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| {{CMG}} '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S. | | __NOTOC__ |
| | {{Tuberculous pericarditis}} |
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| ==Overview==
| | '''For patient information click, [[Pericarditis (patient information)|here]].''' |
| The incidence of [[tuberculosis]] caused by ''[[Mycobacterium tuberculosis]]'' and its complications has significantly decreased in developed nations while its still seems to be high in developing countries. About one third of the world population is believed to be infected with [[tuberculosis]](TB)<ref name="pmid18810682">{{cite journal| author=Lönnroth K, Raviglione M| title=Global epidemiology of tuberculosis: prospects for control. | journal=Semin Respir Crit Care Med | year= 2008 | volume= 29 | issue= 5 | pages= 481-91 | pmid=18810682 | doi=10.1055/s-0028-1085700 | pmc= | url= }} </ref>. In 2006 [[WHO]] estimated the global prevalence of active [[TB]]<ref>WHO. Global Tuberculosis control. WHO/HTM/TB/2008.393. Geneva: World Health Organization; 2008. Available online at http://www.who.int/tb/publications/global_report/2008/en/index.html (Accessed June 27, 2011)</ref> to be 14.4 million with incidence of 9.2 million. And [[TB]] related death accounted for 1.7 million worldwide. One of the important complications of [[TB]] is [[pericarditis]] which is the inflammation of pericardial sac that encases heart.
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| ==Epidemiology and demographics==
| | '''To go back to the main page on Pericarditis, click [[Pericarditis|here]].''' |
| Tuberculous pericarditis is found in approximately 1-2% of patients with [[pulmonary tuberculosis]]<ref name="pmid2046135">{{cite journal| author=Fowler NO| title=Tuberculous pericarditis. | journal=JAMA | year= 1991 | volume= 266 | issue= 1 | pages= 99-103 | pmid=2046135 | doi= | pmc= | url= }} </ref><ref name="pmid7377888">{{cite journal| author=Larrieu AJ, Tyers GF, Williams EH, Derrick JR| title=Recent experience with tuberculous pericarditis. | journal=Ann Thorac Surg | year= 1980 | volume= 29 | issue= 5 | pages= 464-8 | pmid=7377888 | doi= | pmc= | url= }} </ref>. It is the most common cause of pericarditis in Africa and other developing countries where TB is a major public health problem<ref>Mayosi BM, Volmink JA, Commerford PJ. Pericardial disease: an evidence-based approach to diagnosis and treatment. In: Yusuf S, Cairns JA, Camm AJ, Fallen BJ, eds. Evidence-Based Cardiology. 2nd ed. London: BMJ Books; 2003: 735–748.</ref>. The incidence is increasing rapidly in presence of [[HIV]]<ref name="pmid1967676">{{cite journal| author=Cegielski JP, Ramiya K, Lallinger GJ, Mtulia IA, Mbaga IM| title=Pericardial disease and human immunodeficiency virus in Dar es Salaam, Tanzania. | journal=Lancet | year= 1990 | volume= 335 | issue= 8683 | pages= 209-12 | pmid=1967676 | doi= | pmc= | url= }} </ref>.
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| In a study at Western Cape Province of South Africa, tuberculous pericarditis was noted in 69.5% of patients who were referred for diagnostic [[pericardiocentesis]] and one half of the patients were infected with [[HIV]]<ref name="pmid15962545">{{cite journal| author=Reuter H, Burgess LJ, Doubell AF| title=Epidemiology of pericardial effusions at a large academic hospital in South Africa. | journal=Epidemiol Infect | year= 2005 | volume= 133 | issue= 3 | pages= 393-9 | pmid=15962545 | doi= | pmc=PMC2870262 | url= }} </ref>. In contrast, the incidence of tuberculous pericarditis is 4% in developed countries<ref name="pmid3351140">{{cite journal| author=Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J| title=Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment. | journal=J Am Coll Cardiol | year= 1988 | volume= 11 | issue= 4 | pages= 724-8 | pmid=3351140 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3351140 }} </ref>.
