What Is Tuberculous Pericarditis?

When tuberculosis extends to the region around your heart, it causes tuberculous pericarditis. It can result in potentially fatal consequences and symptoms including chest discomfort. Treatment must begin right away.

Mycobacterium tuberculosis (M. tuberculosis) is the bacterium that causes tuberculosis (TB). One of the top 10 causes of death in the world is tuberculosis. Although the majority of cases take place in developing nations, the United States still sees over 8,000 cases a year.

Although TB mostly affects the lungs, it can also spread to the heart and other tissues. Tuberculous pericarditis, an infection of the pericardium, the sac that surrounds the heart, affects about 1% of TB patients.

Continue reading to find out more about this illness's signs, causes, and available treatments.

What are the symptoms of tuberculous pericarditis?

Often, vague symptoms like these are the first signs of tuberculous pericarditis.

• fever
• fatigue
• unintentional weight loss
• night sweats

Chest discomfort is the primary symptom and may:

• Feel piercing or jabbing
• extend to your shoulders, arms, or abdomen
• feel worse when you swallow, cough, or take heavy breaths.
• lying on your left side makes you feel worse
• improve when you bend forward

Other symptoms include:

• weakness
• shortness of breath
• trouble swallowing
• cough

While respiratory symptoms are not always present in patients with tuberculous pericarditis, they can include:

• a bad cough that lasts more than three weeks
• spitting blood in the cough

What causes tuberculous pericarditis?

Tuberculous pericarditis is caused by the same microorganisms that cause pulmonary (lung) TB. When you breathe in respiratory air droplets from an infected person, you can contract M. tuberculosis.

Your airways can allow M. tuberculosis to enter your lungs. 15% of patients get symptoms outside of their lungs as a result of the bacterium spreading through their lymph or blood.

Extrapulmonary TB refers to tuberculosis infection of other body areas. One uncommon form of extrapulmonary TB is tuberculous pericarditis.

Who is at risk of tuberculous pericarditis?

If your immune system is compromised, you are more likely to have a TB infection that spreads to your pericardium. In areas like Southern Africa where both illnesses are widespread, HIV is arguably the biggest risk factor for tuberculous pericarditis.

TB risk factors generally consist of:

• getting into proximity to a TB patient
• travelling to or leaving a nation where tuberculosis is prevalent
• living or working in locations where there is a significant danger of exposure, like:

1. hospitals
2. homeless shelters
3. correctional facilities

• having an illness that compromises your immune system, like HIV

1. severe kidney disease
2. receiving an organ transplant
3. substance misuse
4. diabetes

73% of U.S. TB cases in 2022, according to the Centres for Disease Control and Prevention (CDC), involved foreign-born individuals. The groups with the greatest reported rates among those born outside of the US were those who identify as Asian, Hispanic, or African.

According to CDC data, TB was most prevalent among adults over 65. On the other hand, youngsters can be more vulnerable to pericardial TB infection.

How do doctors diagnose tuberculous pericarditis?

A doctor will initially evaluate your symptoms as well as your personal and family medical history to identify tuberculous pericarditis. These are some other things they could do:

• physical examination to assess your:

1. breathing rate
2. blood pressure
3. oxygen saturation
4. body temperature
5. heart rate

• ECG to assess the health of the heart
• picturing something like:

1. chest X-rays
2. CT scans
3. transthoracic echocardiography

A biopsy, which involves taking a sample of your pericardial fluid with a long, thin needle and running laboratory tests to check for evidence of the bacteria, is one way a doctor can confirm the infection.

What is the treatment for tuberculous pericarditis?

Three objectives guide treatment for tuberculous pericarditis:

• eradicating and limiting the bacterial population
• reducing the pressure caused by fluid accumulation around your heart
• avoiding cardiac remodelling that may result in constrictive pericarditis, a condition in which the sac surrounding your heart thickens and becomes taut.

To eradicate M. tuberculosis, doctors typically prescribe antibiotics for six to twelve months. The most typical combination of drugs consists of:

• isoniazid
• pyrazinamide
• ethambutol
• rifampin

A procedure known as pericardiocentesis may also be required by your doctor to drain fluid from your pericardium. To drain the fluid, a thin needle must be guided by imaging.

A pericardiectomy may be necessary if problems such as constrictive pericarditis arise. To ease pressure on your heart, the pericardium may be removed whole or in part.

The following are some possible therapies to avoid constrictive pericarditis:

• corticosteroid
• A possible TB vaccine: Mycobacterium indicus pranii
• The anti-inflammatory medication colchicine
• Treatment for fibrinolysis, drugs to break up blood clots

What are the possible complications of tuberculous pericarditis?

Serious consequences from tuberculous pericarditis include the following if treatment is delayed:

• scarring, or pericardial fibrosis
• heart pressure (cardiac tamponade)
• narrowing of the pericardium

What is the outlook for people with tuberculous pericarditis?

It can be fatal to have tuberculous pericarditis, particularly if you don't get medical help right away.

Your chances of developing tuberculous pericarditis can increase if you have HIV. According to a 2008 study, 40% of patients with HIV and tuberculous pericarditis passed away within six months. Of those without HIV, 17 percent died.

If you need a pericardiectomy, which has a mortality rate of up to 12%, depending on the facility where you receive the treatment, your prognosis can also be poorer.

Takeaway

Less than 2% of TB patients develop tuberculous pericarditis, an infection of the sac surrounding the heart. Most TB patients experience respiratory symptoms.

To prevent potentially fatal consequences, tuberculous pericarditis needs to be treated as soon as possible. To eradicate the bacterium, treatment typically entails taking medication for longer than six months.

FAQs

Is heart TB curable?

TB disease is curable

Is pericarditis a serious disease?

Pericarditis is not usually a serious condition.

Can TB go away naturally?

Tuberculosis symptoms can seem to go away, but the illness often reactivates.

Can you live a normal life with pericarditis?

it is possible to live a normal life with the right support