- Jason Stout, MD
Jason Stout, MD
- Associate Professor of Medicine
- Duke University Medical Center
Tuberculous pericarditis is an important complication of tuberculosis (TB); the diagnosis can be difficult to establish and is often delayed or missed, resulting in late complications such as constrictive pericarditis and increased mortality . Options for management of advanced disease are limited.
Issues related to evaluation and management of tuberculous pericarditis will be reviewed here. General issues related to diagnosis and management of TB are discussed separately. (See "Epidemiology, clinical manifestations, and diagnosis of tuberculosis in HIV-infected patients" and "Treatment of drug-susceptible pulmonary tuberculosis in HIV-uninfected adults" and "Treatment of pulmonary tuberculosis in HIV-infected adults" and "Diagnosis of pulmonary tuberculosis in HIV-uninfected adults".)
Tuberculous pericarditis occurs in approximately 1 to 2 percent of patients with pulmonary tuberculosis (TB) . In one series of 294 immunocompetent patients in Spain with acute pericarditis (in whom the cause was not apparent at initial evaluation), tuberculous pericarditis was diagnosed in 13 patients (4 percent of cases) . Cardiac tamponade was observed in five patients, and constrictive pericarditis developed in six patients.
In developing countries with a high prevalence of HIV, there has been a dramatic increase in tuberculous pericarditis. In one 1994 series of Tanzanian patients with large pericardial effusions, for example, all of the HIV-infected patients were found to have tuberculous pericarditis .
The incidence of tuberculous pericarditis in the United States has declined with the concomitant decline in prevalence of TB [5-7]. However, in areas of the United States with large immigrant populations from tuberculosis-endemic countries, extrapulmonary TB, including tuberculous pericarditis, is still seen with some frequency [8-10].
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- CLINICAL MANIFESTATIONS
- Physical findings
- - Constrictive pericarditis
- - Effusive constrictive pericarditis
- - Myopericarditis
- - Cardiac tamponade
- General principles
- Initial evaluation
- Pericardial biopsy
- Differential diagnosis
- Antituberculous therapy
- Role of corticosteroids
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS