43. CLINICAL, PARACLINICAL SYMPTOMS, AND TREATMENT IN 12 PATIENTS WITH TUBERCOLOUS CONSTRICTIVE PERICARDITIS IN THE DEPARTMENT OF GENERAL INTERNAL MEDICINE AT THE NATIONAL LUNG HOSPITAL
Main Article Content
Abstract
Objective: Review the clinical and paraclinical characteristics, diagnosis and treatment results of patients with tubercular constrictive pericarditis.
Subjects and methods: Study on a cluster of cases, a retrospective descriptive study at the General Internal Medicine Department of the National Lung Hospital, from January 2023 to December 2023, we admitted and treated 12 patients.
Results: Tuberculous constrictive pericarditis was found in 13.8% of patients with tuberculous pericarditis. The average age of patients was 53.0 ± 18.0. Symptoms included dyspnea 100%, edema 75%, cough 100%, and fever 41.7%. All patients (100%) showed symptoms of right heart failure, with NYHA classification: NYHA II 33.3%, NYHA III 41.7%, NYHA IV 25%. Chest X-ray detected tuberculosis in 75%, and chest CT scan in 83.3%. Bilateral pleural effusion was found in 91.7%, and ascites in 66.7%. The pleural effusion was mainly exudative with ADA 41.8 ± 11.4 u/l. Evidence-based diagnosis of tuberculosis was confirmed in 33.3%. Surgery was performed in 25% of patients. The rate of patients with treatment failure is 25%.
Conclusion: Tuberculous Constrictive Pericarditis often progresses insidiously and is a characteristic of tuberculous pericarditis. Diagnosis remains challenging. However, initial diagnosis can be made through imaging and other characteristic signs such as clinical examination, risk factors, and identifying tuberculosis lesions in other organs. Early pericardiectomy should be performed, followed by continued anti-tuberculosis regimen and corticosteroids. The mortality rate remains high.
Article Details
Keywords
Tuberculosis, tuberculous pericarditis, constrictive pericarditis.
References
[2] Hoàng Minh, Lao màng não, lao màng ngoài tim, lao màng bụng, Nhà xuất bản Y học, Hà Nội, 2002.
[3] Mayosi BM, Commerford PJ, Pericardial disease: an evidence-based approach to diagnosis and treatment, In: Yusuf S, Cairns J.A, Camm A.J (eds), Evidence-Based Cardiology, 2nd edn, London, BMJ Books, 2003, 2735-2748.
[4] D.H.N, Tuberculous pericarditis, a review of 100 cases, S. Afr. Med. J., 1979, 1955, 1877-1880.
[5] Wiysonge CS, Gumedze F et al, IMPI Africa Investigators, Excess mortality in presumed tuberculous pericarditis, Eur. Heart J., 2006, 2027, p. 5452.
[6] Sagrista-Sauleda J, Soler-Soler J, Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment, J. Am. Coll Cardiol, 1988, 11 (14), 724-728.
[7] Mynors JM, Pericarditis - a five year study in the African, Cent Afr. J. Med., 1973, 19 (12), 19-22.
[8] Reuter H, Doubell AF, Epidemiology of pericardial effusions at a large academic hospital in South Africa, Epidemiol Infect, 2005, 133 (3), 393-399.
[9] Watch V, The burden of presumed tuberculosis in hospitalized children in a resource-limited setting in Papua New Guinea: a prospective observational study, Int Health, 2017, 9 (6), 374-378.
[10] Obihara NJ, Tuberculous pericardial effusions in children, J. Pediatric Infect Dis. Soc., 2018, 7 (4), 346-349.
[11] Hugo-Hamman CT, De Moor MM, Tuberculous pericarditis in children: a review of 44 cases, Pediatr Infect Dis. J., 1994, 13 (11), 13-18.
[12] Mayosi BM, Doubell AF, Tuberculous pericarditis, Circulation, 2005, 112 (123), 3608-3616.
[13] Mayosi BM, Prednisolone and Mycobacterium indicus pranii in tuberculous pericarditis to reduced incidence of constrictive pericarditis, N. Engl. J. Med, 2014, 371 (312), 1121-1130.
[14] P.J.M, Pleural fluid biomarkers: beyond the light criteria, Clin Chest Med., 2013, 1, 27-37.
[15] Theron G, Determinants of PCR performance (Xpert MTB/ RIF), including bacterial load and inhibition, for TB diagnosis using specimens from different body compartments, Sci. Rep., 2014, 4, 5658.