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Diagnosis and Management of Tuberculous Pericarditis: What Is New?

Abstract

Purpose of Review

This review provides an update on the immunopathogenesis of tuberculous pericarditis (TBP), investigations to confirm tuberculous etiology, the limitations of anti-tuberculous therapy (ATT), and recent efficacy trials.

Recent Findings

A profibrotic immune response characterizes TBP, with low levels of AcSDKP, high levels of γ-interferon and IL-10 in the pericardium, and high levels of TGF-β and IL-10 in the blood. These findings may have implications for future therapeutic targets. Despite advances in nucleic acid amplification approaches, these tests remain disappointing for TBP. Trials of corticosteroids and colchicine have had mixed results, with no impact on mortality, evidence of a reduction in rates of constrictive pericarditis and potential harm in those with advanced HIV. Small studies suggest that ATT penetrates the pericardium poorly. Given that there is a close association between high bacillary burden and mortality, a rethink about the optimal drug doses and duration may be required.

Summary

The high mortality and morbidity from TBP despite use of anti-tuberculous drugs call for researches targeting host-directed immunological determinants of treatment outcome. There is also a need for the identification of steps in clinical management where interventions are needed to improve outcomes.

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    Correspondence to Godsent Isiguzo.

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    Godsent Isiguzo, Elsa Du Bruyn, Patrick Howlett, and Mpiko Ntsekhe declare that they have no conflict of interest.

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    Electronic supplementary material

    Supplementary Figure 1

    Posterior anterior chest x-ray view of the index patient showing a globular enlaged heart shadow (typical finding in pericardial effusion). (JPG 67 kb)

    Supplementary Figure 2

    An apical four chamber 2D echocardiography image of the index patient who presented in cardiac tamponade. Video shows large pericardial effusion with strands, swinging heart showing right ventricular collapse. (GIF 271 kb)

    Supplementary Figure 3

    Parasternal long axis (PLAX) 2D echocardiography image of the index patient displaying large pericardial effusion with obvious tachycardia and swinging of the heart with contraction and right ventricular collapse. (GIF 2260 kb)

    Supplementary Figure 4

    Subcostal view 2D echocardiography image of the index patient showing a thickened pericardium with effusion and swing heart. (GIF 613 kb)

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    Isiguzo, G., Du Bruyn, E., Howlett, P. et al. Diagnosis and Management of Tuberculous Pericarditis: What Is New?. Curr Cardiol Rep 22, 2 (2020) doi:10.1007/s11886-020-1254-1

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    Keywords

    • Tuberculous pericarditis
    • Mycobacterium tuberculosis