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July 3, 1991, Vol 266, No. 1 >
ARTICLE | July 3, 1991

Tuberculous Pericarditis FREE

Noble O. Fowler, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to Division of Cardiology, Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Bethesda Ave, Room 3354, Cincinnati, OH 45267 (Dr Fowler).


JAMA. 1991;266(1):99-103. doi:10.1001/jama.1991.03470010103039
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References

Tuberculosis is responsible for approximately 4% of cases of acute pericarditis, 7% of cases of cardiac tamponade, and, in older studies, 6% of instances of constrictive pericarditis. However, in some nonindustrialized countries, tuberculosis is a leading cause of pericarditis. The diagnosis is based on demonstration of tubercle bacilli in pericardial fluid or on histologic section of the pericardium, or proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis. Treatment consists of triple drug therapy for at least 9 months (isoniazid, rifampin, and streptomycin or ethambutol). Pyrazinamide can be used for the first 2 months, and the total therapeutic period can then be shortened to 6 months after culture conversion. Three months of corticosteroid therapy may be useful in patients in whom pericardial effusion persists or recurs despite the use of antituberculous drugs. Surgical resection of the pericardium is indicated for recurrent or life-threatening tamponade, or when there is persistent elevation of systemic venous pressure unrelieved by pericardiocentesis. As many as one third to one half of patients will eventually require pericardiectomy despite adequate drug therapy.

(JAMA. 1991;266:99-103)

