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Baylan U, Baidoshvili A, Simsek S, Schalkwijk CG, Niessen HWM, Krijnen PAJ. Increased accumulation of the advanced glycation endproduct Ne(carboxymethyl) lysine in the intramyocardial vasculature in patients with epicarditis. Int J Exp Pathol 2024; 105:48-51. [PMID: 38062984 PMCID: PMC10951421 DOI: 10.1111/iep.12499] [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: 08/08/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 03/21/2024] Open
Abstract
Advanced glycation end-products (AGEs) are implicated in the pathogenesis of vascular disease. In previous studies we have found increased deposition of N(e)-(carboxymethyl)lysine (CML) in intramyocardial vasculature in the heart in acute myocardial infarction and myocarditis. It is known that the process of inflammation plays a role in the formation of AGEs. In this study we have explored the presence of CML (a major AGE) in the heart of patients with epicarditis using a monoclonal anti-CML antibody. Nine patients with epicarditis (n = 9) died and their hearts were used for this study, control were hearts from patients who died from conditions unrelated to heart disease and without signs of myocarditis or epicarditis CML deposition and complement were significantly increased in patients with epicarditis compared to control hearts. Thus epicarditis increases CML depositions in the intramyocardial vasculature.
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Affiliation(s)
- U Baylan
- Department of PathologyAmsterdam University Medical Centre (AUMC)AmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - A Baidoshvili
- Laboratory for Pathology East NetherlandsHengeloThe Netherlands
| | - S Simsek
- Department of Internal MedicineNorthwest ClinicsAlkmaarThe Netherlands
- Department of Internal MedicineAUMCAmsterdamThe Netherlands
| | - CG Schalkwijk
- Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)MaastrichtThe Netherlands
| | - HWM Niessen
- Department of PathologyAmsterdam University Medical Centre (AUMC)AmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - PAJ Krijnen
- Department of PathologyAmsterdam University Medical Centre (AUMC)AmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
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Giliomee LJ, Doubell AF, Robbertse PS, John TJ, Herbst PG. Novel role of cardiovascular MRI to contextualise tuberculous pericardial inflammation and oedema as predictors of constrictive pericarditis. Front Cardiovasc Med 2024; 11:1329767. [PMID: 38562190 PMCID: PMC10982342 DOI: 10.3389/fcvm.2024.1329767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Tuberculosis (TB) and human immunodeficiency virus/acquired immunodeficiency syndrome have reached epidemic proportions, particularly affecting vulnerable populations in low- and middle-income countries of sub-Saharan Africa. TB pericarditis is the commonest cardiac manifestation of TB and is the leading cause of constrictive pericarditis, a reversible (by surgical pericardiectomy) cause of diastolic heart failure in endemic areas. Unpacking the complex mechanisms underpinning constrictive haemodynamics in TB pericarditis has proven challenging, leaving various basic and clinical research questions unanswered. Subsequently, risk stratification strategies for constrictive outcomes have remained unsatisfactory. Unique pericardial tissue characteristics, as identified on cardiovascular magnetic resonance imaging, enable us to stage and quantify pericardial inflammation and may assist in identifying patients at higher risk of tissue remodelling and pericardial constriction, as well as predict the degree of disease reversibility, tailor medical therapy, and determine the ideal timing for surgical pericardiectomy.
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Affiliation(s)
- L. J. Giliomee
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, South Africa
| | - A. F. Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, South Africa
| | - P. S. Robbertse
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, South Africa
| | - T. J. John
- Heart Unit, Mediclinic Panorama, Cape Town, South Africa
| | - P. G. Herbst
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, South Africa
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Cotton M, Sweeting F. Dressler syndrome in the 21 st Century. Future Cardiol 2023; 19:719-721. [PMID: 37933614 DOI: 10.2217/fca-2023-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Matthew Cotton
- Torbay Hospital & South Devon Foundation Trust, TQ2 7AA, UK
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4
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Ayodele S, Kumar P, van Eyk A, Choonara YE. Advances in immunomodulatory strategies for host-directed therapies in combating tuberculosis. Biomed Pharmacother 2023; 162:114588. [PMID: 36989709 DOI: 10.1016/j.biopha.2023.114588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Tuberculosis (TB) maintains its infamous status regarding its detrimental effect on global health, causing the highest mortality by a single infectious agent. The presence of resistance and immune compromising disease favours the disease in maintaining its footing in the health care burden despite various anti-TB drugs used to fight it. Main factors contributing to resistance and difficulty in treating disease include prolonged treatment duration (at least 6 months) and severe toxicity, which further leads to patient non-compliance, and thus a ripple effect leading to therapeutic non-efficacy. The efficacy of new regimens demonstrates that targeting host factors concomitantly with the Mycobacterium tuberculosis (M.tb) strain is urgently required. Due to the huge expenses and time required of up to 20 years for new drug research and development, drug repurposing may be the most economical, circumspective, and conveniently faster journey to embark on. Host-directed therapy (HDT) will dampen the burden of the disease by acting as an immunomodulator, allowing it to defend the body against antibiotic-resistant pathogens whilst minimizing the possibility of developing new resistance to susceptible drugs. Repurposed drugs in TB act as host-directed therapies, acclimatizing the host immune cell to the presence of TB, improving its antimicrobial activity and time taken to get rid of the disease, whilst minimizing inflammation and tissue damage. In this review, we, therefore, explore possible immunomodulatory targets, HDT immunomodulatory agents, and their ability to improve clinical outcomes whilst minimizing the risk of drug resistance, through various pathway targeting and treatment duration reduction.
