Tuberculous pericarditis

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Tuberculous pericarditis
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Tuberculous pericarditis is a form of pericarditis.

Pericarditis pericardium disease that is characterized by an inflammation of the pericardium and has symptom chest pain

Pericarditis is inflammation of the pericardium. Symptoms typically include sudden onset of sharp chest pain. The pain may also be felt in the shoulders, neck, or back. It is typically better sitting up and worse when lying down or breathing deeply. Other symptoms may include fever, weakness, palpitations, and shortness of breath. Occasionally onset of symptoms is gradual.

Pericarditis caused by tuberculosis is difficult to diagnose, because definitive diagnosis requires culturing Mycobacterium tuberculosis from aspirated pericardial fluid or pericardial biopsy, which requires high technical skill and is often not diagnostic (the yield from culture is low even with optimum specimens). The Tygerberg scoring system helps the clinician to decide whether pericarditis is due to tuberculosis or whether it is due to another cause: night sweats (1 point), weight loss (1 point), fever (2 point), serum globulin > 40g/l (3 points), blood total leucocyte count <10 x 109/l (3 points); a total score of 6 or more is highly suggestive of tuberculous pericarditis. [1] Pericardial fluid with an interferon-γ level greater than 50pg/ml is highly specific for tuberculous pericarditis.

Tuberculosis Infectious disease caused by the bacterium Mycobacterium tuberculosis

Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, in which case it is known as latent tuberculosis. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those affected. The classic symptoms of active TB are a chronic cough with blood-containing sputum, fever, night sweats, and weight loss. It was historically called "consumption" due to the weight loss. Infection of other organs can cause a wide range of symptoms.

<i>Mycobacterium tuberculosis</i> Species of bacterium

Mycobacterium tuberculosis is a species of pathogenic bacteria in the family Mycobacteriaceae and the causative agent of tuberculosis. First discovered in 1882 by Robert Koch, M. tuberculosis has an unusual, waxy coating on its cell surface primarily due to the presence of mycolic acid. This coating makes the cells impervious to Gram staining, and as a result, M. tuberculosis can appear either Gram-negative or Gram-positive. Acid-fast stains such as Ziehl-Neelsen, or fluorescent stains such as auramine are used instead to identify M. tuberculosis with a microscope. The physiology of M. tuberculosis is highly aerobic and requires high levels of oxygen. Primarily a pathogen of the mammalian respiratory system, it infects the lungs. The most frequently used diagnostic methods for tuberculosis are the tuberculin skin test, acid-fast stain, culture, and polymerase chain reaction.

Pericardium double-walled sac containing the heart and the roots of the great vessels

The pericardium is a double-walled sac containing the heart and the roots of the great vessels. The pericardial sac has two layers, a serous layer and a fibrous layer. It encloses the pericardial cavity which contains pericardial fluid.

There are no randomized trials which evaluate the length of anti-tuberculosis treatment required for tuberculous pericarditis. [2] [ needs update ] There is a small but not conclusive benefit for treatment with a schedule of steroids with anti-tuberculosis drugs. Open surgical drainage of fluid though effective in preventing cardiac tamponade was associated with more deaths. [3] [ needs update ]

Cardiac tamponade Compression of the heart due to excessive accumulation of fluid in the pericardium (sac in which the heart is enclosed)

Cardiac tamponade, also known as pericardial tamponade, is when fluid in the pericardium builds up, resulting in compression of the heart. Onset may be rapid or gradual. Symptoms typically include those of cardiogenic shock including shortness of breath, weakness, lightheadedness, and cough. Other symptoms may relate to the underlying cause.

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References

  1. Reuter H, Burgess L, van Vuuren W, Doubell A (2006). "Diagnosing tuberculous pericarditis". Q J Med. 99 (12): 827–39. doi:10.1093/qjmed/hcl123. PMID   17121764.
  2. Mayosi BM. (2002). "Interventions for treating tuberculous pericarditis". Cochrane Database of Systematic Reviews (4): CD000526. doi:10.1002/14651858.CD000526. PMC   5618454 . PMID   12519546.
  3. Mayosi BM. (2002). "Interventions for treating tuberculous pericarditis". Cochrane Database of Systematic Reviews (4): CD000526. doi:10.1002/14651858.CD000526. PMC   5618454 . PMID   12519546.
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