA assay using pericardial tissue specimens for tuberculous pericarditis (TBP) diagnosis. Methods MTB culture and MTB-RNA assay were performed for patients with suspected TBP. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of these two assays were analyzed. Results This study included 79 patients. The sensitivity, specificity, PPV, NPV, and AUC were 28.1% (18/64), 100.0% (15/15), 100.0% (18/18), 24.6% (15/61), and 0.64 for the MTB culture and 37.5% (24/64), 100.0% (15/15), 100.0% (24/24), 27.3% (15/55), and 0.69 for the MTB-RNA assay, respectively. Patients with positive pericardial tissue culture were defined as having definite TBP; in other words, culture was the gold standard for this group of patients and had a sensitivity, specificity, PPV, and NPV of 100% and an AUC of 1.00. However, these values were found to be 72.2% (13/18), 100.0% (15/15), 100.0% (13/13), 75.0% (15/20), and 0.86 for the MTB-RNA assay, respectively. Among patients with probable TBP (culture-negative patients), the sensitivity, specificity, NPV, and AUC of MTB culture were 0.0% (0/46), 100.0% (15/15), 24.6% (15/61), and 0.50, respectively, but the PPV could not be determined. These values were found to be 23.9% (11/46), 100.0% (15/15), 100.0% (11/11), 30.0% (15/50), and 0.62 for the MTB-RNA assay, respectively. Conclusion MTB-RNA assay using pericardial tissues had limited diagnostic efficacy for TBP. In culture-positive TBP, the diagnostic accuracy of MTB-RNA was good. In contrast, in culture-negative TBP, its diagnostic accuracy was unsatisfactory.

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Tuberculous Pericarditis—Own Experiences and Recent Recommendations

Cited by 9 publications

References 52 publications

Large Pericardial Effusion—Diagnostic and Therapeutic Options, with a Special Attention to the Role of Prolonged Pericardial Fluid Drainage

Large Pericardial Effusion—Diagnostic and Therapeutic Options, with a Special Attention to the Role of Prolonged Pericardial Fluid Drainage

Constrictive Pericarditis Secondary to Tuberculosis Infection: Literature Review

Clinical Application of the Mycobacterium tuberculosis-RNA Assay of Pericardial Tissue Specimens in the Diagnosis of Tuberculous Pericarditis

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