Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era : the investigation of the management of Pericarditis in Africa (IMPI Africa) registry

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dc.contributor.authorMayosi, Bongani M.
dc.contributor.authorWiysonge, Charles Shey
dc.contributor.authorNtsekhe, Mpiko
dc.contributor.authorVolmink, Jimmy A.
dc.contributor.authorGumedze, Freedom
dc.contributor.authorMaartens, Gary
dc.contributor.authorAje, Akinyemi
dc.contributor.authorThomas, Baby M.
dc.contributor.authorThomas, Kandathil M.
dc.contributor.authorAwotedu, Abolade A.
dc.contributor.authorThembela, Bongani
dc.contributor.authorMntla, Phindile
dc.contributor.authorMaritz [Late], Frans
dc.contributor.authorNgu Blackett, Kathleen
dc.contributor.authorNkouonlack, Duquesne C.
dc.contributor.authorBurch, Vanessa C.
dc.contributor.authorRebe, Kevin
dc.contributor.authorParish, Andy
dc.contributor.authorSliwa, Karen
dc.contributor.authorVezi, Brian Z.
dc.contributor.authorAlam, Nowshad
dc.contributor.authorBrown, Basil G.
dc.contributor.authorGould, Trevor
dc.contributor.authorVisser, Tim
dc.contributor.authorShey, Muki S.
dc.contributor.authorMagula, Nombulelo P.
dc.contributor.authorCommerford, Patrick J.
dc.date.accessioned2010-12-15T07:11:28Z
dc.date.available2010-12-15T07:11:28Z
dc.date.issued2006-01
dc.date.updated2010-11-09T13:06:45Z
dc.description.abstractBackground: The incidence of tuberculous pericarditis has increased in Africa as a result of the human immunodeficiency virus (HIV) epidemic. However, the effect of HIV co-infection on clinical features and prognosis in tuberculous pericarditis is not well characterised. We have used baseline data of the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry to assess the impact of HIV co-infection on clinical presentation, diagnostic evaluation, and treatment of patients with suspected tuberculous pericarditis in sub-Saharan Africa. Methods: Consecutive adult patients in 15 hospitals in three countries in sub-Saharan Africa were recruited on commencement of treatment for tuberculous pericarditis, following informed consent. We recorded demographic, clinical, diagnostic and therapeutic information at baseline, and have used the chi-square test and analysis of variance to assess probabilities of significant differences (in these variables) between groups defined by HIV status. Results: A total of 185 patients were enrolled from 01 March 2004 to 31 October 2004, 147 (79.5%) of whom had effusive, 28 (15.1%) effusive-constrictive, and 10 (5.4%) constrictive or acute dry pericarditis. Seventy-four (40%) had clinical features of HIV infection. Patients with clinical HIV disease were more likely to present with dyspnoea (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.4 to 7.4, P = 0.005) and electrocardiographic features of myopericarditis (OR 2.8, 95% CI 1.1 to 6.9, P = 0.03). In addition to electrocardiographic features of myopericarditis, a positive HIV serological status was associated with greater cardiomegaly (OR 3.89, 95% CI 1.34 to 11.32, P = 0.01) and haemodynamic instability (OR 9.68, 95% CI 2.09 to 44.80, P = 0.0008). However, stage of pericardial disease at diagnosis and use of diagnostic tests were not related to clinical HIV status. Similar results were obtained for serological HIV status. Most patients were treated on clinical grounds, with microbiological evidence of tuberculosis obtained in only 13 (7.0%) patients. Adjunctive corticosteroids were used in 109 (58.9%) patients, with patients having clinical HIV disease less likely to be put on them (OR 0.37, 95% CI 0.20 to 0.68). Seven patients were on antiretroviral drugs. Conclusion Patients with suspected tuberculous pericarditis and HIV infection in Africa have greater evidence of myopericarditis, dyspnoea, and haemodynamic instability. These findings, if confirmed in other studies, may suggest more intensive management of the cardiac disease is warranted in patients with HIV-associated pericardial disease.en_ZA
dc.description.versionPeer Reviewed
dc.format.extent9 p.
dc.identifier.citationMayosi, BM, Wiysonge, CS, Ntsekhe, M, Volmink, JA, Gumedze, F, Maartens, G, Aje, A, Thomas, BM, Thomas, KM, Awotedu, AA, Thembela, B, Mntla, P, Maritz, F, Blackett, KN, Nkouonlack, DC, Burch, VC, Rebe, K, Parish, A, Sliwa, K, 13, Vezi, BZ, Alam, N, Brown, BG, Gould, T, Visser, T, Shey, MS, Magula, NP & Commerford, PJ 2006, 'Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry', BMC Infectious Diseases, 6(1):2.en_ZA
dc.identifier.issn1471-2334
dc.identifier.otherhttp://dx.doi.org/10.1186/1471-2334-6-2
dc.identifier.urihttp://hdl.handle.net/10019.1/5126
dc.language.isoen_ZAen_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.rights.holderMayosi et al.; licensee BioMed Central Ltd.en_ZA
dc.subjectTuberculous pericarditisen_ZA
dc.subjectHuman immunodeficiency virus (HIV) epidemicen_ZA
dc.subjectInvestigation of the Management of Pericarditis in Africa (IMPI Africa) registryen_ZA
dc.titleClinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era : the investigation of the management of Pericarditis in Africa (IMPI Africa) registryen_ZA
dc.typeArticleen_ZA
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