REFERENCES

1 +
Wolinsky E.  Diseases due to mycobacteria.  In: Wyngaarden JB, Smith LH Jr, eds. Cecil's Textbook of Medicine . 18th ed. Philadelphia, Pa: WB Saunders Co; 1988;:1682-1693.
2 +
Strang JIG, Kakaza HHS, 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;;2:759-764.
3 +
Davidson PT.  Treating tuberculosis: what drugs, for how long? Ann Intern Med . 1990;;112:393-395.
4 +
Schepers GWH.  Tuberculous pericarditis. Am J Cardiol . 1962;;9:248-276.
5 +
Permanyer-Miralda G, Sagrista-Sauleda J, Soler-Soler J.  Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol . 1985;;56:623-629.
6 +
Fowler NO. The Pericardium in Health and Disease . Mount Kisco, NY: Futura Publishing Co; 1985;.
7 +
Gimlette TMD.  Constrictive pericarditis. Br Heart J . 1959;;21:9-16.
8 +
McCaughan BC, Schaff HV, Piehler JM, et al.  Early and late results of pericardiectomy for constrictive pericarditis. J Thorac Cardiovasc Surg . 1985;;89:340-350.
9 +
Weir MR, Thornton GF.  Extrapulmonary tuberculosis: experience of a community hospital and review of the literature. Am J Med . 1985;;79:467-478.
10 +
Alvarez S, McCabe WR.  Extrapulmonary tuberculosis revisited: a review of experience at Boston City and other hospitals. Medicine (Baltimore) . 1984;;63:25-55.
11 +
Larrieu AJ, Tyers GFO, Williams EH, Derrick JR.  Recent experience with tuberculous pericarditis. Ann Thorac Surg . 1980;;29:464-468.
12 +
Silver MD, ed. Cardiovascular Pathology . New York, NY: Churchill Livingstone Inc; 1983;:139-140.
13 +
Strang JIG.  Tuberculous pericarditis in Transkei. Clin Cardiol . 1984;;7:667-670.
14 +
Hageman JH, D'Esopo ND, Glenn WWL.  Tuberculosis of the pericardium: a long-term analysis of forty-four proved cases. N Engl J Med . 1964;;270:327-332.
15 +
Rooney JJ, Crocco JA, Lyons HA.  Tuberculous pericarditis. Ann Intern Med . 1970;;72:73-78.
16 +
Fowler NO, Manitsas GT.  Infectious pericarditis. Prog Cardiovasc Dis . 1973;;16:323-336.
17 +
Sagrista-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;;11:724-728.
18 +
Quale JM, Lipschik GY, Heurich AE.  Management of tuberculous pericarditis. Ann Thorac Surg . 1987;;43:653-655.
19 +
Harvey AM, Whitehill MR.  Tuberculous pericarditis. Medicine (Baltimore) . 1937;;16:45-94.
20 +
Pohost GM, O'Rourke RA, eds. Principles and Practice of Cardiovascular Imaging . Boston, Mass: Little Brown & Co Inc; 1991;.
21 +
Brisson-Noël A, Gicquel B, Le Cossier D, Lévy-Frébault V, Nassif X, Hance AJ.  Rapid diagnosis of tuberculosis by amplification of mycobacterial DNA in clinical samples. Lancet . 1989;;2:1069-1071.
22 +
Roberts GD, Goodman NL, Heifets L, et al.  Evaluation of the BACTEC radiometric method for recovery of mycobacteria and drug susceptibility testing of Mycobacterium tuberculosis from acid-fast smear-positive specimens. J Clin Microbiol . 1983;;18:689-696.
23 +
