Tuberculous pericarditis overview
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Differentiating Tuberculous pericarditis from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Fahimeh Shojaei, M.D., Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Historical Perspective
Classification
There is no established system for the classification of Tuberculous pericarditis.
Pathophysiology
Tuberculous pericarditis is the result of hematogenous or lymphatic spread of mycobacterium tuberculosis to the pericardium. This causes acute inflammation of the pericardium and we may have polymorphonuclear (PMN) and leukocytes infiltration in the pericardium. This may lead to pericardial effusion and fibrinous changes of the pericardium. The visceral pericardium thickens with fibrin deposition (changes of constrictive pericarditis). There are four pathologic stages of involvement: stage 1 is presence of diffuse fibrin deposition, granulomas and abundant mycobacterium. Stage 2 is development of serous or serosanguineous pericardial effusion with a predominantly lymphocytic exudate with monocytes and foam cells. Stage 3 is absorption of the effusion with organization of granulomatous caseation and thickening of pericardium secondary to deposition of fibrin and collagen. Stage 4 is development of constrictive pericarditis. The pericardial space is obliterated by dense adhesions with marked thickening of parietal layer and replacement of granulomas by fibrous tissue. Conditions associated with tuberculous pericarditis include pulmonary TB, HIV, malignancy, chemotherapy, and diabetes mellitus. On gross pathology, thickened pericardium, shaggy hemorrhage, and exudate are characteristic findings of tuberculous pericarditis. On microscopic histopathological analysis, acid fast bacilli is characteristic findings of tuberculous pericarditis.
Causes
Common cause of tuberculous pericarditis is lymphatic or hematogenous spread of mycobacterium tuberculosis to the pericardium.
Differentiating Tuberculous pericarditisfrom Other Diseases
Epidemiology and Demographics
The prevalence of tuberculous pericarditis is approximately 1-2% of patients with pulmonary tuberculosis. Patients of all age groups may develop tuberculous pericarditis. The incidence of tuberculous pericarditis increases with age. Tuberculous pericarditis commonly affects elderly. Tuberculous pericarditis usually affects individuals of the black race. Men are more commonly affected by tuberculous pericarditis than female. Since the prevalence of tuberculous pericarditis may follow tuberculosis prevalence, The majority of tuberculous pericarditis cases are reported in South Africa, Indonesia, Nigeria, Pakistan, India, and China.
Risk Factors
Common risk factors in the development of tuberculous pericarditis include immunodeficiency (AIDS, malignancy, chemotherapy, diabetes and elderly), TB exposure, male gender, and African-American race.
Screening
There is insufficient evidence to recommend routine screening for tuberculous pericarditis.
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Study of Choice
Pericardiocentesis is the gold standard test for the diagnosis of tuberculous pericarditis. Pericardial biopsy must be performed when we can't find acid fast bacilli in sputum or pericardial fluid. Finding acid fast bacilli on pericardiocentesis is confirmatory for tuberculous pericarditis.
History and Symptoms
Patients with tuberculous pericarditis may have a positive history of pulmonary TB, HIV infection, any Immune system dysfunction, elderly, black race, male gender, and living/traveling to TB endemic areas. Common symptoms of tuberculous pericarditis include fever, weight loss, night sweat, cough, breathlessness, chest pain, malaise, and ankle edema.