The management of tuberculous pericardial effusion: Experience in 233 consecutive patients
Date
2007
Authors
Reuter H.
Burgess L.J.
Louw V.J.
Doubell A.F.
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Abstract
Aim: We report on the 30-day and one-year outcome of consecutive effusive pericarditis patients, including those with tuberculous pericarditis, over a six-year-period. Methods and Results: Patients with large pericardial effusions requiring pericardiocentesis were included in the study after having given written informed consent. Clinical and radiological evaluations were followed by echo-guided pericardiocentesis, and extended daily intermittent drainage via an indwelling pigtail catheter. A standard short-course anti-tuberculous regimen was initiated. A total of 233 patients was included. One hundred and sixty-two patients had pericardial tuberculosis (TB), including 118 (73%) with microbiological and/or histological evidence of TB and 44 (27%) diagnosed on clinical and supportive laboratory data. Over the six-year period, two patients developed fibrous constrictive pericarditis after receiving adjuvant corticosteroid therapy. The 30-day mortality (8.0%) was statistically higher for HIV-positive patients (corresponding mortality 9.9%) than for HIV-negative patients (6.2%; p = 0.04). The one-year all-cause mortality was 17.3%. It was also higher for HIV-positive (22.2%) than for HIV-negative patients (12.3%; p = 0.03). Cardiac mortality was equal for HIV-positive and -negative patients. Conclusion: Tuberculous pericardial effusions responded well to closed pericardiocentesis and a six-month treatment of antituberculous chemotherapy. The former was effective and safe irrespective of HIV status.
Description
Keywords
corticosteroid derivative, cotrimoxazole, tuberculostatic agent, corticosteroid, adjuvant therapy, adult, article, clinical evaluation, constrictive pericarditis, controlled study, corticosteroid therapy, echocardiography, female, heart catheterization, histopathology, human, Human immunodeficiency virus infection, human tissue, laboratory test, major clinical study, male, microbiological examination, mortality, patient care, pericardial effusion, pericardiocentesis, pericarditis, postoperative complication, short course therapy, surgical drainage, treatment outcome, histology, Human immunodeficiency virus, indwelling catheter, informed consent, microbiology, radiodiagnosis, statistical significance, tuberculous pericarditis, Adult, Analysis of Variance, Anti-Infective Agents, Anti-Inflammatory Agents, Catheters, Indwelling, CD4 Lymphocyte Count, Drainage, Female, Follow-Up Studies, HIV Infections, Humans, Male, Middle Aged, Pericardial Effusion, Pericardiectomy, Pericardiocentesis, Pericarditis, Tuberculous, Prednisone, South Africa, Survival Analysis, Treatment Outcome, Trimethoprim-Sulfamethoxazole Combination
Citation
Cardiovascular Journal of South Africa
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