| | {{CMG}}; '''Associate Editors-In-Chief:''' {{Fs}}, [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. |
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| ==Natural history and complications==
| | '''''Synonyms and keywords:''''' TB pericarditis |
| Tuberculous pericarditis often has a complicated course with worse outcomes. It can lead to '''[[pericardial effusion]]''' and subsequently, '''[[cardiac tamponade]]''' which may require urgent intervention including [[pericardiocentesis]]. Mortality rate of tuberculous pericarditis in preantibiotic era was 80-90%<ref>Harvey AM, Whitehill MR. Tuberculous pericarditis. Medicine. 1937; 16: 45–94</ref>. Mortality rate currently is 8-17%<ref name="pmid472922">{{cite journal| author=Desai HN| title=Tuberculous pericarditis. A review of 100 cases. | journal=S Afr Med J | year= 1979 | volume= 55 | issue= 22 | pages= 877-80 | pmid=472922 | doi= | pmc= | url= }} </ref><ref name="pmid7185934">{{cite journal| author=Bhan GL| title=Tuberculous pericarditis. | journal=J Infect | year= 1980 | volume= 2 | issue= 4 | pages= 360-4 | pmid=7185934 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7185934 }} </ref> and 17-34% if associated with HIV<ref name="pmid10908256">{{cite journal| author=Hakim JG, Ternouth I, Mushangi E, Siziya S, Robertson V, Malin A| title=Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients. | journal=Heart | year= 2000 | volume= 84 | issue= 2 | pages= 183-8 | pmid=10908256 | doi= | pmc=PMC1760932 | url= }} </ref>.
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| Tuberculous pericarditis can also cause '''[[heart failure]]''' as observed in Eastern Cape and Zimbabwe where it is a common cause, but less common than [[rheumatic heart disease]] and more common than [[hypertensive heart disease]] and [[cardiomyopathy]]<ref name="pmid6509811">{{cite journal| author=Strang JI| title=Tuberculous pericarditis in Transkei. | journal=Clin Cardiol | year= 1984 | volume= 7 | issue= 12 | pages= 667-70 | pmid=6509811 | doi= | pmc= | url= }} </ref><ref name="pmid9810393">{{cite journal| author=Hakim JG, Manyemba J| title=Cardiac disease distribution among patients referred for echocardiography in Harare, Zimbabwe. | journal=Cent Afr J Med | year= 1998 | volume= 44 | issue= 6 | pages= 140-4 | pmid=9810393 | doi= | pmc= | url= }} </ref>
| | == [[Tuberculous pericarditis overview|Overview]] == |
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| '''[[Constrictive pericarditis]]''' is another complication of tuberculous pericarditis occurring in 30-60% of patients despite prompt antituberculosis treatment and the use of corticosteroids<ref name="pmid14443596">{{cite journal| author=SCHRIRE V| title=Experience with pericarditis at Groote Schuur Hospital, Cape Town: an analysis of one hundred and sixty cases studied over a six-year period. | journal=S Afr Med J | year= 1959 | volume= 33 | issue= | pages= 810-7 | pmid=14443596 | doi= | pmc= | url= }} </ref><ref name="pmid3351140">{{cite journal| author=Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J| title=Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment. | journal=J Am Coll Cardiol | year= 1988 | volume= 11 | issue= 4 | pages= 724-8 | pmid=3351140 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3351140 }} </ref>
| | == [[Tuberculous pericarditis historical perspective|Historical Perspective]] == |
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| ==Pathophysiology== | | == [[Tuberculous pericarditis classification|Classification]] == |
| Tuberculous pericarditis develop from lymphatic spread from peritracheal, peribronchial or [[mediastinal lymphnodes]] or by contiguous spread from a focus of infection in lung or pleura. This causes acute inflammation of pericardium with infiltration of polymorphonuclear (PMN) leukocytes and pericardial vascularization. This may lead to [[pericardial effusion]] and fibrinous change of pericardium. There are four pathologic stages observed:<ref name="pmid18610109">{{cite journal| author=Peel AA| title=TUBERCULOUS PERICARDITIS. | journal=Br Heart J | year= 1948 | volume= 10 | issue= 3 | pages= 195-207 | pmid=18610109 | doi= | pmc=PMC481044 | url= }} </ref><ref name="pmid4050698">{{cite journal| author=Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J| title=Primary acute pericardial disease: a prospective series of 231 consecutive patients. | journal=Am J Cardiol | year= 1985 | volume= 56 | issue= 10 | pages= 623-30 | pmid=4050698 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4050698 }} </ref><ref name="pmid16330703">{{cite journal| author=Mayosi BM, Burgess LJ, Doubell AF| title=Tuberculous pericarditis. | journal=Circulation | year= 2005 | volume= 112 | issue= 23 | pages= 3608-16 | pmid=16330703 | doi=10.1161/CIRCULATIONAHA.105.543066 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16330703 }} </ref>
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| :'''Stage 1:''' Presence of diffuse fibrin deposition, granulomas and abundant mycobacterium
| | == [[Tuberculous pericarditis pathophysiology|Pathophysiology]] == |
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| :'''Stage 2:''' Development of serous or serosanguineous pericardial effusion with a predominantly lymphocytic exudate with monocytes and foam cells
| | == [[Tuberculous pericarditis causes|Causes]] == |
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| :'''Stage 3:''' Absorption of effusion with organization of granulomatous caseation and thickening of pericardium secondary to deposition of fibrin and collagen.
