What to know about tuberculous pericarditis

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TB is a transmissible disease that can occur when Mycobacterium tuberculosis bacteria enter the body — typically the lungs — and cause infection. The disease can cause symptoms such as chest pain, a severe cough, and coughing up blood.

Pericarditis, or swelling of the pericardium, typically causes chest pain.

Viral or bacterial infections commonly cause pericarditis. Other noninfectious causes include injury, heart surgery, and cancer. Although it is rare for TB to cause pericarditis in developed countries, the disease is a major cause of TBP in developing countries.

In TBP, Mycobacterium tuberculosis bacteria infect the pericardium. The bacteria typically reach the area by traveling through the lymphatic system from the lungs to nearby lymph nodes or other structures.

TBP can lead to complications such as:

• Acute pericarditis: Pericarditis that develops suddenly and does not typically last long.
• Constrictive pericarditis: A severe condition in which the pericardium tissue becomes hardened and thick, preventing the heart from functioning correctly.
• Massive pericardial effusion: Pericardial effusion refers to an accumulation of fluid in the pericardium. This may cause cardiac tamponade.
• Cardiac tamponade: This is a condition in which excessive amounts of fluid gather inside the pericardium and compress the heart. Cardiac tamponade is a medical emergency.

TBP can develop with vague or nonspecific symptoms, often making it challenging to recognize and diagnose.

People with TBP do not typically experience severe, sudden chest pain that doctors associate with pericarditis.

Some symptoms may include:

• fever
• shortness of breath
• fatigue
• night sweats
• unintentional weight loss
• cough
• chest pain

While pericarditis often has a generally favorable outlook and might resolve without medical intervention, the outlook for TBP tends to be less favorable.

What is the mortality rate for TBP?

TBP has a high mortality rate of 17–40% over 6 months. People with TBP who develop severe complications, such as constrictive pericarditis, may have a higher risk of dying.

Still, early diagnosis and treatment can help reduce the risk of health complications and improve a person’s outcome.

There are no simple, rapid testing methods available to diagnose TBP. This can make diagnosis challenging. The condition goes undiagnosed in around 15–20% of cases.

When doctors suspect TBP, they obtain samples first. This includes extracting fluid from the pericardium or ordering a biopsy of pericardial tissue. A pericardial biopsy involves extracting a small amount of tissue. Samples are sent off for testing.

Tests typically involve detecting Mycobacterium tuberculosis using the following lab techniques:

• smear
• culture
• polymerase chain reactions tests — this is usually a first-line test, and results are highly reliable if positive

Doctors may also send samples for histopathological exam, which involves looking for signs of damage or disease in extracted tissues.

The time for results to come back can vary. For example, it can take 6 weeks for a fluid culture to return.

Still, doctors must assess the test results before determining whether a person has TBP.

TBP treatment aims to do the following:

• destroy and control Mycobacterium tuberculosis bacteria
• relieve compression on the heart
• reduce the risk of complications

Doctors typically treat TBP with medication for 6 months or longer. Medication for TBP may include antitubercular medications (ones doctors prescribe to treat TB), such as:

• pyrazinamide
• rifampicin
• isoniazid
• ethambutol

Also, doctors may prescribe prednisone, a medication that helps reduce inflammation.

If excessive fluid has gathered in the pericardium, a person will require pericardiocentesis. This procedure involves draining pericardial fluid through a small tube to prevent it from compressing the heart.

Learn more about how doctors treat TB.

TBP occurs when the bacteria that cause TB — Mycobacterium tuberculosis — infects the pericardium. The condition can cause life threatening complications, such as constrictive pericarditis and cardiac tamponade.

The symptoms of tuberculous pericarditis can be nonspecific. This, in combination with a lack of fast, reliable testing methods, means it can be difficult for doctors to diagnose TBP.

Treatment typically consists of medication that doctors prescribe to treat TB. If fluid accumulates in the pericardium, a person may need excess fluid removing to prevent heart compression.

The outlook for TBP is generally unfavorable, and the condition has a high mortality rate. Still, early diagnosis and treatment can help improve the outlook.