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| {{Pericarditis}} | | {{Tuberculous pericarditis}} |
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| {{CMG}} '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.
| | '''For patient information click, [[Pericarditis (patient information)|here]].''' |
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| ==Overview==
| | '''To go back to the main page on Pericarditis, click [[Pericarditis|here]].''' |
| The incidence of [[tuberculosis]] caused by ''[[Mycobacterium tuberculosis]]'' and its complications has significantly decreased in developed nations while it remains high in developing countries. Approximately 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 cases. [[TB]] accounts for 1.7 million deaths 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==
| | {{CMG}}; '''Associate Editors-In-Chief:''' {{Fs}}, [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. |
| 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>.
| | '''''Synonyms and keywords:''''' TB pericarditis |
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| ==Natural history and complications== | | == [[Tuberculous pericarditis overview|Overview]] == |
| Tuberculous pericarditis often has a complicated course and poor clinical outcomes. It can lead to '''[[pericardial effusion]]''' and subsequently, '''[[cardiac tamponade]]''' which may require urgent intervention including [[pericardiocentesis]]. The mortality rate of tuberculous pericarditis in the preantibiotic era was 80-90%<ref>Harvey AM, Whitehill MR. Tuberculous pericarditis. Medicine. 1937; 16: 45–94</ref>. The mortality rate in the modern era is currently 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 is 17-34% if the TB is 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 historical perspective|Historical Perspective]] == |
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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 classification|Classification]] == |
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| ==Pathophysiology== | | == [[Tuberculous pericarditis pathophysiology|Pathophysiology]] == |
| Tuberculous pericarditis develops as a result of 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 the 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 of involvement:<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 causes|Causes]] == |
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| :'''Stage 2:''' Development of serous or serosanguineous pericardial effusion with a predominantly lymphocytic exudate with monocytes and foam cells
| | == [[Pericarditis differential diagnosis|Differentiating Tuberculous Pericarditis from other Diseases]] == |
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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.
| | == [[Tuberculous pericarditis epidemiology and demographics|Epidemiology and Demographics]] == |
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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 risk factors|Risk Factors]] == |
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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 a 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 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]] |