| | == [[Pericarditis differential diagnosis|Differentiating Tuberculous Pericarditis from other Diseases]] == |
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| :'''Stage 4:''' Development of constrictive pericarditis. Pericardial space is obliterated by dense adhesions with marked thickening of parietal layer and replacement of granulomas by fibrous tissue.
| | == [[Tuberculous pericarditis epidemiology and demographics|Epidemiology and Demographics]] == |
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| Effusive constrictive pericarditis may be seen in some patients. The visceral pericardium thickens with fibrin deposition (changes of [[constrictive pericarditis]]) and concomitantly there is presence of pericardial effusion which may present as [[cardiac tamponade]]. In this scenario, the [[diastolic pressure]] continues to be elevated after pericardiocentesis due to persistent constriction.
| | == [[Tuberculous pericarditis risk factors|Risk Factors]] == |
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| | == [[Tuberculous pericarditis screening|Screening]] == |
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| | == [[Tuberculous pericarditis natural history|Natural History, Complications and Prognosis]] == |
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| ==Diagnosis== | | ==Diagnosis== |
| Tuberculous pericarditis has a variable clinical presentation and should be considered in the evaluation of all cases of pericarditis without a rapidly self-limited course<ref name="pmid3351140">{{cite journal| author=Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J| title=Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment. | journal=J Am Coll Cardiol | year= 1988 | volume= 11 | issue= 4 | pages= 724-8 | pmid=3351140 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3351140 }} </ref>. | | [[Tuberculous pericarditis diagnostic study of choice|Diagnostic study of choice]] | [[Tuberculous pericarditis history and symptoms|History and Symptoms]] | [[Tuberculous pericarditis physical examination|Physical Examination]] | [[Tuberculous pericarditis laboratory findings|Laboratory Findings]] | [[Tuberculous pericarditis electrocardiogram|Electrocardiogram]] | [[Tuberculous pericarditis x ray|X-Ray Findings]] | [[Tuberculous pericarditis echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Tuberculous pericarditis CT scan|CT-Scan Findings]] | [[Tuberculous pericarditis MRI|MRI Findings]] | [[Tuberculous pericarditis other imaging findings|Other Imaging Findings]] | [[Tuberculous pericarditis other diagnostic studies|Other Diagnostic Studies]] |
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| | ==Treatment== |
| | [[Tuberculous pericarditis medical therapy|Medical Therapy]] | [[Tuberculous pericarditis interventions|Interventions]] | [[Tuberculous pericarditis surgery|Surgery]] | [[Tuberculous pericarditis primary prevention|Primary Prevention]] | [[Tuberculous pericarditis secondary prevention|Secondary Prevention]] | [[Tuberculous pericarditis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Tuberculous pericarditis future or investigational therapies|Future or Investigational Therapies]] |
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| | ==Related Chapters== |
| | * [[Pericarditis]] |
| | * [[Tuberculosis]] |
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| | {{WH}} |
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| | {{WS}} |
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| | [[Category:Cardiology]] |
| | [[Category:Diseases involving the fasciae]] |
| | [[Category:Inflammations]] |
| | [[Category:Emergency medicine]] |
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| ==References==
| | [[Category:Tuberculosis]] |
| {{reflist|2}}
| | [[Category:Disease]] |