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Bajpai J, Roy S, Shukla S, Pradhan A, Kant S, Shah S. Detection of drug-resistant Mycobacterium tuberculosis in pericardial fluid culture and its correlation with cartridge based nucleic acid amplification test and adenosine deaminase activity. Indian J Tuberc 2023; 71 Suppl 1:S59-S66. [PMID: 39067957 DOI: 10.1016/j.ijtb.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/22/2023] [Indexed: 07/30/2024]
Abstract
BACKGROUND Pericardial effusion is the accumulation of fluid in the pericardial cavity. In nations with high tuberculosis (TB) load, TB is the most common cause of pericardial effusion. 1-2% of patients with pulmonary TB develop Pericardial TB worldwide. Multi-drug-resistant (MDR) TB, including extrapulmonary TB (EPTB) cases, are rising in number. Adenosine Deaminase (ADA) is an enzyme in lymphocytes and myeloid cells, which has certain immune functions in the body. ADA levels are increased in inflammatory conditions, like pleural, pericardial, or joint effusions, of bacterial etiology, granulomatous conditions, neoplasms, and autoimmune pathologies. TB is the only lymphocytosis involving disease with increased ADA levels. MDR EPTB is rare, but cases are on the rise, and tuberculous pericardial effusion is one such example. Hence, it is important to know the percentage of cases detected by a culture that can be identified by cartridge-based nucleic acid amplification test (CBNAAT), their resistance patterns, and to identify potential markers like ADA, which can help in early identification of cases. The objectives of this study were to identify the Mycobacterium tuberculosis (MTB) bacilli in culture, and correlate them with cartridge-based nucleic acid amplification test (CBNAAT) results and their drug-resistance, in the Pericardial tubercular effusion, and to find if Adenosine Deaminase (ADA) levels can be used as a predictor of the presence of MTB in pericardial fluid. METHODOLOGY We enrolled 52 patients with moderate to large tuberculous pericardial effusion, based on pericardial fluid analysis, CBNAAT, and culture methods, between January 2021 and December 2021. RESULTS The mean age of the patients was 41.85 + 17.88 years, with a median of 38 years. Males made up 57.7% of the total patients. MTB was detected in 16 (30.8%) patients in the CBNAAT evaluations. 14 (87.5%) of the CBNAAT-positive TB patients were sensitive to Rifampicin, whereas the remaining 2 (12.5%) were resistant to Rifampicin on CBNAAT. MTB was found to be growing in 8 (15.38%) drug sensitivity test cultures. Out of these 8, 6 were sensitive to first-line drugs, whereas 2 were resistant to both Isoniazid and Rifampicin. The presence of cough was found to have a significant difference between CBNAAT-detected MTB positive and negative patients (p = 0.020), whereas an insignificant difference was found for the presence of hypertension, diabetes mellitus, obesity, dyspnea, or fever. There was also an insignificant difference between the number of patients positive for the Tuberculin skin test, between the two groups. ADA was significantly higher in the MTB-detected CBNAAT group (85.91 + 37.60U/L vs 39.78 + 24.31U/L, p = 0.005), whereas the total leukocyte count, lymphocytes, neutrophils, random blood sugar levels, and serum protein levels had no significant difference. The area under the Receiver Operator Curve (CBNAAT positive: dependent variable; ADA: test result variable) was 0.854 (null hypothesis rejected), with a standard error of 0.078. CONCLUSIONS Culture is the gold standard method to diagnose tuberculosis. Detection of MTB on pericardial fluid culture is very uncommon, though in our study, culture came out positive in 16% of patients, and 4% were resistant to rifampicin and isoniazid. Higher ADA levels in pericardial fluid are an indicator of tuberculous pericardial effusion.
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Affiliation(s)
- Jyoti Bajpai
- Department of Respiratory Medicine, Kasturba Chest Hospital, King George's Medical University, Lucknow, India
| | - Shubhajeet Roy
- Faculty of Medical Sciences, King George's Medical University, Lucknow, India
| | - Suruchi Shukla
- Department of Microbiology, King George's Medical University, Lucknow, India
| | - Akshyaya Pradhan
- Department of Cardiology, Lari Cardiology Centre, King George's Medical University, Lucknow, India.
| | - Surya Kant
- Department of Respiratory Medicine, Kasturba Chest Hospital, King George's Medical University, Lucknow, India
| | - Shobhit Shah
- Department of Cardiology, Lari Cardiology Centre, King George's Medical University, Lucknow, India
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Khatun N, Akivis Y, Ji B, Chandrakumar HP, Bukharovich I, John S. Tuberculous Pericarditis Presenting as Cardiac Tamponade: Role of Echocardiography. J Med Cases 2023; 14:271-276. [PMID: 37692365 PMCID: PMC10482598 DOI: 10.14740/jmc4119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/06/2023] [Indexed: 09/12/2023] Open
Abstract
Tuberculous pericarditis, a rare but potentially lethal manifestation of tuberculosis, poses diagnostic and therapeutic challenges in clinical practice. Its nonspecific clinical presentation often mimics other conditions, leading to delayed or missed diagnoses. We report a 25-year-old male with no past medical history, who presented with nonspecific symptoms such as fatigue, weight loss, body aches, and dyspnea. An electrocardiogram showed low voltage QRS complex with electrical alternans, and transthoracic echocardiography (TTE) showed large pericardial effusion with tamponade physiology with right ventricular diastolic collapse, the collapse of the right atrium and the inferior vena cava was dilated with a respiratory variation of less than 50%. The diagnosis of tuberculous pericarditis was made based on clinical presentation, imaging, and laboratory findings, including a positive QuantiFERON-TB gold test and pericardial fluid analysis, despite negative cultures. This case highlights the significance of considering tuberculosis in the differential diagnosis of pericardial effusion and underscores the role of imaging and laboratory investigations in diagnosis. Management of tuberculous pericarditis involves a combination of antituberculous chemotherapy, pericardiocentesis, and corticosteroids. Despite its rarity, tuberculous pericarditis carries a high mortality rate and can present as cardiac tamponade, as illustrated in our case. This underscores the need for high clinical suspicion, especially in high-risk populations, for timely diagnosis and initiation of treatment.
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Affiliation(s)
- Nazima Khatun
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | - Yonatan Akivis
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | - Beisi Ji
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | - Harshith P. Chandrakumar
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | | | - Sabu John
- Kings County Hospital Center, Brooklyn, NY 11203, USA
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Tominaga K, Tanaka T, Kanazawa M, Watanabe S, Nemoto R, Abe K, Kanamori A, Yamamiya A, Goda K, Kushima Y, Chibana K, Masawa T, Fukuda T, Hibi T, Irisawa A. A Case of Crohn's Disease with Cardiac Tamponade Caused by Tuberculous Pericarditis: Assessment of a Rare Phenomenon. Healthcare (Basel) 2021; 9:healthcare9060695. [PMID: 34207677 PMCID: PMC8227572 DOI: 10.3390/healthcare9060695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/26/2021] [Accepted: 06/08/2021] [Indexed: 01/14/2023] Open
Abstract
A 28-year-old woman was hospitalized for cardiac tamponade caused by tuberculous pericarditis. She was taking ustekinumab (UST) for Crohn’s disease. UST is not considered to significantly increase the risk of developing serious infections, including tuberculosis. However, there is still a risk of Mycobacterium tuberculosis reactivation. Therefore, for patients on concurrent UST and antituberculosis medication, a close collaboration among specialists in infectious diseases, cardiology, and gastroenterology is necessary.
