Tuberculous pericarditis natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Natural History, Complications and Prognosis

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%[1]. The mortality rate in the modern era is currently 8-17%[2][3] and is 17-34% if the TB is associated with HIV[4].

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. In this region, TB pericarditis is a more common cause of heart failure than hypertensive heart disease and cardiomyopathy[5][6]

Constrictive pericarditis is another complication of tuberculous pericarditis occurring in 30-60% of patients despite prompt antituberculosis treatment and the use of corticosteroids[7][8]

References

  1. Harvey AM, Whitehill MR. Tuberculous pericarditis. Medicine. 1937; 16: 45–94
  2. Desai HN (1979). "Tuberculous pericarditis. A review of 100 cases". S Afr Med J. 55 (22): 877–80. PMID 472922.
  3. Bhan GL (1980). "Tuberculous pericarditis". J Infect. 2 (4): 360–4. PMID 7185934.
  4. Hakim JG, Ternouth I, Mushangi E, Siziya S, Robertson V, Malin A (2000). "Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients". Heart. 84 (2): 183–8. PMC 1760932. PMID 10908256.
  5. Strang JI (1984). "Tuberculous pericarditis in Transkei". Clin Cardiol. 7 (12): 667–70. PMID 6509811.
  6. Hakim JG, Manyemba J (1998). "Cardiac disease distribution among patients referred for echocardiography in Harare, Zimbabwe". Cent Afr J Med. 44 (6): 140–4. PMID 9810393.
  7. SCHRIRE V (1959). "Experience with pericarditis at Groote Schuur Hospital, Cape Town: an analysis of one hundred and sixty cases studied over a six-year period". S Afr Med J. 33: 810–7. PMID 14443596.
  8. Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J (1988). "Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment". J Am Coll Cardiol. 11 (4): 724–8. PMID 3351140.

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