title: The role of histopathology in establishing the diagnosis of tuberculous pericardial effusions in the presence of HIV.
abstract: OBJECTIVE
  To establish the influence of human immunodeficiency virus (HIV) infection on the histopathological features of patients presenting with tuberculous pericarditis.
  
  
  RESULTS
  A prospective study was carried out at Tygerberg Academic Hospital, South Africa; 36 patients with large pericardial effusions had open pericardial biopsies under general anaesthesia and were included in the study. Patients underwent pericardiocentesis, followed by daily intermittent catheter drainage; a comprehensive diagnostic work-up (including histopathology of the pericardial tissue) was also performed. Histological tuberculous pericarditis was diagnosed according to predetermined criteria. Tuberculous pericarditis was identified in 25 patients, five of whom were HIV+. The presence of granulomatous inflammation (with or without necrosis) and/or Ziehl-Neelsen positivity yielded the best test results (sensitivity 64%, specificity 100% and diagnostic efficiency 75%).
  
  
  CONCLUSIONS
  Co-infection with HIV impacts on the histopathological features of pericardial tuberculosis and leads to a decrease in the sensitivity of the test. In areas which have a high prevalence of tuberculosis, the combination of a sensitive test such as adenosine deaminase, chest X-ray and clinical features has a higher diagnostic efficiency than pericardial biopsy in diagnosing tuberculous pericarditis.
authors.affiliation: Cardiology Unit/TREAD Research, Tygerberg Hospital and Stellenbosch University, Parow, South Africa.
authors.forename: H
authors.initials: H
authors.lastname: Reuter
authors.forename: L J
authors.initials: LJ
authors.lastname: Burgess
authors.forename: J
authors.initials: J
authors.lastname: Schneider
authors.forename: W
authors.initials: W
authors.lastname: Van Vuuren
authors.forename: A F
authors.initials: AF
authors.lastname: Doubell
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000473:pathology; D000243:Adenosine Deaminase / Q000032:analysis; D001706:Biopsy; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010495:Pericarditis, Tuberculous / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D010496:Pericardium / Q000382:microbiology / Q000473:pathology / Q000821:virology; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D000243:Adenosine Deaminase