Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Tuberculous pericarditis

Jason Stout, MD
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH


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 [1]. 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 "Diagnosis of pulmonary tuberculosis in HIV-uninfected patients" and "Epidemiology, clinical manifestations, and diagnosis of tuberculosis in HIV-infected patients" and "Treatment of pulmonary tuberculosis in HIV-uninfected adults" and "Treatment of pulmonary tuberculosis in HIV-infected adults".)


Tuberculous pericarditis occurs in approximately 1 to 2 percent of patients with pulmonary tuberculosis (TB) [2]. 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) [3]. 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 [4].

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].


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Aug 23, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Diagnostic Standards and Classification of Tuberculosis in Adults and Children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med 2000; 161:1376.
  2. Larrieu AJ, Tyers GF, Williams EH, Derrick JR. Recent experience with tuberculous pericarditis. Ann Thorac Surg 1980; 29:464.
  3. Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J. Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment. J Am Coll Cardiol 1988; 11:724.
  4. Cegielski JP, Lwakatare J, Dukes CS, et al. Tuberculous pericarditis in Tanzanian patients with and without HIV infection. Tuber Lung Dis 1994; 75:429.
  5. McCaughan BC, Schaff HV, Piehler JM, et al. Early and late results of pericardiectomy for constrictive pericarditis. J Thorac Cardiovasc Surg 1985; 89:340.
  6. Cameron J, Oesterle SN, Baldwin JC, Hancock EW. The etiologic spectrum of constrictive pericarditis. Am Heart J 1987; 113:354.
  7. ROBERTSON R, ARNOLD CR. Constrictive pericarditis with particular reference to etiology. Circulation 1962; 26:525.
  8. Trautner BW, Darouiche RO. Tuberculous pericarditis: optimal diagnosis and management. Clin Infect Dis 2001; 33:954.
  9. Fiske CT, Griffin MR, Erin H, et al. Black race, sex, and extrapulmonary tuberculosis risk: an observational study. BMC Infect Dis 2010; 10:16.
  10. Kipp AM, Stout JE, Hamilton CD, Van Rie A. Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 - 2006. BMC Public Health 2008; 8:107.
  11. Ortbals DW, Avioli LV. Tuberculous pericarditis. Arch Intern Med 1979; 139:231.
  12. Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis. Circulation 2005; 112:3608.
  13. Strang G, Latouf S, Commerford P, et al. Bedside culture to confirm tuberculous pericarditis. Lancet 1991; 338:1600.
  14. BARR JF. The use of pericardial biopsy in establishing etiologic diagnosis in acute pericarditis. AMA Arch Intern Med 1955; 96:693.
  15. Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol 1985; 56:623.
  16. Fowler NO, Manitsas GT. Infectious pericarditis. Prog Cardiovasc Dis 1973; 16:323.
  17. Gooi HC, Smith JM. Tuberculous pericarditis in Birmingham. Thorax 1978; 33:94.
  19. Strang JI, Kakaza HH, Gibson DG, et al. Controlled clinical trial of complete open surgical drainage and of prednisolone in treatment of tuberculous pericardial effusion in Transkei. Lancet 1988; 2:759.
  20. Desai HN. Tuberculous pericarditis. A review of 100 cases. S Afr Med J 1979; 55:877.
  21. Ntsekhe M, Wiysonge CS, Gumedze F, et al. HIV infection is associated with a lower incidence of constriction in presumed tuberculous pericarditis: a prospective observational study. PLoS One 2008; 3:e2253.
  22. Hancock EW. On the elastic and rigid forms of constrictive pericarditis. Am Heart J 1980; 100:917.
  23. Syed FF, Ntsekhe M, Gumedze F, et al. Myopericarditis in tuberculous pericardial effusion: prevalence, predictors and outcome. Heart 2014; 100:135.
  24. Guazzi M, Polese A, Magrini F, et al. Negative influences of ascites on the cardiac function of cirrhotic patients. Am J Med 1975; 59:165.
  25. Reuter H, Burgess LJ, Doubell AF. Role of chest radiography in diagnosing patients with tuberculous pericarditis. Cardiovasc J S Afr 2005; 16:108.
  26. Reuter H, Burgess LJ, Carstens ME, Doubell AF. Adenosine deaminase activity--more than a diagnostic tool in tuberculous pericarditis. Cardiovasc J S Afr 2005; 16:143.
  27. Cherian G. Diagnosis of tuberculous aetiology in pericardial effusions. Postgrad Med J 2004; 80:262.