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Affiliation(s)
- Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
- Correspondence: ; Tel.: +81-282-872147
| | - Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Mimari Kanazawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Shoko Watanabe
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Rena Nemoto
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Keiichiro Abe
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Akira Kanamori
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Yoshitomo Kushima
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi 321-0293, Japan; (Y.K.); (K.C.)
| | - Kazuyuki Chibana
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi 321-0293, Japan; (Y.K.); (K.C.)
| | - Taito Masawa
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan;
| | - Tomohiro Fukuda
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo 108-8642, Japan; (T.F.); (T.H.)
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo 108-8642, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo 108-8642, Japan; (T.F.); (T.H.)
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
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An overview of human pericardial space and pericardial fluid. Cardiovasc Pathol 2021; 53:107346. [PMID: 34023529 DOI: 10.1016/j.carpath.2021.107346] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022] Open
Abstract
The pericardium is a double-layered fibro-serous sac that envelops the majority of the surface of the heart as well as the great vessels. Pericardial fluid is also contained within the pericardial space. Together, the pericardium and pericardial fluid contribute to a homeostatic environment that facilitates normal cardiac function. Different diseases and procedural interventions may disrupt this homeostatic space causing an imbalance in the composition of immune mediators or by mechanical stress. Inflammatory cells, cytokines, and chemokines are present in the pericardial space. How these specific mediators contribute to different diseases is the subject of debate and research. With the advent of highly specialized assays that can identify and quantify various mediators we can potentially establish specific and sensitive biomarkers that can be used to differentiate pathologies, and aid clinicians in improving clinical outcomes for patients.
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Malgope R, Basu S, Sinha MK. Clinico-Etiological Profile of Children with Pericardial Effusion in a Tertiary Care Hospital in Eastern India. J Trop Pediatr 2021; 67:6042807. [PMID: 33346812 DOI: 10.1093/tropej/fmaa118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Pericardial effusion may be due to various causes. With the changing scenario of newer generation antibiotics and robust immunization program our aim is to identify the change, if any, in etiology and disease menifestations. METHODOLOGY This is a hospital-based uni-center prospective study with a population of 30 children for a period of 1½ year. Clinico-epidemiological features, investigations, complications and short-term outcome were assessed. RESULTS We found 13 (43.33%) patients having mild, 11 (36.67%) had moderate and 6 (20%) had severe pericardial effusion. Cardiac tamponade was present in six cases. Among the study population 9 (30%) patients were diagnosed as having pyogenic pericardial effusion and 8 (26.67%) had tubercular effusion. The predominant symptoms of pericardial effusion in our children were fever and tachycardia (83.33%).Other symptoms at presentation were tachycardia (76.67%), cough (63.33%), chest pain (50%), orthopnea (43.33%) and skin rash (16.67%). Pericardiocentesis was done in 14 cases (46.67%) of which 4 patients (13.33%) required pig tail catheterization. DISCUSSION Infectious etiology still remains the primary cause of pericardial effusion in our country. The presenting clinical signs are very much nonspecific and also not so prominent unless hemodynamic compromisation occurs. CONCLUSION This study showed that bacterial and tubercular pericardial effusions are still two most prevalent etiological diagnosis in this part of country. Early diagnosis and treatment has good outcome.
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Affiliation(s)
| | - Suprit Basu
- Department of Pediatrics, Institute of Postgraduate Medical Education & Research, Kolkata 700061, India
| | - Malay Kumar Sinha
- Department of Pediatrics, Institute of Postgraduate Medical Education & Research, Kolkata 700061, India
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Felipe-Reyes D, Buitrago-Toro K, Jiménez-Salazar S, Carlos-Alvarez L. Pericarditis tuberculosa en paciente inmunocompetente. Reporte de caso. DUAZARY 2021. [DOI: 10.21676/2389783x.3834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La pericarditis tuberculosa es una rara manifestación extrapulmonar que afecta a menos del 4% de los pacientes con tuberculosis (TB), con alta morbimortalidad ante diagnósticos tardíos, especialmente en aquellos pacientes inmunocomprometidos. Su presentación es inespecífica y la sintomatología deriva de la velocidad de instauración del derrame pericárdico, registrándose casos mortales debido a taponamiento cardiaco. La confirmación diagnóstica se obtiene con la identificación de la micobacteria en muestra de pericardio o líquido pericárdico, con una alta tasa de sospecha fundamentada en pruebas adicionales como la cuantificación del interferón gamma no estimulado, lisozima pericárdica y adenosina desaminasa (ADA) en liquido pericárdico. El tratamiento consiste en una combinación de terapia antituberculosa, drenaje pericárdico, y corticoesteroides como adyuvantes. Se presenta el caso de un varón de 64 años inmunocompetente, fumador frecuente en el pasado, con una alta sospecha diagnostica para TB, confirmada con resultado positivo para ADA (55,8 UI/L) en fluido pericárdico permitiendo iniciar un tratamiento adecuado con mejoría clínica posterior durante el seguimiento.
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Diagnostic values of Xpert MTB/RIF, T-SPOT.TB and adenosine deaminase for HIV-negative tuberculous pericarditis in a high burden setting: a prospective observational study. Sci Rep 2020; 10:16325. [PMID: 33004934 PMCID: PMC7530650 DOI: 10.1038/s41598-020-73220-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
The diagnosis of tuberculous pericarditis (TBP) remains challenging. This prospective study evaluated the diagnostic value of Xpert MTB/RIF (Xpert) and T-SPOT.TB and adenosine deaminase (ADA) for TBP in a high burden setting. A total of 123 HIV-negative patients with suspected TBP were enrolled at a tertiary referral hospital in China. Pericardial fluids were collected and subjected to the three rapid tests, and the results were compared with the final confirmed diagnosis. Of 105 patients in the final analysis, 39 (37.1%) were microbiologically, histopathologically or clinically diagnosed with TBP. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio (DOR) for Xpert were 66.7%, 98.5%, 96.3%, 83.3%, 44.0, 0.338, and 130.0, respectively, compared to 92.3%, 87.9%, 81.8%, 95.1%, 7.6, 0.088, and 87.0, respectively, for T-SPOT.TB, and 82.1%, 92.4%, 86.5%, 89.7%, 10.8, 0.194, and 55.8, respectively, for ADA (≥ 40 U/L). ROC curve analysis revealed a cut-off point of 48.5 spot-forming cells per million pericardial effusion mononuclear cells for T-SPOT.TB, which had a DOR value of 183.8, while a cut-off point of 41.5 U/L for ADA had a DOR value of 70.9. Xpert (Step 1: rule-in) followed by T-SPOT.TB [cut-off point] (Step 2: rule-out) showed the highest DOR value of 252.0, with only 5.7% (6/105) of patients misdiagnosed. The two-step algorithm consisting of Xpert and T-SPOT.TB could offer rapid and accurate diagnosis of TBP.
