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]
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| Definition (MSH) | INFLAMMATION of the sac surrounding the heart (PERICARDIUM) due to MYCOBACTERIUM TUBERCULOSIS infection. Pericarditis can lead to swelling (PERICARDIAL EFFUSION), compression of the heart (CARDIAC TAMPONADE), and preventing normal beating of the heart. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D010495 |
| ICD10 | A18.84 |
| SnomedCT | 67256000 |
| English | Pericarditides, Tuberculous, Pericarditis, Tuberculous, Tuberculous Pericarditides, Tuberculous Pericarditis, TUBERCULOUS PERICARDITIS, tuberculosis of pericardium (diagnosis), tuberculosis of pericardium, pericardial tuberculosis, tuberculous pericarditis, tuberculous pericarditis (diagnosis), Pericarditis, Tuberculous [Disease/Finding], Tuberculous pericarditis, Pericarditis tuberculous, Tuberculosis of pericardium, Tuberculosis of pericardium (disorder), pericardium; tuberculous (etiology), pericardium; tuberculous (manifestation), tuberculosis; pericardium (etiology), tuberculosis; pericardium (manifestation) |
| Swedish | Hjärtsäcksinflammation, tuberkulös |
| Japanese | ｹｯｶｸｾｲｼﾝﾏｸｴﾝ, 結核性心膜炎, 心膜炎-結核性 |
| Finnish | Tuberkuloottinen sydänpussitulehdus |
| Russian | PERIKARDIT TUBERKULEZNYI, ПЕРИКАРДИТ ТУБЕРКУЛЕЗНЫЙ |
| Czech | Tuberkulózní perikarditida, tuberkulózní perikarditida, perikarditida tuberkulózní |
| Polish | Zapalenie osierdzia gruźlicze |
| Spanish | pericarditis tuberculosa, tuberculosis del pericardio (trastorno), tuberculosis del pericardio, Pericarditis tuberculosa, Pericarditis Tuberculosa |
| Hungarian | tuberculoticus pericarditis |
| Norwegian | Tuberkuløs perikarditt |
| Dutch | pericard; tuberculose, tuberculose; pericard, pericarditis tuberculeus, Pericarditis tuberculosa |
| Portuguese | Pericardite tuberculosa, Pericardite Tuberculosa |
| German | tuberkuloese Perikarditis, Perikarditis, tuberkulöse, Tuberkulöse Perikarditis |
| French | Péricardite tuberculeuse |
| Italian | Pericardite tubercolare |