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Najd Ghahremani A, Abdollahi M, Shokrpoor S, Ashrafi Tamai I. Pericarditis caused by Proteus mirabilis in sheep. Vet Med Sci 2023. [PMID: 37192480 DOI: 10.1002/vms3.1160] [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: 01/03/2023] [Revised: 03/24/2023] [Accepted: 04/18/2023] [Indexed: 05/18/2023] Open
Abstract
Pericarditis means inflammation in the pericardial sac. Pericarditis is divided into three categories based on morphology, including fibrinous, purulent, and constrictive. In the present study, a 7-month-old male Ghezel breed sheep was examined for low weighting rate for three months. Tachypnea, tachycardia, heart friction sound, absence of fever and normal appetite were recorded in the clinical examination. In the patient's history, there was a history of perforated chest trauma behind the left scapula about three months ago. After the echocardiography examination and bacteriology procedures, purulent pericarditis caused by Proteus mirabilis was diagnosed. The bacterium was analysed using genome sequencing and new strain called Abhar114 was diagnosed. This is the first report of pericarditis caused by Proteus mirabilis in sheep.
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Affiliation(s)
- Abolfazl Najd Ghahremani
- Faculty of Veterinary Medicine, Department of Internal Medicine, University of Tehran, Tehran, Iran
| | - Mostafa Abdollahi
- Faculty of Veterinary Medicine, Department of Clinical Sciences, Semnan University, Semnan, Iran
| | - Sara Shokrpoor
- Faculty of Veterinary Medicine, Department of Pathology, University of Tehran, Tehran, Iran
| | - Iraj Ashrafi Tamai
- Faculty of Veterinary Medicine, Department of Microbiology and Immunology, University of Tehran, Tehran, Iran
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Sumajaya IDGD, Aryadi IPH, Eryana IM. Effusive-constrictive pericarditis as first manifestation of late-onset systemic lupus erythematosus: an atypical case with grave prognosis. Egypt Heart J 2023; 75:30. [PMID: 37079144 PMCID: PMC10119344 DOI: 10.1186/s43044-023-00353-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/05/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that has a great diversity of clinical presentations and occurs mostly in young women. However, late-onset SLE does exist and seldom presents with an atypical case, including pericardial effusion (PE). CASE PRESENTATION A 64 years old Asian woman presented with weakness all over the body and slight breathlessness for the past 2 days before the hospital admission. Her initial vital signs are 80/50 mmHg for blood pressure and a respiration rate of 24 breaths/min. Rhonchi were heard on the left lung and pitting edema on both legs. No evidence of any skin rash. Laboratory examination displayed anemia, hematocrit decrement, and azotemia. A 12-lead ECG demonstrated left-axis deviation with low voltage (Fig. 1). Chest X-ray showed left massive pleural effusion (Fig. 2). Transthoracic echocardiography revealed biatrial enlargement, normal EF 60%, diastolic dysfunction grade II, and thickening of the pericardium with mild circumferential PE corresponding with effusive-constrictive pericarditis (Fig. 3). The patient also brought CT angiography and cardiac MRI result, which confirmed pericarditis with PE. Treatment was initiated in ICU with fluid resuscitation of normal saline. The patient's routine oral treatments, including furosemide, ramipril, colchicine, and bisoprolol, were carried on. An autoimmune workup was performed by a cardiologist and demonstrated an elevation in antinuclear antibody/ANA (IF) of 1:100, which finally unveiled a diagnosis of SLE. Pericardial effusion is one critical condition to consider, despite it being an uncommon presentation in late-onset SLE. Mild pericarditis in an SLE case can be treated with corticosteroid administration. Colchicine also has been found to reduce the risk of pericarditis recurrence. However, an atypical presentation from this case led to a slightly delayed treatment that escalated the morbidity and mortality risk. The patient had a sudden cardiac arrest and passed away 3 days after being treated. Fig. 1 Initial electrocardiogram demonstrated left-axis deviation, low voltage QRS complex and T-wave inversion on lead V1-V3 Fig. 2 Chest radiograph showed left massive pleural effusion Fig. 3 Transthoracic echocardiogram displayed increased left ventricular filling pressure with diastolic dysfunction grade III, mild circumferential pericardial effusion with adjacent pleural effusion CONCLUSIONS: Atypical presentation during late-onset SLE, mainly in the form of pericardial effusion even constrictive pericarditis, should be taken into a consideration since they are a scarce feature in SLE patients. Swift recognition and prompt treatment are important for the optimal outcome.