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Gao ZW, Wang X, Lin F, Dong K. Total adenosine deaminase highly correlated with adenosine deaminase 2 activity in serum. Ann Rheum Dis 2020; 81:e30. [PMID: 32001434 DOI: 10.1136/annrheumdis-2020-217007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Zhao-Wei Gao
- Department of Clinical Laboratories, Fourth Military Medical University, Xi'an, China
| | - Xi Wang
- Department of Clinical Laboratories, Fourth Military Medical University, Xi'an, China
| | - Fang Lin
- Department of Clinical Laboratories, Fourth Military Medical University, Xi'an, China
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Abstract
A 65-year-old Vietnamese man with hypertension, type 2 diabetes mellitus, and chronic hepatitis B with cirrhosis presented with a 2-week history of shortness of breath at rest, orthopnea, and lower extremity edema. He reported a 4-month history of nonproductive cough, 5-kg weight loss, and fatigue. He immigrated to the United States as an adult more than 20 years before presentation. His temperature was 37°C, heart rate was 78/min, respiratory rate was 17/min, and blood pressure was 158/95 mm Hg. A chest radiographic image suggested cardiomegaly and a computed tomographic scan demonstrated a moderate to large pericardial effusion. A pericardial drain was placed and pericardial fluid was sent to the laboratory for evaluation. Initial pericardial fluid study results are presented in the Table. Empirical treatment for tuberculosis was initiated. Three days later, an adenosine deaminase (ADA) level of 118.1 U/L (normal range, 0.0-11.3 U/L) from pericardial fluid was reported from the laboratory.
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Affiliation(s)
- Edward Chau
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California
| | - Minoo Sarkarati
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California
| | - Brad Spellberg
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California
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Trindade F, Vitorino R, Leite-Moreira A, Falcão-Pires I. Pericardial fluid: an underrated molecular library of heart conditions and a potential vehicle for cardiac therapy. Basic Res Cardiol 2019; 114:10. [DOI: 10.1007/s00395-019-0716-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 12/17/2018] [Accepted: 01/08/2019] [Indexed: 12/16/2022]
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Abstract
Viral pericarditis is the most common cause of acute pericarditis and it is typically responsive to aspirin or nonsteroidal anti-inflammatory drugs. Tuberculous pericarditis is common in immunocompromised patients or in immunocompetent patients in endemic areas. The diagnosis of tuberculous pericarditis usually requires a multidisciplinary approach, and presumptive treatment should be started for people with suspected infections living in endemic areas. Antituberculous treatment along with corticosteroid therapy can reduce complications from constrictive pericarditis. Purulent pericarditis is fatal if untreated. Bacterial and fungal cultures from pericardial fluid and blood are essential to determine the best treatment.
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Affiliation(s)
- Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular and Stroke Institute Imaging Center, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
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Loncar R, Ostojic L, Tabakovic-Loncar V, Roguljić A. Diagnostic Potential of Carcinoembryonic Antigen and Ferritine in Tuberculous and Malignant Pleural Effusion. TUMORI JOURNAL 2018; 81:440-4. [PMID: 8804473 DOI: 10.1177/030089169508100612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the study was to determine the diagnostic value of carcinoembryonic antigen (CEA) and ferritine in malignant and tuberculous non-bloody pleural effusion. The etiology of diseases was determined by cytologic, histologic and microbiologic methods. CEA concentration above 5 ng/ml and ferritine concentration above 200 ng/ml were considered to be positive. There was significant difference in the value of CEA measured in malignant and in tuberculous pleural effusion (P < 0.005) as well as in the sera (P < 0.01) of these two groups. There was no correlation between concentration of CEA and ferritine in malignant pleural effusion. Ratio between CEA and ferritine in effusions and sera was of no help in discrminating malignant from tuberculous effusions. No correlation between examined markers and physical status of patients was observed. The sensitivity and specificity of CEA assay in malignant pleural effusion was 65% and 90%, respectively, and for ferritine 67% and 80%, respectively. A high correlation was observed between the CEA concentration in malignant pleural effusion and sera patients (r = 0.95). Combined sensitivity and specificity of CEA and ferritine was 65.9% and 85%. Bayes theorem was used to calculate the positive predictive values for CEA and ferritine, which were 53% and 37%, respectively. Results obtained in the study show the relatively good diagnostic potential of CEA.
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Affiliation(s)
- R Loncar
- Central Institute for Tumors and Allied Diseases, Zagreb, Croatia
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Szturmowicz M, Tomkowski W, Fijalkowska A, Burakowski J, Sakowicz A, Filipecki S. The Role of Carcinoembryonic Antigen (CEA) and Neuron-Specific Enolase (NSE) Evaluation in Pericardial Fluid for the Recognition of Malignant Pericarditis. Int J Biol Markers 2018; 12:96-101. [PMID: 9479590 DOI: 10.1177/172460089701200302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was designed to assess the value of tumor marker evaluation in pericardial fluid for the recognition of malignant pericarditis. Thirty-six patients with signs and symptoms of large pericardial effusion entered the study. Pericardiocentesis with pericardial fluid drainage was performed in all of them. CEA and NSE levels were evaluated in the pericardial fluid and compared to pericardial fluid cytology. The median CEA value in malignant effusions was 80 ng/ml (range 0-305 ng/ml) and in non-malignant ones 1.26 ng/ml (range 0.2-18.4 ng/ml), p<0.01. The sensitivity of CEA elevation above 5 ng/ml for the recognition of malignant pericarditis was 73% and the specificity was 90%. Pericardial fluid cytology was positive in 22 of 26 patients with malignant pericarditis (85%). CEA exceeding 5 ng/ml or positive cytology were seen in 96% of the patients with malignant pericarditis. The median NSE value in malignant pericardial effusions was 41.8 μg/l (range 2-172 μg/l) and in non-malignant ones 5.85 μg/l (range 1-83.9 μg/l), p<0.3. For the differential diagnosis of large pericardial effusions we would recommend simultaneous cytologic examination of pericardial fluid and CEA assessment. NSE measurement in hemorrhagic pericardial fluid is of limited value.
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Affiliation(s)
- M Szturmowicz
- Department of Internal Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
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Szturmowicz M, Tomkowski W, Fijalkowska A, Kupis W, Cieślik A, Demkow U, Langfort R, Wiechecka A, Orlowski T, Torbicki A. Diagnostic Utility of Cyfra 21-1 and Cea Assays in Pericardial Fluid for the Recognition of Neoplastic Pericarditis. Int J Biol Markers 2018. [DOI: 10.1177/172460080502000107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A positive cytology result in pericardial fluid is the gold standard for recognition of malignant pericardial effusion. Unfortunately, in 30–50% of patients with malignant pericardial effusion cytological examination of the pericardial fluid is negative. Tumor marker assessment in pericardial fluid may help to recognize malignant pericardial effusion. The aim of our study was to estimate the value of CYFRA 21-1 and CEA measurement in pericardial fluid for the recognition of malignant pericardial effusion. To our knowledge this is the first study on CYFRA 21-1 assessment in pericardial effusion. The examined group consisted of 50 patients with malignant pericardial effusion and 34 patients with non-malignant pericardial effusion. Median CEA concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 80 ng/mL (0–317) and 0.5 ng/mL (0–18.4), respectively (p<0.001). Median CYFRA 21-1 concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 260 ng/mL (5.3–10080) and 22.4 ng/mL (1.87–317.6), respectively (p<0.001). The optimal cutoff value for CYFRA 21-1 in pericardial effusion was 100 ng/mL. CYFRA 21-1 >100 ng/mL or CEA >5 ng/mL were found in 14/15 patients with malignant pericardial effusion and negative pericardial fluid cytology. We therefore strongly recommend the use of CYFRA 21-1 and/or CEA in addition to pericardial fluid cytology for the recognition of malignant pericardial effusion.
