II. Epidemiology
- Most common cause of Pericarditis worldwide in the developing world
- Incidence of Tuberculous Pericarditis may be as high as 70% in Africa
III. Pathophysiology
-
Mycobacteria enter pericardial space via lymphatic or hematogenous spread
- Once in the Pericardium, Mycobacteria trigger a strong, delayed Hypersensitivity Reaction
- Stages: Pericardium Contents
- Stage 1: Acid-fast bacilli, PMNs and a Fibrinous exudate (classic Pericarditis symptoms)
- Stage 2: Lymphocytic exudate, serosanguinous effusion (CHF or Cardiac Tamponade presentation)
- Stage 3: Pericardial thickening, Granulomas, fibrosis (Constrictive pericardititis)
- Stage 4: Scarring of the Pericardium (Constrictive pericardititis)
IV. Risk Factors
- Most Tuberculous Pericarditis patients also have HIV Infection
V. Symptoms
- Fever
- Night Sweats
- Weight loss
VI. Signs
- See Pericarditis
- Pericarditis Friction Rub
- Exudative Pericardial Effusion
VII. Differential Diagnosis
VIII. Diagnosis
- Empiric diagnosis in endemic, developing regions with low resources OR
-
Pericardiocentesis
- Adenosine deaminase (ADA) in pericardial fluid is a specific marker for Tuberculosis
- Acid Fast Bacteria may also be seen in pericardial fluid
- Pericardial fluid culture has highest sensitivity for acid fast Bacteria (but requires weeks of growth)
IX. Labs
- Serum globulin increased
- Leukocytosis
X. Management
- Anti-Tuberculosis medications
- See Active Tuberculosis Treatment
- Consult infectious disease
- Starts with 4 drug therapy for first 2 months (then 2 drugs for another 4 months)
- Concurrent Prednisone taper may be considered
- Cardiac Complication management
- Consult cardiology
- Manage Congestive Heart Failure, Cardiac Tamponade, constrictive Pericarditis
XI. Complications
- Cardiac Tamponade
- Mortality 85% in untreated cases
XII. References
- Klasek and Alblaihed (2023) Crit Dec Emerg Med 37(6): 4-11
- Reuter (2006) Q J Med 99:827-39 [PubMed]