  28. Rooney JJ, Crocco JA, Lyons HA. Tuberculous pericarditis. Ann Intern Med 1970; 72:73.
  29. Ewer K, Deeks J, Alvarez L, et al. Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak. Lancet 2003; 361:1168.
  30. Reuter H, Burgess L, van Vuuren W, Doubell A. Diagnosing tuberculous pericarditis. QJM 2006; 99:827.
  31. Harvey AM, Whitehill MR. Tuberculous pericarditis. Medicine 1937; 16:45.
  32. Light RW. Pleural effusions. Med Clin North Am 1977; 61:1339.
  33. Burgess LJ, Reuter H, Carstens ME, et al. Cytokine production in patients with tuberculous pericarditis. Int J Tuberc Lung Dis 2002; 6:439.
  34. Rana BS, Jones RA, Simpson IA. Recurrent pericardial effusion: the value of polymerase chain reaction in the diagnosis of tuberculosis. Heart 1999; 82:246.
  35. Lee JH, Lee CW, Lee SG, et al. Comparison of polymerase chain reaction with adenosine deaminase activity in pericardial fluid for the diagnosis of tuberculous pericarditis. Am J Med 2002; 113:519.
  36. Maisch B, Seferović PM, Ristić AD, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J 2004; 25:587.
  37. Zeka AN, Tasbakan S, Cavusoglu C. Evaluation of the GeneXpert MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulmonary and extrapulmonary specimens. J Clin Microbiol 2011; 49:4138.
  38. Burgess LJ, Reuter H, Carstens ME, et al. The use of adenosine deaminase and interferon-gamma as diagnostic tools for tuberculous pericarditis. Chest 2002; 122:900.
  39. Komsuoğlu B, Göldelï O, Kulan K, Komsuoğlu SS. The diagnostic and prognostic value of adenosine deaminase in tuberculous pericarditis. Eur Heart J 1995; 16:1126.
  40. SCHEPERS GW. Tuberculous pericarditis. Am J Cardiol 1962; 9:248.
  41. Corey GR, Campbell PT, Van Trigt P, et al. Etiology of large pericardial effusions. Am J Med 1993; 95:209.
  42. Cheitlin MD, Serfas LJ, Sbar SS, Glasser SP. Tuberculous pericarditis: is limited pericardial biopsy sufficient for diagnosis? Report of two cases. Am Rev Respir Dis 1968; 98:287.
  43. Cegielski JP, Devlin BH, Morris AJ, et al. Comparison of PCR, culture, and histopathology for diagnosis of tuberculous pericarditis. J Clin Microbiol 1997; 35:3254.
  44. Sagristà-Sauleda J, Mercé J, Permanyer-Miralda G, Soler-Soler J. Clinical clues to the causes of large pericardial effusions. Am J Med 2000; 109:95.
  45. Strang JI. Tuberculous pericarditis in Transkei. Clin Cardiol 1984; 7:667.
  46. Hakim JG, Manyemba J. Cardiac disease distribution among patients referred for echocardiography in Harare, Zimbabwe. Cent Afr J Med 1998; 44:140.
  47. Bhan GL. Tuberculous pericarditis. J Infect 1980; 2:360.
  48. Hakim JG, Ternouth I, Mushangi E, et al. Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients. Heart 2000; 84:183.
  49. Long R, Younes M, Patton N, Hershfield E. Tuberculous pericarditis: long-term outcome in patients who received medical therapy alone. Am Heart J 1989; 117:1133.
  50. Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis 2016; 63:e147.
  51. Soler-Soler J, Sagristà-Sauleda J, Permanyer-Miralda G. Management of pericardial effusion. Heart 2001; 86:235.
  52. Mayosi BM, Ntsekhe M, Bosch J, et al. Prednisolone and Mycobacterium indicus pranii in tuberculous pericarditis. N Engl J Med 2014; 371:1121.
  53. Strang JI, Nunn AJ, Johnson DA, et al. Management of tuberculous constrictive pericarditis and tuberculous pericardial effusion in Transkei: results at 10 years follow-up. QJM 2004; 97:525.
  54. Mayosi BM, Ntsekhe M, Volmink JA, Commerford PJ. Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev 2002; :CD000526.
  55. SCHRIRE V. Experience with pericarditis at Groote Schuur Hospital, Cape Town: an analysis of one hundred and sixty cases studied over a six-year period. S Afr Med J 1959; 33:810.
  56. Ntsekhe M, Wiysonge C, Volmink JA, et al. Adjuvant corticosteroids for tuberculous pericarditis: promising, but not proven. QJM 2003; 96:593.
  57. Strang JI, Kakaza HH, Gibson DG, et al. Controlled trial of prednisolone as adjuvant in treatment of tuberculous constrictive pericarditis in Transkei. Lancet 1987; 2:1418.
  58. Dooley DP, Carpenter JL, Rademacher S. Adjunctive corticosteroid therapy for tuberculosis: a critical reappraisal of the literature. Clin Infect Dis 1997; 25:872.
  59. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf (Accessed on October 16, 2014).
  60. Carson TJ, Murray GF, Wilcox BR, Starek PJ. The role of surgery in tuberculous pericarditis. Ann Thorac Surg 1974; 17:163.