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Affiliation(s)
- M. Szturmowicz
- Department of Internal Medicine National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - W. Tomkowski
- Cardiopulmonary Intensive Care Division National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - A. Fijalkowska
- Department of Internal Medicine National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - W. Kupis
- Department of Thoracic Surgery National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - A. Cieślik
- Department of Internal Medicine National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - U. Demkow
- Department of Clinical Biochemistry National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - R. Langfort
- Department of Pathology National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - A. Wiechecka
- Department of Radiology National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - T. Orlowski
- Department of Thoracic Surgery National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - A. Torbicki
- Department of Internal Medicine National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
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Wiysonge CS, Ntsekhe M, Thabane L, Volmink J, Majombozi D, Gumedze F, Pandie S, Mayosi BM. Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev 2017; 9:CD000526. [PMID: 28902412 PMCID: PMC5618454 DOI: 10.1002/14651858.cd000526.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tuberculous pericarditis can impair the heart's function and cause death; long term, it can cause the membrane to fibrose and constrict causing heart failure. In addition to antituberculous chemotherapy, treatments include corticosteroids, drainage, and surgery. OBJECTIVES To assess the effects of treatments for tuberculous pericarditis. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register (27 March 2017); the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library (2017, Issue 2); MEDLINE (1966 to 27 March 2017); Embase (1974 to 27 March 2017); and LILACS (1982 to 27 March 2017). In addition we searched the metaRegister of Controlled Trials (mRCT) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal using 'tuberculosis' and 'pericard*' as search terms on 27 March 2017. We searched ClinicalTrials.gov and contacted researchers in the field of tuberculous pericarditis. This is a new version of the original 2002 review. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs. DATA COLLECTION AND ANALYSIS Two review authors independently screened search outputs, evaluated study eligibility, assessed risk of bias, and extracted data; and we resolved any discrepancies by discussion and consensus. One trial assessed the effects of both corticosteroid and Mycobacterium indicus pranii treatment in a two-by-two factorial design; we excluded data from the group that received both interventions. We conducted fixed-effect meta-analysis and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS Seven trials met the inclusion criteria; all were from sub-Saharan Africa and included 1959 participants, with 1051/1959 (54%) HIV-positive. All trials evaluated corticosteroids and one each evaluated colchicine, M. indicus pranii immunotherapy, and open surgical drainage. Four trials (1841 participants) were at low risk of bias, and three trials (118 participants) were at high risk of bias.In people who are not infected with HIV, corticosteroids may reduce deaths from all causes (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.59 to 1.09; 660 participants, 4 trials, low certainty evidence) and the need for repeat pericardiocentesis (RR 0.85, 95% CI 0.70 to 1.04; 492 participants, 2 trials, low certainty evidence). Corticosteroids probably reduce deaths from pericarditis (RR 0.39, 95% CI 0.19 to 0.80; 660 participants, 4 trials, moderate certainty evidence). However, we do not know whether or not corticosteroids have an effect on constriction or cancer among HIV-negative people (very low certainty evidence).In people living with HIV, only 19.9% (203/1959) were on antiretroviral drugs. Corticosteroids may reduce constriction (RR 0.55, 0.26 to 1.16; 575 participants, 3 trials, low certainty evidence). It is uncertain whether corticosteroids have an effect on all-cause death or cancer (very low certainty evidence); and may have little or no effect on repeat pericardiocentesis (RR 1.02, 0.89 to 1.18; 517 participants, 2 trials, low certainty evidence).For colchicine among people living with HIV, we found one small trial (33 participants) which had insufficient data to make any conclusions about any effects on death or constrictive pericarditis.Irrespective of HIV status, due to very low certainty evidence from one trial, it is uncertain whether adding M. indicus pranii immunotherapy to antituberculous drugs has an effect on any outcome.Open surgical drainage for effusion may reduce repeat pericardiocentesis In HIV-negative people (RR 0.23, 95% CI 0.07 to 0.76; 122 participants, 1 trial, low certainty evidence) but may make little or no difference to other outcomes. We did not find an eligible trial that assessed the effects of open surgical drainage in people living with HIV.The review authors found no eligible trials that examined the length of antituberculous treatment needed nor the effects of other adjunctive treatments for tuberculous pericarditis. AUTHORS' CONCLUSIONS For HIV-negative patients, corticosteroids may reduce death. For HIV-positive patients not on antiretroviral drugs, corticosteroids may reduce constriction. For HIV-positive patients with good antiretroviral drug viral suppression, clinicians may consider the results from HIV-negative patients more relevant.Further research may help evaluate percutaneous drainage of the pericardium under local anaesthesia, the timing of pericardiectomy in tuberculous constrictive pericarditis, and new antibiotic regimens.
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Affiliation(s)
- Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Mpiko Ntsekhe
- Groote Schuur HospitalDivision of CardiologyObservatory 7925Cape TownSouth Africa
| | - Lehana Thabane
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics50 Charlton Ave ERoom H325, St. Joseph's HealthcareHamiltonONCanadaL8N 4A6
| | - Jimmy Volmink
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Dumisani Majombozi
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Freedom Gumedze
- University of Cape TownDepartment of Statistical SciencesCape TownSouth Africa
| | - Shaheen Pandie
- University of Cape TownDepartment of MedicineCape TownSouth Africa
| | - Bongani M Mayosi
- University of Cape TownDepartment of MedicineCape TownSouth Africa
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Szturmowicz M, Pawlak-Cieślik A, Fijałkowska A, Gątarek J, Skoczylas A, Dybowska M, Błasińska-Przerwa K, Langfort R, Tomkowski W. The value of the new scoring system for predicting neoplastic pericarditis in the patients with large pericardial effusion. Support Care Cancer 2017; 25:2399-2403. [PMID: 28258502 DOI: 10.1007/s00520-017-3645-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/17/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Early recognition of neoplastic pericarditis (npe) is crucial for the planning of subsequent therapy. The aim of the present study was to construct the scoring system assessing the probability of npe, in the patients requiring pericardial fluid (pf) drainage due to large pericardial effusion. METHODS One hundred forty-six patients, 74 males and 72 females, entered the study. Npe based on positive pf cytology and/or pericardial biopsy specimen was recognised in 66 patients, non-npe in 80. Original scoring system was constructed based on parameters with the highest diagnostic value: mediastinal lymphadenopathy on chest CT scan, increased concentration of tumour markers (cytokeratin 19 fragments-Cyfra 21-1 and carcinoembryonic antigen-CEA) in pf, bloody character of pf, signs of imminent cardiac tamponade on echocardiography and tachycardia exceeding 90 beats/min on ECG. Each parameter was scored with positive or negative points depending on the positive and negative predictive values (PPV, NPV). RESULTS The area under curve (AUC) for the scoring system was 0.926 (95%CI 0.852-0.963) and it was higher than AUC for Cyfra 21-1 0.789 (95%CI 0.684-0.893) or CEA 0.758 (95%CI 0.652-0.864). The score optimally discriminating between npe and non-npe was 0 points (sensitivity 0.84, specificity 0.91, PPV 0.9, NPV 0.85). CONCLUSION Despite chest CT and tumour marker evaluation in pericardial fluid were good discriminators between npe and non-npe, the applied scoring system further improved the predicting of neoplastic disease in the studied population.