Margolis ML, Van Uitert BL.  Anergy in tuberculosis. Biomed Pharmacother . 1985;;39:292-298.
24 +
Chaisson RE, Schecter GF, Theuer CP, Rutherford GW, Echenberg DF, Hopewell PC.  Tuberculosis in patients with the acquired immunodeficiency syndrome: clinical features, response to therapy, and survival. Am Rev Respir Dis . 1987;;136:570-574.
25 +
Snider DE Jr, Hopewell PC, Mills J, Reichman LB.  Mycobacterioses and the acquired immunodeficiency syndrome: a joint position paper of the American Thoracic Society and the Centers for Disease Control. Am Rev Respir Dis . 1987;;136:492-496.
26 +
Dutt AK, Moers D, Stead WW.  Short-course chemotherapy for extrapulmonary tuberculosis: nine years' experience. Ann Intern Med . 1986;;104:7-12.
27 +
Combs DL, O'Brien RJ, Geiter U.  USPHS tuberculosis short-course chemotherapy trial 21: effectiveness, toxicity, and acceptability. Ann Intern Med . 1990;;112:397-406.
28 +
Fennell WMP.  Surgical treatment of constrictive tuberculous pericarditis. S Afr Med J . 1982;;62:353-355.
29 +
Holman E, Willett F.  Treatment of active tuberculous pericarditis by pericardiectomy. JAMA . 1951;;146:1-7.
30 +
Carson TJ, Murray GF, Wilcox BR, Starek PJK.  The role of surgery in tuberculous pericarditis. Ann Thorac Surg . 1974;;17:163-167.
31 +
Sonneberg FA, Parker SG.  Elective pericardiectomy for tuberculous pericarditis: should the snappers be snipped? Med Decis Making . 1986;;6:110-123.
32 +
Ortbals DW, Avioli LV.  Tuberculous pericarditis. Arch Intern Med . 1979;;139:231-234.
33 +
Gooi HC, Smith JM.  Tuberculous pericarditis in Birmingham. Thorax . 1978;;33:94-96.
34 +
Desai HN.  Tuberculous pericarditis: a review of 100 cases. S Afr Med J . 1979;;55:877-880.
35 +
Long R, Younes M, Patton N, Hershfield E.  Tuberculous pericarditis: long-term outcome in patients who received medical therapy alone. Am Heart J . 1989;;117:1133-1139.
36 +
Pitchenik AE, Fertel D, Bloch AB.  Mycobacterial disease: epidemiology, diagnosis, treatment and prevention. Clin Chest Med . 1988;;9:425-441.
37 +
Sathe SS, Reichman LB.  Mycobacterial disease in patients infected with the human immunodeficiency virus. Clin Chest Med . 1989;;10:445-463.
38 +
Dalli E, Quesada A, Juan G, Navarro R, Payá R, Tormo V.  Tuberculous pericarditis as the first manifestation of acquired immunodeficiency syndrome. Am Heart J . 1987;;114:905-906.
39 +
Anderson DW, Virmani R.  Progress in pathology: emerging patterns of heart disease in human immunodeficiency virus infection. Hum Pathol . 1990;;21:253-259.
40 +
Rieder HL, Cauthen GM, Bloch AB, et al.  Tuberculosis and acquired immunodeficiency syndrome-Florida. Arch Intern Med . 1989;;149:1268-1273.
41 +
Pitchenik AE, Rubinson HA.  The radiographic appearance of tuberculosis in patients with the acquired immune deficiency syndrome (AIDS) and pre-AIDS. Am Rev Respir Dis . 1985;;131:393-396.

