Tuberculous Pericarditis

Tuberculous pericarditis is pericardial inflammation caused by tubercle bacilli, often coexisting with other TB. It usually has hemorrhagic effusion with fever, chest pain, dyspnea, pericardial friction rub, and normal or mildly elevated WBC. Later pericardial thickening may progress to the subacute/chronic phase, some to constrictive pericarditis. Early treatment is crucial for prognosis; once diagnosed, anti-TB or surgical treatment is given. Aggressive TB control markedly reduces incidence. Abroad, nonspecific pericarditis predominates; domestically TB is most common, accounting for 21.3-35.8% of pericardial disease in China.

Common Symptoms

Dyspnea; jugular venous distension; hemorrhagic effusion; night sweats; small pulse pressure; tachycardia; weight loss; paradoxical pulse; palpitations; orthopnea

Causes and Pathogenesis

(1) Etiology: Human and bovine M. tuberculosis are pathogenic to humans. Bacilli resist acid, alkali, alcohol, cold, heat, drying, light, and chemicals; moist heat kills them at 65°C/30 min, 70°C/10 min, 80°C/5 min; dry heat needs >20 min at 100°C; direct sun kills sputum bacilli in 2 h, UV in 10 min; they survive months in shade; 5% phenol or 20% bleach takes 24 h. (2) Pathogenesis: Usually from intrathoracic lymph node, pleural, or peritoneal TB via retrograde lymphatics, direct spread, rupture of caseous nodes, or systemic hematogenous dissemination. The pathological course has four stages: dry, exudative, absorbent, and constrictive; clinically exudative and constrictive are most common. Exudative pericarditis may be part of systemic polyserositis reflecting high host hypersensitivity; serofibrinous fluid accumulates, with miliary foci or caseation on the swollen, fibrinous, dull pericardium. With a favorable course, the effusion and fibrin absorb completely; if fibrin organizes, connective tissue thickens and widely adheres to the pericardial cavity, even pleural/chest wall adhesions, called constrictive pericarditis or Pick disease. Thickening varies, up to 2 cm in severe cases; pericardial calcification is occasional.

Treatment

Drug therapy, supportive therapy

Preventive Measures

1. Control sources: Early detection and rational treatment of smear-positive patients is fundamental; family members of infants with active TB should be examined; school/childcare staff should have regular checkups. 2. Universal BCG: Intradermal injection 0.05 mg in the upper left deltoid in neonates; BCG contraindications: positive Mantoux, eczema/skin disease, recovery from acute infectious disease (1 month), congenital thymic aplasia, or severe combined immunodeficiency. 3. Preventive chemotherapy for: Mantoux-positive unvaccinated children under 3; close contacts of open pulmonary TB; recent Mantoux converters; strong reactors; or positive reactors requiring long-term corticosteroids/immunosuppressants.

Department to Visit

It is recommended to visit the Cardiology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.