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Affiliation(s)
- M Szturmowicz
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
| | - A Pawlak-Cieślik
- Independent Centre of Public Outpatient Care Units, Warsaw, Poland
| | - A Fijałkowska
- Department of Cardiology National Research Institute for Mother and Child, Warsaw, Poland
| | - J Gątarek
- Department of Thoracic Surgery, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - A Skoczylas
- Freelance Statistical Analytic, Warsaw, Poland
| | - M Dybowska
- Cardiopulmonary Intensive Care Unit, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - K Błasińska-Przerwa
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - R Langfort
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - W Tomkowski
- Cardiopulmonary Intensive Care Unit, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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Oh PC, Han SH, Koh KK. Reply to comment on: idiopathic pericarditis presenting large hemorrhagic pericardial effusion by Dr. George A Lazaros. Int J Cardiol 2014; 172:250. [PMID: 24461991 DOI: 10.1016/j.ijcard.2013.12.280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/30/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Pyung Chun Oh
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea; Gachon Cardiovascular Research Institute, Incheon, Republic of Korea
| | - Seung Hwan Han
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea; Gachon Cardiovascular Research Institute, Incheon, Republic of Korea
| | - Kwang Kon Koh
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea; Gachon Cardiovascular Research Institute, Incheon, Republic of Korea.
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18
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Peritoneal Tuberculosis: An Uncommon Disease Calling for Close Scrutiny. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2013. [DOI: 10.5812/archcid.16672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Oh PC, Baek SJ, Moon J, Han SH, Park KY, Koh KK. Idiopathic pericarditis presenting large hemorrhagic pericardial effusion. Int J Cardiol 2013; 168:4467-9. [PMID: 23871624 DOI: 10.1016/j.ijcard.2013.06.140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 06/30/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Pyung Chun Oh
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Karatolios K, Pankuweit S, Moosdorf RG, Maisch B. Vascular endothelial growth factor in malignant and benign pericardial effusion. Clin Cardiol 2012; 35:377-81. [PMID: 22302718 DOI: 10.1002/clc.21967] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 12/28/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The pathogenetic role of vascular endothelial growth factor (VEGF) in malignant pericardial effusion and diagnostic value of pericardial VEGF levels to discriminate malignant from benign pericardial effusions are uncertain. HYPOTHESIS We hypothesized that pericardial VEGF levels would be higher in malignant than benign pericardial effusion and that VEGF would be a useful marker for the diagnosis of malignant pericardial effusion. METHODS Using an enzyme-linked immunosorbent assay, we assessed pericardial and serum VEGF levels in patients with malignant pericardial effusion (n = 19), in patients with nonmalignant pericardial effusion (n = 30), and for control, in patients without pericardial disease (n = 26). RESULTS Vascular endothelial growth factor pericardial levels in malignant pericardial effusion (13 593.8 ± 22 410.24 pg/mL) were significantly higher compared with VEGF in nonmalignant effusion (610.63 ± 1289.08 pg/mL; P = 0.001) and pericardial fluid (5.5 ± 15.97 pg/mL; P < 0.001). In serum, VEGF was significantly higher in patients with nonmalignant pericardial effusion (188.3 ± 240.35 pg/mL) compared with patients with malignant pericardial effusion (67.52 ± 125.77 pg/mL; P = 0.024) and coronary artery disease patients (29.13 ± 76.26 pg/mL; P < 0.001). Pericardial VEGF levels were significantly higher than matched serum levels only in patients with malignant pericardial effusion (P = 0.023). Pericardial VEGF levels ≥2385 pg/mL had 75% sensitivity and 90% specificity for the recognition of malignant pericardial effusion in patients with breast or lung cancer. CONCLUSIONS Vascular endothelial growth factor levels in pericardial effusion are markedly elevated in patients with malignant pericardial effusion, indicating abundant local release within the pericardial cavity. It is thus possible that VEGF participates in the pathogenesis of malignant pericardial effusion. Measurement of VEGF in pericardial effusion offers potential as a diagnostic tool to discriminate malignant from benign effusions in patients with breast or lung cancer.
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21
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Osteoprotegerin (OPG) and TNF-related apoptosis-inducing ligand (TRAIL) levels in malignant and benign pericardial effusions. Clin Biochem 2011; 45:237-42. [PMID: 22202560 DOI: 10.1016/j.clinbiochem.2011.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Osteoprotegerin (OPG) is a regulator of bone and vascular homeostasis and acts as a decoy receptor for proapoptotic TNF-related apoptosis-inducing ligand (TRAIL). DESIGN AND METHODS We assessed pericardial and serum levels of OPG and TRAIL in pericardial effusions (PE) of malignant (mPE, n=24) or non-malignant (nPE, n=34) origin, and in pericardial fluid (PF, n=25) of coronary artery disease (CAD) patients by ELISA. RESULTS OPG was at least 5 fold higher in PE or PF compared to serum, with a significantly higher ratio of pericardial to serum OPG in patients with mPE or nPE compared to PF (mPE vs. PF, p=0.011; nPE vs. PF, p<0.001). TRAIL was only detectable in mPE and PF. Logistic regression analysis revealed that a high ratio of pericardial to serum OPG and high TRAIL in PE were the best variable combination to predict malignancy of PE. CONCLUSIONS Pericardial and systemic OPG or TRAIL are potential diagnostic tools to discriminate between malignant or benign PE.
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22
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Florián MC, Franco S, Santacruz D, Montoya KF. Pericarditis tuberculosa: presentación de un caso y revisión de la literatura. REVISTA COLOMBIANA DE CARDIOLOGÍA 2011. [DOI: 10.1016/s0120-5633(11)70200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Karatolios K, Maisch B, Pankuweit S. Tumormarker im Perikarderguss bei malignen und nichtmalignen Perikardergüssen. Herz 2011; 36:290-5. [DOI: 10.1007/s00059-011-3451-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Sheth S, Wang DD, Kasapis C. Current and emerging strategies for the treatment of acute pericarditis: a systematic review. J Inflamm Res 2010; 3:135-42. [PMID: 22096363 PMCID: PMC3218740 DOI: 10.2147/jir.s10268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pericarditis is a common disorder that has multiple causes and presents in various primary-care and secondary-care settings. It is diagnosed in 0.1% of all hospital admissions and in 5% of emergency room visits for chest pain. Despite the advance of new diagnostic techniques, pericarditis is most commonly idiopathic, and radiation therapy, cardiac surgery, and percutaneous procedures have become important causes. Pericarditis is frequently benign and self-limiting. Nonsteroidal anti-inflammatory agents remain the first-line treatment for uncomplicated cases. Integrated use of new imaging methods facilitates accurate detection and management of complications such as pericardial effusion or constriction. In this article, we perform a systematic review on the etiology, clinical presentation, diagnostic evaluation, and management of acute pericarditis. We summarize current evidence on contemporary and emerging treatment strategies.