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1 +
Wolinsky E.  Diseases due to mycobacteria.  In: Wyngaarden JB, Smith LH Jr, eds. Cecil's Textbook of Medicine . 18th ed. Philadelphia, Pa: WB Saunders Co; 1988;:1682-1693.
2 +
Strang JIG, Kakaza HHS, 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;;2:759-764.
3 +
Davidson PT.  Treating tuberculosis: what drugs, for how long? Ann Intern Med . 1990;;112:393-395.
4 +
Schepers GWH.  Tuberculous pericarditis. Am J Cardiol . 1962;;9:248-276.
5 +
Permanyer-Miralda G, Sagrista-Sauleda J, Soler-Soler J.  Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol . 1985;;56:623-629.
6 +
Fowler NO. The Pericardium in Health and Disease . Mount Kisco, NY: Futura Publishing Co; 1985;.
7 +
Gimlette TMD.  Constrictive pericarditis. Br Heart J . 1959;;21:9-16.
8 +
McCaughan BC, Schaff HV, Piehler JM, et al.  Early and late results of pericardiectomy for constrictive pericarditis. J Thorac Cardiovasc Surg . 1985;;89:340-350.
9 +
Weir MR, Thornton GF.  Extrapulmonary tuberculosis: experience of a community hospital and review of the literature. Am J Med . 1985;;79:467-478.
10 +
Alvarez S, McCabe WR.  Extrapulmonary tuberculosis revisited: a review of experience at Boston City and other hospitals. Medicine (Baltimore) . 1984;;63:25-55.
11 +
Larrieu AJ, Tyers GFO, Williams EH, Derrick JR.  Recent experience with tuberculous pericarditis. Ann Thorac Surg . 1980;;29:464-468.
12 +
Silver MD, ed. Cardiovascular Pathology . New York, NY: Churchill Livingstone Inc; 1983;:139-140.
13 +
Strang JIG.  Tuberculous pericarditis in Transkei. Clin Cardiol . 1984;;7:667-670.
14 +
Hageman JH, D'Esopo ND, Glenn WWL.  Tuberculosis of the pericardium: a long-term analysis of forty-four proved cases. N Engl J Med . 1964;;270:327-332.
15 +
Rooney JJ, Crocco JA, Lyons HA.  Tuberculous pericarditis. Ann Intern Med . 1970;;72:73-78.
16 +
Fowler NO, Manitsas GT.  Infectious pericarditis. Prog Cardiovasc Dis . 1973;;16:323-336.
17 +
Sagrista-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;;11:724-728.
18 +
Quale JM, Lipschik GY, Heurich AE.  Management of tuberculous pericarditis. Ann Thorac Surg . 1987;;43:653-655.
19 +
Harvey AM, Whitehill MR.  Tuberculous pericarditis. Medicine (Baltimore) . 1937;;16:45-94.
20 +
Pohost GM, O'Rourke RA, eds. Principles and Practice of Cardiovascular Imaging . Boston, Mass: Little Brown & Co Inc; 1991;.
21 +
Brisson-Noël A, Gicquel B, Le Cossier D, Lévy-Frébault V, Nassif X, Hance AJ.  Rapid diagnosis of tuberculosis by amplification of mycobacterial DNA in clinical samples. Lancet . 1989;;2:1069-1071.
22 +
Roberts GD, Goodman NL, Heifets L, et al.  Evaluation of the BACTEC radiometric method for recovery of mycobacteria and drug susceptibility testing of Mycobacterium tuberculosis from acid-fast smear-positive specimens. J Clin Microbiol . 1983;;18:689-696.
23 +
Margolis ML, Van Uitert BL.  Anergy in tuberculosis. Biomed Pharmacother . 1985;;39:292-298.
24 +
Chaisson RE, Schecter GF, Theuer CP, Rutherford GW, Echenberg DF, Hopewell PC.  Tuberculosis in patients with the acquired immunodeficiency syndrome: clinical features, response to therapy, and survival. Am Rev Respir Dis . 1987;;136:570-574.
25 +
Snider DE Jr, Hopewell PC, Mills J, Reichman LB.  Mycobacterioses and the acquired immunodeficiency syndrome: a joint position paper of the American Thoracic Society and the Centers for Disease Control. Am Rev Respir Dis . 1987;;136:492-496.
26 +
Dutt AK, Moers D, Stead WW.  Short-course chemotherapy for extrapulmonary tuberculosis: nine years' experience. Ann Intern Med . 1986;;104:7-12.
27 +
Combs DL, O'Brien RJ, Geiter U.  USPHS tuberculosis short-course chemotherapy trial 21: effectiveness, toxicity, and acceptability. Ann Intern Med . 1990;;112:397-406.
28 +
Fennell WMP.  Surgical treatment of constrictive tuberculous pericarditis. S Afr Med J . 1982;;62:353-355.
29 +
Holman E, Willett F.  Treatment of active tuberculous pericarditis by pericardiectomy. JAMA . 1951;;146:1-7.
30 +
Carson TJ, Murray GF, Wilcox BR, Starek PJK.  The role of surgery in tuberculous pericarditis. Ann Thorac Surg . 1974;;17:163-167.
31 +
Sonneberg FA, Parker SG.  Elective pericardiectomy for tuberculous pericarditis: should the snappers be snipped? Med Decis Making . 1986;;6:110-123.
32 +
Ortbals DW, Avioli LV.  Tuberculous pericarditis. Arch Intern Med . 1979;;139:231-234.
33 +
Gooi HC, Smith JM.  Tuberculous pericarditis in Birmingham. Thorax . 1978;;33:94-96.
34 +
Desai HN.  Tuberculous pericarditis: a review of 100 cases. S Afr Med J . 1979;;55:877-880.
35 +
Long R, Younes M, Patton N, Hershfield E.  Tuberculous pericarditis: long-term outcome in patients who received medical therapy alone. Am Heart J . 1989;;117:1133-1139.
36 +
Pitchenik AE, Fertel D, Bloch AB.  Mycobacterial disease: epidemiology, diagnosis, treatment and prevention. Clin Chest Med . 1988;;9:425-441.
37 +
Sathe SS, Reichman LB.  Mycobacterial disease in patients infected with the human immunodeficiency virus. Clin Chest Med . 1989;;10:445-463.
38 +
Dalli E, Quesada A, Juan G, Navarro R, Payá R, Tormo V.  Tuberculous pericarditis as the first manifestation of acquired immunodeficiency syndrome. Am Heart J . 1987;;114:905-906.
39 +
Anderson DW, Virmani R.  Progress in pathology: emerging patterns of heart disease in human immunodeficiency virus infection. Hum Pathol . 1990;;21:253-259.
40 +
Rieder HL, Cauthen GM, Bloch AB, et al.  Tuberculosis and acquired immunodeficiency syndrome-Florida. Arch Intern Med . 1989;;149:1268-1273.
41 +
Pitchenik AE, Rubinson HA.  The radiographic appearance of tuberculosis in patients with the acquired immune deficiency syndrome (AIDS) and pre-AIDS. Am Rev Respir Dis . 1985;;131:393-396.

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