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(Circulation. 2005;112:3608-3616.)
© 2005 American Heart Association, Inc.

Heart Disease in Africa

Tuberculous Pericarditis

Bongani M. Mayosi, MBChB, DPhil; Lesley J. Burgess, MMed (Chem Path), PhD; Anton F. Doubell, MMed (Int), PhD

From the Cardiac Clinic, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town (B.M.M.), and TREAD Research/Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow (L.J.B., A.F.D.), South Africa.

Correspondence to Dr Bongani M. Mayosi, The Cardiac Clinic, E25 Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa. E-mail bmayosi{at}uctgsh1.uct.ac.za

Received February 15, 2005; revision received September 2, 2005; accepted September 28, 2005.

Background— The incidence of tuberculous pericarditis is increasing in Africa as a result of the human immunodeficiency virus (HIV) epidemic. The primary objective of this article was to review and summarize the literature on the pathogenesis, diagnosis, and management of tuberculous pericarditis.

Methods and Results— We searched MEDLINE (January 1966 to May 2005) and the Cochrane Library (Issue 1, 2005) for information on relevant references. A "definite" diagnosis of tuberculous pericarditis is based on the demonstration of tubercle bacilli in pericardial fluid or on a histological section of the pericardium; "probable" tuberculous pericarditis is based on the proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis, a lymphocytic pericardial exudate with elevated adenosine deaminase levels, and/or appropriate response to a trial of antituberculosis chemotherapy. Treatment consists of the standard 4-drug antituberculosis regimen for 6 months. It is uncertain whether adjunctive corticosteroids are effective in reducing mortality or progression to constriction. Surgical resection of the pericardium remains the appropriate treatment for constrictive pericarditis. The timing of surgical intervention is controversial, but many experts recommend a trial of medical therapy for noncalcific pericardial constriction, and pericardiectomy in nonresponders after 4 to 8 weeks of antituberculosis chemotherapy.

Conclusions— Research is needed to improve the diagnosis, assess the effectiveness of adjunctive steroids, and determine the impact of HIV infection on the outcome of tuberculous pericarditis.

Key Words: pericarditis • pericardium • tuberculosis • infection

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