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Affiliation(s)
| | | | - I Made Eryana
- Emergency Department, Dharma Kerti Hospital, Bali, 82113, Indonesia
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Namiguchi K, Sakaue T, Okazaki M, Kanno K, Komoda Y, Shikata F, Kurata M, Ota N, Kubota Y, Kurobe H, Nishimura T, Masumoto J, Higashiyama S, Izutani H. Unique Angiogenesis From Cardiac Arterioles During Pericardial Adhesion Formation. Front Cardiovasc Med 2022; 8:761591. [PMID: 35187100 PMCID: PMC8852280 DOI: 10.3389/fcvm.2021.761591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/22/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives The molecular mechanisms underlying post-operative pericardial adhesions remain poorly understood. We aimed to unveil the temporal molecular and cellular mechanisms underlying tissue dynamics during adhesion formation, including inflammation, angiogenesis, and fibrosis. Methods and Results We visualized cell-based tissue dynamics during pericardial adhesion using histological evaluations. To determine the molecular mechanism, RNA-seq was performed. Chemical inhibitors were administered to confirm the molecular mechanism underlying adhesion formation. A high degree of adhesion formation was observed during the stages in which collagen production was promoted. Histological analyses showed that arterioles excessively sprouted from pericardial tissues after the accumulation of neutrophils on the heart surface in mice as well as humans. The combination of RNA-seq and histological analyses revealed that hyperproliferative endothelial and smooth muscle cells with dedifferentiation appeared in cytokine-exposed sprouting vessels and adhesion tissue but not in quiescent vessels in the heart. SMAD2/3 and ERK activation was observed in sprouting vessels. The simultaneous abrogation of PI3K/ERK or TGF-β/MMP9 signaling significantly decreased angiogenic sprouting, followed by inhibition of adhesion formation. Depleting MMP9-positive neutrophils shortened mice survival and decreased angiogenic sprouting and fibrosis in the adhesion. Our data suggest that TGF-β/matrix metalloproteinase-dependent tissue remodeling and PI3K/ERK signaling activation might contribute to unique angiogenesis with dedifferentiation of vascular smooth muscle cells from the contractile to the synthetic phenotype for fibrosis in the pericardial cavity. Conclusions Our findings provide new insights in developing prevention strategies for pericardial adhesions by targeting the recruitment of vascular cells from heart tissues.
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Affiliation(s)
- Kenji Namiguchi
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Tomohisa Sakaue
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
- Department of Cell Growth and Tumor Regulation, Proteo-Science Center, Toon, Japan
- *Correspondence: Tomohisa Sakaue
| | - Mikio Okazaki
- Department of General Thoracic Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Kaho Kanno
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yuhei Komoda
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Mie Kurata
- Department of Pathology, Division of Analytical Pathology, Ehime University Graduate School of Medicine, Toon, Japan
- Department of Pathology, Proteo-Science Center, Toon, Japan
| | - Noritaka Ota
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yoshiaki Kubota
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Hirotsugu Kurobe
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takashi Nishimura
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Junya Masumoto
- Department of Pathology, Division of Analytical Pathology, Ehime University Graduate School of Medicine, Toon, Japan
- Department of Pathology, Proteo-Science Center, Toon, Japan
| | - Shigeki Higashiyama
- Department of Cell Growth and Tumor Regulation, Proteo-Science Center, Toon, Japan
- Department of Biochemistry and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Japan
- Department of Molecular and Cellular Biology, Research Center, Osaka International Cancer Institute, Osaka, Japan
| | - Hironori Izutani
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
- Hironori Izutani
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Pericardiectomy for constrictive pericarditis in a resource constraint setting. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:165-172. [PMID: 34703474 PMCID: PMC8525283 DOI: 10.5114/kitp.2021.109390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022]
Abstract
Introduction Constrictive pericarditis is the endpoint of the natural history of acute pericarditis of different aetiologies where a chronic inflammatory process results in a thickened, fibrotic and inelastic pericardium with consequent impairment of diastolic function and systemic congestion. Aim To evaluate the clinical features, diagnosis, surgical management and outcome of patients with constrictive pericarditis as managed in a local setting of a tertiary hospital in Ghana. Material and methods A retrospective review of the medical records of patients who had undergone pericardiectomy for constrictive pericarditis at a teaching hospital. Results Ten patients underwent pericardiectomy for the period of study. There were 8 (80%) males and 2 (20%) females. The mean age was 20.4 ±17.2 years. Six of the patients 6 (60%) were in NYHA class III. Preoperative diagnostics included chest X-ray, echocardiography, and computed tomography scan. The surgical approach for the pericardiectomy was median sternotomy. The mean operative time was 159.9 ±43.0 min. The mean postoperative days spent before being discharged was 6.9 ±2.3 days. Nine (90%) of the patients were in NYHA class I after a mean follow-up of 19.3 ±16.7 months. One patient died 6 weeks after surgery with heart failure and one patient was lost to follow-up. Conclusions Surgical pericardiectomy via median sternotomy is still the standard modality of treatment for constrictive pericarditis with excellent results even in resource constraint settings.