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Affiliation(s)
- Samar Sheth
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Imazio M, Spodick DH, Brucato A, Trinchero R, Markel G, Adler Y. Diagnostic issues in the clinical management of pericarditis. Int J Clin Pract 2010; 64:1384-92. [PMID: 20487049 DOI: 10.1111/j.1742-1241.2009.02178.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIMS To review the current major diagnostic issues on the diagnosis of acute and recurrent pericarditis. METHODS To review the current available evidence, we performed a through search of several evidence-based sources of information, including Cochrane Database of Systematic Reviews, Clinical Evidence, Evidence-based guidelines from National Guidelines Clearinghouse and a comprehensive Medline search with the MeSH terms 'pericarditis', 'etiology' and 'diagnosis'. RESULTS The diagnosis of pericarditis is based on clinical criteria including symptoms, presence of specific physical findings (rubs), electrocardiographical changes and pericardial effusion. Although the aetiology may be varied, most cases are idiopathic or viral, even after an extensive diagnostic evaluation. In such cases, the course is often benign following anti-inflammatory treatment, and management would be not affected by a more precise diagnostic evaluation. A triage of pericarditis can be safely performed on the basis of the clinical and echocardiographical presentation. Specific diagnostic tests are not warranted if no specific aetiologies are suspected on the basis of the epidemiological background, history and presentation. High-risk features associated with specific aetiologies or complications include: fever > 38 degrees C, subacute onset, large pericardial effusion, cardiac tamponade, lack of response to aspirin or a NSAID. CONCLUSIONS A targeted diagnostic evaluation is warranted in acute and recurrent pericarditis, with a specific aetiological search to rule out tuberculous, purulent or neoplastic pericarditis, as well as pericarditis related to a systemic disease, in selected patients according to the epidemiological background, presentation and clinical suspicion.
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Affiliation(s)
- M Imazio
- Cardiology Department, Maria Vittoria Hospital, Torino, Italy.
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26
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Hernández J, Jaramillo A, Mejía GI, Barón P, Gomez V, Restrepo MA, Robledo J. Assessment of mycobacteremia detection as a complementary method for the diagnosis of tuberculosis in HIV-infected patients. Eur J Clin Microbiol Infect Dis 2010; 29:1435-41. [PMID: 20734098 DOI: 10.1007/s10096-010-1023-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 07/28/2010] [Indexed: 10/19/2022]
Abstract
The purpose of this investigation was to assess the usefulness of mycobacteremia detection in human immunodeficiency virus (HIV) patients with suspected tuberculosis. The study included 47 patients with suspected tuberculosis and confirmed HIV infection. A first blood sample was incubated in a BACTEC 9050 MB system, while white blood cells isolation was performed on a second blood specimen before incubation in a BACTEC MGIT 960 system. The third specimen was taken from the affected organs of each patient according to their clinical profile. Twelve (25.5%) patients were positive for mycobacterial infection identified by any of the methods used. Ten (21.2%) were positive for Mycobacterium tuberculosis and 2 (4.3%) for M. avium. Six patients were diagnosed by the culture of specimen from affected organs only, whilst three other patients were positive exclusively for blood cultures. Three additional patients were diagnosed by both methods. Four patients with negative cultures were ultimately diagnosed with tuberculosis by measuring the adenosine deaminase levels. Mycobacteremia detection can be used to increase the sensitivity of the diagnosis of tuberculosis and other mycobacteria in patients with HIV. However, it cannot be used as the sole diagnostic method. Clinical specimen cultures do not provide 100% diagnostic accuracy and it is, therefore, critical to further improve the mycobacteria detection sensitivity.
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Affiliation(s)
- J Hernández
- Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas (CIB), Cra 72A No. 78B-141, Medellín, Colombia
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Brendt P, Herbstreit F, Peters J. Cardiogenic shock following cesarean delivery due to undiagnosed tuberculous constrictive pericarditis. Int J Obstet Anesth 2010; 19:448-51. [PMID: 20708920 DOI: 10.1016/j.ijoa.2010.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 07/15/2009] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
Abstract
We describe an uncommon cause of cardiogenic shock following cesarean delivery in a 24-year-old multiparous woman at 26 weeks of gestation. Hemodynamic instability was erroneously attributed to amniotic infection syndrome and sepsis, which resulted in delayed diagnosis and treatment of tuberculous constrictive pericarditis. Inotropic support, pericardectomy, and implantation of a left ventricular assist device were required for maternal survival.
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Affiliation(s)
- P Brendt
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany.
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28
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Calabrese F, Carturan E, Thiene G. Cardiac infections: focus on molecular diagnosis. Cardiovasc Pathol 2010; 19:171-82. [DOI: 10.1016/j.carpath.2009.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/24/2009] [Accepted: 09/28/2009] [Indexed: 01/09/2023] Open
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Karatolios K, Alter P, Maisch B. Differenzierung von malignen und nichtmalignen, inflammatorischen Perikardergüssen mit Biomarkern. Herz 2010; 34:624-33. [DOI: 10.1007/s00059-009-3304-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Kim SH, Song JM, Jung IH, Kim MJ, Kang DH, Song JK. Initial echocardiographic characteristics of pericardial effusion determine the pericardial complications. Int J Cardiol 2009; 136:151-5. [DOI: 10.1016/j.ijcard.2008.04.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 03/25/2008] [Accepted: 04/23/2008] [Indexed: 11/16/2022]
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31
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Imazio M, Brucato A, DeRosa FG, Lestuzzi C, Bombana E, Scipione F, Leuzzi S, Cecchi E, Trinchero R, Adler Y. Aetiological diagnosis in acute and recurrent pericarditis: when and how. J Cardiovasc Med (Hagerstown) 2009; 10:217-30. [DOI: 10.2459/jcm.0b013e328322f9b1] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Han SH, Koh KK, Lee SJ, Seo JG, Choi SJ, Ha SY. Malignant pericardial effusion not diagnosed by pericardial fluid and biopsy: Importance of CT scan. Int J Cardiol 2007; 117:e53-5. [PMID: 17292495 DOI: 10.1016/j.ijcard.2006.11.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 11/11/2006] [Indexed: 11/30/2022]
Abstract
A 47-year-old female came to the emergency room due to dyspnea for 1 month. Initial chest X-ray showed enlargement of the cardiac silhouette. Emergent echocardiogram demonstrated large amount of pericardial effusion. Pericardiostomy with pericardial biopsy was performed. The etiology of large amount of hemorrhagic pericardial effusion could not be confirmed even by aggressive analysis of pericardial fluid and pericardial biopsy. CT scan of the mediastinum was performed. Percutaneous fine needle aspiration biopsy demonstrated thymic carcinoma with focal squamous differentiation. When the analysis of pericardial fluid and pericardial biopsy cannot reveal the etiology of hemorrhagic pericardial effusion, CT scan should be performed.
