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Causes, Symptoms, Treatment & Diagnosis of Tuberculous Pericarditis

Submitted by Nic on August 7, 2013

Tuberculous pericarditis is linked to the pulmonary tuberculosis. In any given population, 1 in 2 % of patients suffering from pulmonary tuberculosis will also be affected by tuberculosis pericarditis.

Causes

Pulmonary tuberculosis results from an infection of the bacteria mycobacterium tuberculosis. You can contract tuberculosis by inhaling air droplets that contain the bacteria. When near or in a room with an infected person, sneezing or coughing on his/her part may result in transmission of the bacteria. People with weak immune systems are also more prone to getting tuberculosis. Additionally, patients who are undergoing chemotherapy, suffering from AIDS, and have diabetes or people on certain medications are at a high risk of contracting this disease. Elderly people and children are also susceptible to this disease.

Symptoms

Predominant tuberculous pericarditis symptoms include chest pain, cough, dyspnea or shortness of breath, ankle edema or swelling of the ankle, difficulty in breathing while lying down, night sweats, and weight loss. Other serious indications could include fever, decrease in blood pressure (pulsus paradoxus), fast heart beat (tachycardia), enlargement of the heart (cardiomegaly), enlarged liver (hepatomegaly), excessive fluid in the lungs (pleural effusion), pericardial rub, distended veins in the neck, and faint heart tones.

If you are showing signs of any of these symptoms, make sure that you see your doctor so that he/she can help diagnose your condition and put you on a proper treatment plan.

Treatment

Depending on the severity of the condition and the patient’s overall age and health, one or more of the following methods can be employed in tuberculous pericarditus treatment.

  • Corticosteroids/diuretics/pain relieving medications: Corticosteroids or NSAIDs help to lessen the inflammation, while diuretics aid with getting rid of the extra fluid in the pericardium.
  • Prescribed antibiotics: Antibiotics help to get rid of bacteria that are causing the infection and inflammation.
  • Pericardiocentesis: Pericardiocentesis is method of a treatment where the fluid surrounding the pericardium or pericardial effusion is removed by inserting a narrow needle in through the chest into the pericardial sac and draining the fluid out. A small rubber drain is inserted in for a day or two to permit steady drainage of any fluid that remains inside the sac.
  • Pericardiectomy: Pericardiectomy is a highly invasive and high-risk surgical procedure that involves the removal of the pericardial lining around the heart. A pericardiectomy is usually a last resort when heart function has been compromised.

Diagnosis

A confirmed tuberculous pericarditis diagnosis can be based on the manifestation of tubercle bacilli in the fluid found around the pericardium or by examining the pericardial tissue. Probable tuberculous pericarditis is suspected if a patient is suffering from tuberculosis with no explanation for pericarditis.

Certain tests can be conducted to confirm diagnosis.

  • Tuberculin testing requires that you undergo a PPD skin test that is used to diagnose tuberculosis in patients. The test is positive for majority patients with a normal immune response who are suffering from tuberculous pericarditis. Negative PPD test results indicate reduced the chances and probability of tuberculous pericarditis. Unfortunately, in some cases, the PPD skin test comes up negative in HIV positive patients and those suffering from tuberculous pericardial disease.
  • Pericardiocentisis is used to drain the fluid from the pericardium. Testing this fluid is also helpful in diagnosis. The protein count is very high in the pericardial fluid in most patients who have tuberculous pericarditis.
  • Another option that is safe to perform is the pericardial biopsy where tissue and fluid are taken from the patient to be examined. If the tissues are stained with acid fast reagents, it is a sign of tuberculous pericarditis.

References

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