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Ashaari S, Sohaib HA, Bolger K. A case report: symptomatic pericarditis post-COVID-19 vaccination. Eur Heart J Case Rep 2021; 5:ytab375. [PMID: 34693198 PMCID: PMC8522432 DOI: 10.1093/ehjcr/ytab375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/21/2021] [Accepted: 09/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has led to the rapid development of COVID-19 vaccine. The Centers for Disease Control and Prevention (CDC) has recently reported increase in myopericarditis incidence post-COVID-19 vaccination. Post-vaccination myopericarditis as side effect has been reported, however, is infrequent. We described a case of pericarditis post-first dose of Pfizer-BioNTech vaccine. CASE SUMMARY A patient presented with typical symptoms of pericarditis and related electrocardiogram and echocardiogram changes, 7 days post receiving the first dose of COVID-19 vaccine. No other causes were identified from series of investigations. Patient had good symptomatic relief with non-steroidal anti-inflammatory medication. DISCUSSION The incidence of pericarditis post-vaccination is rare, with limited reporting in previous literatures. No causal relationship has yet to be established due to small number of cases. The benefits of COVID-19 vaccination currently outweigh the side effect profile and are recommended as the first-line approach to control the current pandemic.
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Affiliation(s)
- Sarah Ashaari
- Department of Medicine, Tipperary University Hospital, Health Service Executive (HSE), Clonmel, Co. Tipperary E91 VY40, Ireland
| | - Hafiz Ahmed Sohaib
- Department of Medicine, Tipperary University Hospital, Health Service Executive (HSE), Clonmel, Co. Tipperary E91 VY40, Ireland
| | - Kenneth Bolger
- Department of Medicine, Tipperary University Hospital, Health Service Executive (HSE), Clonmel, Co. Tipperary E91 VY40, Ireland
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Levi M, Parenti F, Muscatello LV, Battaia S, Santilli R, Perego M, Montinaro V, Massari F, Sarli G, Brunetti B. Pathological Findings of Canine Idiopathic Pericarditis and Pericardial Mesotheliomas: Correlation with Clinical and Survival Data. Vet Sci 2021; 8:vetsci8080162. [PMID: 34437484 PMCID: PMC8402876 DOI: 10.3390/vetsci8080162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/31/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
Idiopathic pericarditis (IP) and pericardial mesothelioma (PM) are causes of pericardial effusion in dogs. Pericardiectomy can be a definitive treatment in the case of idiopathic pericardial effusion or a short-term intervention for mesothelioma. The aim of the present study was to investigate which histopathologic parameters are correlated with clinical outcomes in a cohort of dogs that underwent pericardiectomy. The histopathological findings of 22 IPs and 5 PMs were compared with clinical and survival data and the immunohistochemical characterization of immune cells (CD3, CD79α, Iba1). In IP, the mesothelium was lost in 20 cases, reactive in 9, atypical in 3, and mesothelial papillary hyperplasia (MPH) was observed in 4 cases. Numerous macrophages were found in both IPs and PMs especially at the superficial layer of the pericardium. T lymphocytes were observed in mild to moderate numbers and were more numerous than B lymphocytes in both IPs and PMs. MPH was correlated with the quantity of lymphoplasmacytic infiltrate in the superficial layer, inversely related to the thickness of the pericardium, and associated with a longer overall survival. Pericardial fibrosis was present in 19 out of 22 IPs and in all mesotheliomas and was correlated with increased time from initial presentation and pericardiectomy and lymphoplasmacytic infiltrate in the deep zone. Pericardial thickness was correlated with the amount of lymphoplasmacytic and macrophagic infiltrate in the deep zone. Mesothelioma was associated with an increased number of pericardiocentesis procedures before pericardiectomy and with the presence of macrophages in the superficial pericardial layer, edema, fibrin, and hemorrhage. Disease-free interval and overall survival were significantly shorter in patients with mesothelioma compared with IP.
