II. Epidemiology

  1. Most common cause of Pericarditis worldwide in the developing world
  2. Incidence of Tuberculous Pericarditis may be as high as 70% in Africa

III. Pathophysiology

  1. Mycobacteria enter pericardial space via lymphatic or hematogenous spread
    1. Once in the Pericardium, Mycobacteria trigger a strong, delayed Hypersensitivity Reaction
  2. Stages: Pericardium Contents
    1. Stage 1: Acid-fast bacilli, PMNs and a Fibrinous exudate (classic Pericarditis symptoms)
    2. Stage 2: Lymphocytic exudate, serosanguinous effusion (CHF or Cardiac Tamponade presentation)
    3. Stage 3: Pericardial thickening, Granulomas, fibrosis (Constrictive pericardititis)
    4. Stage 4: Scarring of the Pericardium (Constrictive pericardititis)

IV. Risk Factors

  1. Most Tuberculous Pericarditis patients also have HIV Infection

V. Symptoms

  1. Fever
  2. Night Sweats
  3. Weight loss

VI. Signs

  1. See Pericarditis
  2. Pericarditis Friction Rub
  3. Exudative Pericardial Effusion

VII. Differential Diagnosis

VIII. Diagnosis

  1. Empiric diagnosis in endemic, developing regions with low resources OR
  2. Pericardiocentesis
    1. Adenosine deaminase (ADA) in pericardial fluid is a specific marker for Tuberculosis
    2. Acid Fast Bacteria may also be seen in pericardial fluid
      1. Pericardial fluid culture has highest sensitivity for acid fast Bacteria (but requires weeks of growth)

IX. Labs

  1. Serum globulin increased
  2. Leukocytosis

X. Management

  1. Anti-Tuberculosis medications
    1. See Active Tuberculosis Treatment
    2. Consult infectious disease
    3. Starts with 4 drug therapy for first 2 months (then 2 drugs for another 4 months)
    4. Concurrent Prednisone taper may be considered
  2. Cardiac Complication management
    1. Consult cardiology
    2. Manage Congestive Heart Failure, Cardiac Tamponade, constrictive Pericarditis

XI. Complications

  1. Cardiac Tamponade
  2. Mortality 85% in untreated cases

XII. References

  1. Klasek and Alblaihed (2023) Crit Dec Emerg Med 37(6): 4-11
  2. Reuter (2006) Q J Med 99:827-39 [PubMed]

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