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Zamirian M, Mokhtarian M, Motazedian MH, Monabati A, Reza Rezaian G. Constrictive pericarditis: Detection of mycobacterium tuberculosis in paraffin-embedded pericardial tissues by polymerase chain reaction. Clin Biochem 2007; 40:355-8. [PMID: 17303104 DOI: 10.1016/j.clinbiochem.2006.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 12/03/2006] [Accepted: 12/27/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although the utility of polymerase chain reaction (PCR) for diagnosis of acute pleuro-pericardial tuberculosis has been well established, its use for chronic constrictive pericarditis is yet to be reported. AIMS To define the sensitivity and specificity of PCR for diagnosis of tuberculosis (TB) in patients with constrictive pericarditis. METHODS The medical records of 30 consecutive patients with constrictive pericarditis were reviewed. In addition their historical paraffin-embedded pericardial tissues were used for new histopathologic examination and PCR amplification for Mycobacterium tuberculosis genome. RESULTS There were 23 males and 7 females with a mean age of 35+/-19.5 years. The anticipated causes of constriction included idiopathic (n=21), tuberculosis (n=5), cardiac surgery (n=2) and post traumatic (n=2). PCR became positive in nine patients. Four out of 5 patients with tuberculous granuloma had a positive test result. In addition all 4 patients with non-tuberculous constrictive pericarditis had a negative test result. Therefore considering the presence or absence of granuloma as a diagnostic criteria, the sensitivity and specificity of PCR were 4/5 (80%) and 20/25 (80%), respectively.
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Affiliation(s)
- Mahmood Zamirian
- Department of Internal Medicine (Cardiology), Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
Bacterial pericarditis occurs by direct infection during trauma, thoracic surgery, or catheter drainage, by spread from an intrathoracic, myocardial, or subdiaphragmatic focus, and by hematogenous dissemination. The frequent causes are Staphylococcus and Streptococcus (rheumatic pancarditis), Haemophilus, and M. tuberculosis. In AIDS pericarditis, the incidence of bacterial infection is much higher than in the general population, with a high proportion of Mycobacterium avium-intracellulare infection. Purulent pericarditis is the most serious manifestation of bacterial pericarditis, characterized by gross pus in the pericardium or microscopically purulent effusion. It is an acute, fulminant illness with fever in virtually all patients. Chest pain is uncommon. Purulent pericarditis is always fatal if untreated. The mortality rate in treated patients is 40%, and death is mostly due to cardiac tamponade, systemic toxicity, cardiac decompensation, and constriction. Tuberculous infection may present as acute pericarditis, cardiac tamponade, silent (often large) relapsing pericardial effusion, effusive-constrictive pericarditis, toxic symptoms with persistent fever, and acute, subacute, or chronic constriction. The mortality in untreated patients approaches 85%. Urgent pericardial drainage, combined with intravenous antibacterial therapy (e.g. vancomycin 1g twice daily, ceftriaxone 1-2g twice daily, and ciprofloxacin 400 mg/day) is mandatory in purulent pericarditis. Irrigation with urokinase or streptokinase, using large catheters, may liquify the purulent exudate, but open surgical drainage is preferable. The initial treatment of tuberculous pericarditis should include isoniazid 300 mg/day, rifampin 600 mg/day, pyrazinamide 15-30 mg/kg/day, and ethambutol 15-25 mg/kg/day. Prednisone 1-2 mg/kg/day is given for 5-7 days and progressively reduced to discontinuation in 6-8 weeks. Drug sensitivity testing is essential. Pericardiectomy is reserved for recurrent effusions or continued elevation of central venous pressure after 4-6 weeks of antituberculous and corticosteroid therapy.
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Affiliation(s)
- Sabine Pankuweit
- Department of Internal Medicine - Cardiology, Philipps University, Marburg, Germany
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Sagristà Sauleda J, Permanyer Miralda G, Soler Soler J. Orientación diagnóstica y manejo de los síndromes pericárdicos agudos. Rev Esp Cardiol 2005. [DOI: 10.1157/13077235] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Burgess LJ. Biochemical analysis of pleural, peritoneal and pericardial effusions. Clin Chim Acta 2004; 343:61-84. [PMID: 15115678 DOI: 10.1016/j.cccn.2004.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Revised: 01/30/2004] [Accepted: 02/02/2004] [Indexed: 02/01/2023]
Abstract
Body fluids other than blood, urine and cerebrospinal fluid are often submitted for biochemical analysis. Of these, pleural, peritoneal and pericardial fluids are the most common. Laboratory tests are a useful tool to assess the aetiology, pathophysiology and subsequent treatment of effusions. A wide range of biochemical tests may be requested. This review critically examines the various analytes that have been used to investigate these body fluids.
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Affiliation(s)
- L J Burgess
- TREAD Research/Cardiology Unit, Stellenbosch University, P.O. Box 19174, Tygerberg 7505, Parow, South Africa.
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39
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Nardell EA, Fan D, Shepard JAO, Mark EJ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-2004. A 30-year-old woman with a pericardial effusion. N Engl J Med 2004; 351:279-87. [PMID: 15254287 DOI: 10.1056/nejmcpc049014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Edward A Nardell
- Division of Pulmonary Medicine, Cambridge Hospital, Cambridge, Mass, USA
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40
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Guigay J. Quels sont les nouveaux outils diagnostiques de la tuberculose ? Quel est leur intérêt pour la prise en charge du malade et quelles sont leurs indications ? Rev Mal Respir 2004; 21:S44-50. [PMID: 15344270 DOI: 10.1016/s0761-8425(04)71384-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Guigay
- Service de Pneumologie, HIA Percy, Clamart, France.
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41
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Harms K, Nozell S, Chen X. The common and distinct target genes of the p53 family transcription factors. Cell Mol Life Sci 2004; 61:822-42. [PMID: 15095006 PMCID: PMC11138747 DOI: 10.1007/s00018-003-3304-4] [Citation(s) in RCA: 230] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
p53 is the most commonly mutated gene in human cancer. After activation by cellular stresses such as DNA damage or oncogene activation, p53, a sequence-specific DNA-binding protein, induces the expression of target genes which mediate tumor suppression. Two recently identified p53 homologues, p63 and p73, appear to function similarly to p53, that is, they both activate target gene expression and suppress cell growth when overexpressed; however, the p63 and p73 genes are rarely mutated in human cancer and do not adhere to Knudson's classical model of a tumor suppressor gene. Recently, exciting observations suggest nonoverlapping functions for the family members. Herein, we outline the recent literatures identifying and characterizing both the common and distinct target genes of the p53 family transcription factors in relation to their signaling pathways.
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Affiliation(s)
- K. Harms
- Department of Cell Biology, University of Alabama at Birmingham, 1918 University Blvd., 35294 Birmingham, Alabama USA
| | - S. Nozell
- Department of Cell Biology, University of Alabama at Birmingham, 1918 University Blvd., 35294 Birmingham, Alabama USA
| | - X. Chen
- Department of Cell Biology, University of Alabama at Birmingham, 1918 University Blvd., 35294 Birmingham, Alabama USA
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Abstract
Pericarditis is a common disorder that has multiple causes and presents in various primary-care and secondary-care settings. New diagnostic techniques have improved the sampling and analysis of pericardial fluid and allow comprehensive characterisation of cause. Despite this advance, pericarditis is most commonly idiopathic, and radiation therapy, cardiac surgery, and percutaneous procedures have become important causes. Pericarditis is frequently self-limiting, and non-steroidal anti-inflammatory agents remain the first-line treatment for uncomplicated cases. Integrated use of new imaging methods facilitates accurate detection and management of complications such as pericardial effusion or constriction. Differentiation of constrictive pericarditis from restrictive cardiomyopathy remains a clinical challenge but is facilitated by tissue doppler and colour M-mode echocardiography. Most pericardial effusions can be safely managed with an echo-guided percutaneous approach. Pericardiectomy remains the definitive treatment for constrictive pericarditis and provides symptomatic relief in most cases. In the future, the pericardial space might become a conduit for treatments directed at the pericardium and myocardium.