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Affiliation(s)
- Michela Levi
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy; (M.L.); (F.P.); (G.S.); (B.B.)
| | - Federico Parenti
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy; (M.L.); (F.P.); (G.S.); (B.B.)
| | - Luisa Vera Muscatello
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy; (M.L.); (F.P.); (G.S.); (B.B.)
- Correspondence:
| | - Stefano Battaia
- Ospedale Veterinario I Portoni Rossi, Via Roma 57, Zola Predosa, 40069 Bologna, Italy; (S.B.); (M.P.); (V.M.); (F.M.)
- Clinica Veterinaria Malpensa, Viale Marconi 27, Samarate, 21017 Varese, Italy;
| | - Roberto Santilli
- Clinica Veterinaria Malpensa, Viale Marconi 27, Samarate, 21017 Varese, Italy;
- Department of Clinical Sciences, Cornell University, 930 Campus Road, Ithaca, NY 14853, USA
| | - Manuela Perego
- Ospedale Veterinario I Portoni Rossi, Via Roma 57, Zola Predosa, 40069 Bologna, Italy; (S.B.); (M.P.); (V.M.); (F.M.)
- Clinica Veterinaria Malpensa, Viale Marconi 27, Samarate, 21017 Varese, Italy;
| | - Vincenzo Montinaro
- Ospedale Veterinario I Portoni Rossi, Via Roma 57, Zola Predosa, 40069 Bologna, Italy; (S.B.); (M.P.); (V.M.); (F.M.)
| | - Federico Massari
- Ospedale Veterinario I Portoni Rossi, Via Roma 57, Zola Predosa, 40069 Bologna, Italy; (S.B.); (M.P.); (V.M.); (F.M.)
- DOCVET, Clinica Veterinaria Nervianese, Via Lampugnani 3, 20014 Nerviano, Italy
| | - Giuseppe Sarli
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy; (M.L.); (F.P.); (G.S.); (B.B.)
| | - Barbara Brunetti
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy; (M.L.); (F.P.); (G.S.); (B.B.)
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Cardiac Immunology: A New Era for Immune Cells in the Heart. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 32910424 DOI: 10.1007/5584_2020_576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
The immune system is essential for the development and homeostasis of the human body. Our current understanding of the immune system on disease pathogenesis has drastically expanded over the last decade with the definition of additional non-canonical roles in various tissues. Recently, tissue-resident immune cells have become an important research topic for understanding their roles in the prevention, pathogenesis, and recovery from the diseases. Heart resident immune cells, particularly macrophage subtypes, and their characteristic morphology, distribution in the cardiac tissue, and transcriptional profile have been recently reported in the experimental animal models, unrevealing novel and unexpected roles in electrophysiological regulation of the heart both at the steady-state and diseased state. Immunological processes have been widely studied in both sterile cardiac disorders, such as myocardial infarction, autoimmune cardiac diseases, or infectious cardiac diseases, such as myocarditis, endocarditis, and acute rheumatic carditis. Following cardiac injury, innate and adaptive immunity have critical roles in pro- and anti-inflammatory processes. Heart resident immune cells not only provide defense against infectious diseases but also contribute to the homeostasis. In recent years, physiological changes and pathological processes were demonstrated to alter the abundance, distribution, polarization, and diversity of immune cells in the heart. Accumulating evidence indicates that cardiac remodeling is controlled by the complex crosstalk between cardiomyocytes and cardiac immune cells through the gap junctions, providing the ion flow to achieve synchronization and modulation of contractility. This review article aims to review the well-documented roles of both resident and recruited immune cell in the heart, as well as their recently uncovered unconventional roles in both cardiac homeostasis and cardiovascular diseases. We have mostly focused on studies on animal models used in preclinical research, underlying the need for further investigations in humans or in vitro human models. It may be foreseen that the further comprehensive investigations of cardiac immunology might harbor new therapeutic options for cardiac disorders that have tremendous medical potential.
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12
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Raizada V, Sato K, Alashi A, Kumar A, Kwon D, Ramchand J, Dillenbeck A, Zumwalt RE, Vangala AS, Earley TD, Klein A. Depressed right ventricular systolic function in heart failure due to constrictive pericarditis. ESC Heart Fail 2021; 8:3119-3129. [PMID: 34137193 PMCID: PMC8318427 DOI: 10.1002/ehf2.13418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 12/22/2022] Open
Abstract
Aims Heart failure in constrictive pericarditis (CP) is attributed to impaired biventricular diastolic filling. However, diseases that cause CP due to myocardial infiltration and fibrosis can also impair biventricular systolic function (sf) and contribute to heart failure. This study of patients with CP examined biventricular sf and the effect of myocardial infiltration by pericardial diseases and the resulting fibrosis on ventricular sf. Methods and results Histopathologic examinations of right ventricular (RV) and left ventricular (LV) myocardia and pericardia were performed on three autopsied hearts of patients with pericardial diseases. Additionally, in 40 adults with clinical heart failure and 40 healthy adults (controls), sf of both ventricles was examined by echocardiography, including strain measurements, and biventricular diastolic filling and pulmonary artery pressures were assessed by cardiac catheterization. Cardiac histopathology indicated thickening of the pericardium with fibrosis, disease infiltrating the myocardium, greater infiltration of the RV than the LV, and an association of pericardial thickness with myocardial infiltrations. Functional analysis indicated that RVsf was impaired on all echo indices, including strain measurement, but LVsf was preserved. Conclusions Diseases causing CP are not restricted to the pericardium but also infiltrate the biventricular myocardium and affect the thin‐walled RV more than the thick‐walled LV, resulting in depressed RVsf. The present results help explain clinical heart failure in the presence of restricted diastolic filling in CP. Depression of RVsf due to progression of fibrosis in the RV myocardium may increase the risk of delayed pericardiectomy.
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Affiliation(s)
- Veena Raizada
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 2211 Lomas Blvd, Albuquerque, NM, 87131, USA
| | - Kimi Sato
- Department of Internal Medicine, Cardiology Division, University of Tsukuba, Tsukuba, Japan
| | - Alaa Alashi
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Deborah Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Jay Ramchand
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Amy Dillenbeck
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Ross E Zumwalt
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 2211 Lomas Blvd, Albuquerque, NM, 87131, USA
| | - Adarsh S Vangala
- Department of Internal Medicine, Arizona Health Sciences Center, Tucson, AZ, USA
| | - Tyler D Earley
- Department of Internal Medicine, Samaritan Health Services, Corvallis, OR, USA
| | - Allan Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
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13
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Diaconu R, Popescu L, Voicu A, Donoiu I. Subacute effusive-constrictive pericarditis in a patient with COVID-19. BMJ Case Rep 2021; 14:14/6/e242443. [PMID: 34116993 PMCID: PMC8201976 DOI: 10.1136/bcr-2021-242443] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We report the case of a previously healthy young woman, who developed a severe form of COVID-19 with massive pneumonia and acute pericarditis in whom constrictive physiology developed rapidly. To our knowledge, this represents the second reported case of SARS-CoV-2 constrictive pericarditis, a rare, but severe cardiac complication.
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Affiliation(s)
- Rodica Diaconu
- Cardiology, Craiova County Emergency Hospital, Craiova, Dolj, Romania
| | - Lucian Popescu
- Cardiology, Craiova County Emergency Hospital, Craiova, Dolj, Romania
| | - Anda Voicu
- Cardiology, Craiova County Emergency Hospital, Craiova, Dolj, Romania
| | - Ionut Donoiu
- Department of Cardiology, Craiova University of Medicine and Pharmacy, Craiova, Romania
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14
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Reddy A, Nethercott S, Duehmke R, Nair S, Abdul-Samad O. ‘Dry’ Pericarditis with Rapid Progression to Tamponade as a Feature of COVID-19. EUROPEAN MEDICAL JOURNAL 2021. [DOI: 10.33590/emj/20-00244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pericardial inflammation is a recognised feature of coronavirus disease (COVID-19). The authors herein present the case of a female with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection who developed a large and life-threatening pericardial effusion over a few days following the onset of pericarditis, despite prompt commencement of treatment. This was successfully drained, and she was discharged in stable condition on oral nonsteroidal anti-inflammatory drugs and colchicine.At 6-week follow-up she had made a full recovery, and repeat echocardiography demonstrated no recurrence of effusion or evidence of constrictive physiology.
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Affiliation(s)
- Ashwin Reddy
- Royal Papworth NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Sarah Nethercott
- Addenbrookes Hospital NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Rudolph Duehmke
- James Paget University Hospital NHS Foundation Trust, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth, UK
| | - Sunil Nair
- James Paget University Hospital NHS Foundation Trust, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth, UK
| | - Omar Abdul-Samad
- James Paget University Hospital NHS Foundation Trust, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth, UK
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15
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Gupta S, Jesrani G, Gaba S, Gupta M, Kumar S. Constrictive Pericarditis as an Initial Manifestation of Systemic Lupus Erythematosus. Cureus 2020; 12:e11256. [PMID: 33269173 PMCID: PMC7707119 DOI: 10.7759/cureus.11256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A young female presented with new-onset rash, oral ulcers and dyspnea without overt features of heart failure. She was diagnosed with systemic lupus erythematosus with early constrictive pericarditis, cutaneous lupus and serositis in the form of pericardial and pleural effusion. There was no renal, neurological and joint involvement. She was treated with steroid pulse and other ancillary drugs that led to remission with improvement in the symptoms and reversal of echocardiographic changes of constrictive pericarditis. Oral steroids were successfully tapered off after four months, and only hydroxychloroquine was continued. Constrictive pericarditis is an uncommon feature of lupus and its occurrence as an initial manifestation, without a history of repeated episodes of acute pericarditis, is rarely reported.