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Affiliation(s)
- Richard W Troughton
- Department of Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
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Kameyama K, Huang CL, Okamoto T, Ishikawa S, Yamamoto Y, Yokomise H. Video-assisted thoracoscopic pericardial fenestration for tuberculous pericardial effusion. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2004; 52:68-70. [PMID: 14997974 DOI: 10.1007/s11748-004-0086-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 72-year-old woman was admitted with chest discomfort and general fatigue. She was diagnosed as having cardiac tamponade with massive pericardial effusion. Percutaneous pericardiocentesis yielded bloody effusion. Tuberculous pericarditis was suspected owing to the adenosine deaminase level in this fluid. Video-assisted thoracoscopic pericardial fenestration (VATSPF) was performed for the diagnosis and treatment. Polymerase chain reaction detected Mycobacterium tuberculosis DNA in the pericardial tissues, confirming the diagnosis of tuberculous pericarditis. She received a combination of three-kind medication and anti-tuberculous regimen, and a follow-up check up for more than 2 years, exhibiting a good postoperative course. We conclude that VATSPF can be a useful procedure not only for diagnosis but for release of tuberculous pericarditis with cardiac tamponade and for prophylaxis of constrictive pericarditis.
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Affiliation(s)
- Kotaro Kameyama
- Second Department of Surgery, Kagawa Medical University, Kita-gun, Kagawa, Japan
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44
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Tuberculosis of the Heart and Pericardium. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH. Guía de Práctica Clínica para el diagnóstico y tratamiento de las enfermedades del pericardio. Versión resumida. Rev Esp Cardiol 2004; 57:1090-114. [PMID: 15544758 DOI: 10.1016/s0300-8932(04)77245-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Affiliation(s)
- Bernhard Maisch
- Department of Internal Medicine-Cardiology, Faculty of Medicine, Philipps University, Marburg, Germany.
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47
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Lee JH, Lee CW, Lee SG, Yang HS, Hong MK, Kim JJ, Park SW, Chi HS, Park SJ. Comparison of polymerase chain reaction with adenosine deaminase activity in pericardial fluid for the diagnosis of tuberculous pericarditis. Am J Med 2002; 113:519-21. [PMID: 12427503 DOI: 10.1016/s0002-9343(02)01261-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jae-Hwan Lee
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea
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48
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Burgess LJ, Reuter H, Carstens ME, Taljaard JJF, Doubell AF. The use of adenosine deaminase and interferon-gamma as diagnostic tools for tuberculous pericarditis. Chest 2002; 122:900-5. [PMID: 12226030 DOI: 10.1378/chest.122.3.900] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Traditional diagnostic tests for pericardial tuberculosis (TB) are insensitive and often require long culture periods, and this has led to more emphasis being placed on biochemical tests such as the pericardial adenosine deaminase (ADA) test. However, controversy exists as to its diagnostic utility. In addition, the use of interferon (IFN)-gamma, which is a reliable indicator of pleural and peritoneal TB, has not been explored in pericardial effusions. We investigated ADA and IFN-gamma levels in pericardial effusions of different etiologies. METHODS AND RESULTS A prospective study was carried out from February 1995 to February 1998 at Tygerberg Hospital (South Africa), with pericardial taps being performed under echocardiographic guidance. During this period, 110 consecutive patients presenting with large pericardial effusions were included in the study. Diagnoses were made according to predetermined criteria, and they included TB (n = 64), malignancy (n = 12), nontuberculous infections (n = 5), other effusions (n = 19), and effusions of uncertain origin (n = 10). The median ADA level in the tuberculous group was 71.7 U/L (range, 10.3 to 303.6 U/L), which was significantly higher than that in any other group (p < 0.05). With a cutoff level for ADA activity of 30 U/L, sensitivity was 94%, specificity was 68%, and positive predictive value was 80%. IFN-gamma levels were determined in 30 subjects. The median IFN-gamma concentration in the tuberculous group was > 1,000 pg/L, which was significantly higher than in any other diagnostic group (p < 0.0005). A cutoff value of 200 pg/L for IFN-gamma resulted in a sensitivity and specificity of 100% for the diagnosis of pericardial TB. CONCLUSION Pericardial fluid levels of ADA and IFN-gamma are useful in the diagnosis of tuberculous pericarditis.
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Affiliation(s)
- Lesley J Burgess
- Department of Cardiology, Tygerberg Hospital and University of Stellenbosch, South Africa.
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Mayosi BM, Ntsekhe M, Volmink JA, Commerford PJ. Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev 2002:CD000526. [PMID: 12519546 DOI: 10.1002/14651858.cd000526] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Tuberculous pericarditis - tuberculosis infection of the pericardial membrane (pericardium) covering the heart - is becoming more common. The infection can result in fluid around the heart or fibrosis of the pericardium, which can be fatal. OBJECTIVES In people with tuberculous pericarditis, to evaluate the effects on death, life-threatening conditions, and persistent disability of: (1) 6-month antituberculous drug regimens compared with regimens of 9 months or more; (2) corticosteroids; (3) pericardial drainage; and (4) pericardiectomy. SEARCH STRATEGY We searched the Cochrane Infectious Diseases Group trials register (June 2002), the Cochrane Controlled Trials Register (Issue 2, 2002), MEDLINE (1966 to June 2002), EMBASE (1980 to May 2002), and checked the reference lists of existing reviews. We also contacted organizations and individuals working in the field. SELECTION CRITERIA Randomized and quasi-randomized controlled trials of treatments for tuberculous pericarditis. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. Meta-analysis using fixed effects models calculated summary statistics, provided there was no statistically significant heterogeneity, and expressed results as relative risk. Study authors were contacted for additional information. MAIN RESULTS Four trials met the inclusion criteria, with a total of 469 participants. Treatments tested were adjuvant steroids and surgical drainage. Two trials with a total of 383 participants tested adjuvant steroids in participants with suspected tuberculous pericarditis in the pre-HIV era. Fewer participants died in the intervention group, but numbers were small (relative risk [RR] 0.65; 95% confidence interval [CI] 0.36 to 1.16, n = 350). One small trial tested steroids in HIV positive participants with effusion showed a similar pattern (RR 0.50; 95% CI 0.19 to 1.28, n = 58). One trial examined open surgical drainage compared with conservative management, and showed surgery relieved cardiac tamponade. REVIEWER'S CONCLUSIONS Steroids could have important clinical benefits, but the trials published to date are too small to demonstrate an effect. This requires large placebo controlled trials. Subgroup analysis could explore whether effusion or fibrosis modify the effects. Therapeutic pericardiocentesis under local anaesthesia and pericardiectomy also require further evaluation.
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Affiliation(s)
- B M Mayosi
- The Cardiac Clinic, E25 Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa.
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50
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Abstract
This article presents the various manifestations of cardiac infections found in the immunosuppressed host. Emphasis is placed on the correlation between specific impairments of host defenses and the occurrence of certain types of pathogens. The effect of immunosuppression on the clinical manifestations of these infections is discussed. Finally, appropriate diagnostic modalities are presented for the major types of infections.
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Affiliation(s)
- J L Brusch
- Department of Medicine, Infectious Disease Service, Cambridge Hospital, Massachusetts, USA
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