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16
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Shimamoto K, Hamatani Y, Fukushima S, Kanzaki H, Fujita T, Kusano KF, Yasuda S, Izumi C. Extracardiac Mass After Pericardiectomy: Mediastinal Fat Replacement Secondary to Progressive Constrictive Pericarditis. JACC Case Rep 2020; 3:339-344. [PMID: 34317531 PMCID: PMC8310937 DOI: 10.1016/j.jaccas.2020.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022]
Abstract
We describe an extracardiac mass in a 72-year-old man with a history of pericardiectomy for constrictive pericarditis. Imaging studies revealed that progressive shrinkage of the residual pericardium compressed mitral valve anteriority, and fat replacement of the secondarily enlarged posterior space of the atrioventricular groove appeared as a space-occupying lesion. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Keiko Shimamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yasuhiro Hamatani
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Address for correspondence: Dr. Yasuhiro Hamatani, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shimmachi, Suita, Osaka 564-8565, Japan.
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kengo F. Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
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17
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Sattar Y, Ullah W, Rauf H, Virk HUH, Yadav S, Chowdhury M, Connerney M, Mamtani S, Pahuja M, Patel RD, Mir T, Almas T, Moussa Pacha H, Chadi Alraies M. COVID-19 cardiovascular epidemiology, cellular pathogenesis, clinical manifestations and management. IJC HEART & VASCULATURE 2020; 29:100589. [PMID: 32724831 PMCID: PMC7359794 DOI: 10.1016/j.ijcha.2020.100589] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 02/08/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) is a rapidly progressing global pandemic that may present with a variety of cardiac manifestations including, but not limited to, myocardial injury, myocardial infarction, arrhythmias, heart failure, cardiomyopathy, shock, thromboembolism, and cardiac arrest. These cardiovascular effects are worse in patients who have pre-existing cardiac conditions such as coronary artery disease, hypertension, diabetes mellitus, and coagulation abnormalities. Other predisposing risk factors include advanced age, immunocompromised state, and underlying systemic inflammatory conditions. Here we review the cellular pathophysiology, clinical manifestations and treatment modalities of the cardiac manifestations seen in patients with COVID-19.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai – Elmhurst Hospital, NY, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, PA, USA
| | - Hiba Rauf
- Internal Medicine, American Society of Clinical Oncology, VA, USA
| | - Hafeez ul Hassan Virk
- Interventional Cardiology, Case Western Reserve University/University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Sunita Yadav
- Internal Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, USA
| | - Medhat Chowdhury
- Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Michael Connerney
- Internal Medicine, Icahn School of Medicine at Mount Sinai – Elmhurst Hospital, NY, USA
| | - Sahil Mamtani
- Internal Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, USA
| | - Mohit Pahuja
- Internal Medicine, Rochester General Hospital, Rochester, NY, USA
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Raj D. Patel
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
- University of Illinois College of Medicine Peoria, Chicago, IL, USA
| | - Tanveer Mir
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Talal Almas
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Homam Moussa Pacha
- Cardiology Department, University of Texas, Memorial Hermann Heart and Vascular Institute, Houston, TX, USA
| | - M. Chadi Alraies
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
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18
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Naicker K, Ntsekhe M. Tuberculous pericardial disease: a focused update on diagnosis, therapy and prevention of complications. Cardiovasc Diagn Ther 2020; 10:289-295. [PMID: 32420111 DOI: 10.21037/cdt.2019.09.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tuberculous pericarditis (TBP) is the most important manifestation of tuberculous heart disease and is still associated with a significant morbidity and mortality in TB endemic areas. The high prevalence of the disorder over the last 3 decades has been fueled by the human immunodeficiency virus/AIDS (HIV/AIDS) pandemic in these areas. The objective of this review is to provide a focused update on developments in the diagnosis and therapy of this condition, prevention of its complications, as well as future novel therapies. The definitive diagnosis of a tuberculous etiology in patients with suspected TBP continues to pose a challenge for clinicians. Clinical prediction scores, although never formally validated have been used with some success. However, they may be prone to both over and underdiagnosis due to lack of pericardial fluid analysis. Recent studies evaluating Xpert MTB/RIF, suggest that this advanced polymerase chain reaction (PCR) based technology does not provide increased accuracy compared to earlier iterations. However a combined two test approach starting with Xpert MTB/RIF followed by either adenosine deaminase (ADA) or interferon gamma (IFN-γ) may provide for significantly enhanced specificity and sensitivity cost permitting. Pericardiocentesis remains the gold standard for managing the compressive pericardial fluid and its adverse hemodynamic sequelae. A four drug anti-TB drug regimen at standard doses and duration is recommended. However recent evidence suggests that these drugs penetrate the pericardium very poorly potentially explaining the high mortality observed particularly in those who are culture positive with a high bacillary load. Constrictive pericarditis is the main long-term complication of TBP and is still a significant cause of heart failure in Sub-Saharan Africa. This is important because access to definitive surgical therapy where TBP is prevalent continues to be low, highlighting the need to develop strategies or interventions to prevent fibrosis and constriction. Recent detailed advanced studies of pericardial fluid in TBP have revealed a strong profibrotic transcriptomic profile, with high amounts of pro-inflammatory cytokines and low levels of the anti-fibrotic tetrapeptide N-Acetyl-Seryl-Aspartyl-Lysyl-Proline (Ac-SDKP). These new insights may explain in part the high propensity to fibrosis associated with the condition and offer hope for the future use of targeted therapy to interrupt pathways and mediators of tissue damage and subsequent maladaptive healing and fibrosis. The value of effective pericardiocentesis in reducing these pro-inflammatory and pro-fibrotic cytokines and peptides in an attempt to prevent pericardial constriction has yet to be established but has generated hypotheses for ongoing and future research.
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Affiliation(s)
- Kishendree Naicker
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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19
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Howlett P, Du Bruyn E, Morrison H, Godsent IC, Wilkinson KA, Ntsekhe M, Wilkinson RJ. The immunopathogenesis of tuberculous pericarditis. Microbes Infect 2020; 22:172-181. [PMID: 32092538 DOI: 10.1016/j.micinf.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
Tuberculous pericarditis is a severe form of extrapulmonary tuberculosis and is the commonest cause of pericardial effusion in high incidence settings. Mortality ranges between 8 and 34%, and it is the leading cause of pericardial constriction in Africa and Asia. Current understanding of the disease is based on models derived from studies performed in the 1940-50s. This review summarises recent advances in the histology, microbiology and immunology of tuberculous pericarditis, with special focus on the effect of Human Immunodeficiency Virus (HIV) and the determinants of constriction.
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Affiliation(s)
- Patrick Howlett
- National Heart & Lung Institute, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY, United Kingdom; Department of Medicine, University of Cape Town, Observatory 7925, South Africa.
| | - Elsa Du Bruyn
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
| | - Hazel Morrison
- The Jenner Institute, University of Oxford, Old Road Campus Research Build, Roosevelt Dr, Oxford OX3 7DQ, United Kingdom
| | - Isiguzo C Godsent
- National Heart & Lung Institute, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY, United Kingdom; Department of Medicine, Federal Teaching Hospital Abakaliki, Nigeria
| | - Katalin A Wilkinson
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa; Francis Crick Institute, 1 Midland Rd, London NW1 1AT, United Kingdom
| | - Mpiko Ntsekhe
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
| | - Robert J Wilkinson
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa; Francis Crick Institute, 1 Midland Rd, London NW1 1AT, United Kingdom; Department of Infectious Diseases, Imperial College London, W2 1PG, United Kingdom
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20
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Lima NDA, Stancic C, Vos D, Carmen Diaz Insua MMD, Lima CCDV, de Castro RL, Maravelas R, Melgar TA. Hospital admissions for tuberculous pericarditis in the United States 2002-2014. Int J Mycobacteriol 2019; 8:347-350. [PMID: 31793504 DOI: 10.4103/ijmy.ijmy_150_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Extra pulmonary manifestations of tuberculosis (TB) are rare in developed countries. TB is the main etiology of chronic pericarditis in developing countries, but it's epidemiology is not unknown in the United States. Methods This retrospective study used the Healthcare Utilization Projects/Nationwide Inpatient Sample (HCUPS/NIS) database from 2002-2014 to evaluate the characteristics, risk factors, trends over time and region of tuberculous pericarditis in the United States. Results The data during the study period consists of 100,790,900 discharges accounting for 482,872,274 weighted discharges. The data showed 744 weighted discharges with indication of both tuberculosis and pericarditis. A co-ocurrence of TB pericarditis and malignancy or chronic kidney disease was more common than in patients without TB pericarditis. The frequency of co-ocurrence of TB pericarditis and HIV infection, obesity, alcohol abuse and organ transplant was not elevated. Conclusion TB pericarditis is rare disease in the USA and the classical risk factors for lung tuberculosis may not be associated with TB pericarditis. CKD and malignancy appear to be associated with TB pericarditis, further studies are required to determine causality.
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Affiliation(s)
- Neiberg de Alcantara Lima
- Department of Internal Medicine, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Christopher Stancic
- Department of Internal Medicine, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Duncan Vos
- Statistics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | | | | | - Ricardo Lessa de Castro
- Department of Internal Medicine, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Rheanne Maravelas
- Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Thomas A Melgar
- Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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