The management of tuberculous pericardial effusion: experience in 233 consecutive patients.
OBJECTIVE
We report on the 30-day and one-year outcome of consecutive effusive pericarditis patients, including those with tuberculous pericarditis, over a six-year-period.


RESULTS
Patients with large pericardial effusions requiring pericardiocentesis were included in the study after having given written informed consent. Clinical and radiological evaluations were followed by echo-guided pericardiocentesis, and extended daily intermittent drainage via an indwelling pigtail catheter. A standard short-course anti-tuberculous regimen was initiated. A total of 233 patients was included. One hundred and sixty-two patients had pericardial tuberculosis (TB), including 118 (73%) with microbiological and/ or histological evidence of TB and 44 (27%) diagnosed on clinical and supportive laboratory data. Over the six-year period, two patients developed fibrous constrictive pericarditis after receiving adjuvant corticosteroid therapy. The 30-day mortality (8.0%) was statistically higher for HIV-positive patients (corresponding mortality 9.9%) than for HIV-negative patients (6.2%; p = 0.04). The one year all-cause mortality was 17.3%. It was also higher for HIV-positive (22.2%) than for IV-negative patients (12.3%; p = 0.03). Cardiac mortality was equal for HIV-positive and -negative patients.


CONCLUSIONS
Tuberculous pericardial effusions responded well to closed pericardiocentesis and a six-month treatment of antituberculous chemotherapy. The former was effective and safe irrespective of HIV status.
Reuter
H
H
TREAD Research/Cardiology Unit, Tygerberg Hospital and University of Stellenbosch, Parow, Western Cape, South Africa.
Burgess
L J
LJ
Louw
V J
VJ
Doubell
A F
AF
D000328:Adult; D000704:Analysis of Variance; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002408:Catheters, Indwelling / Q000009:adverse effects; D004322:Drainage / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000276:immunology / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D010492:Pericardiectomy; D020519:Pericardiocentesis / Q000009:adverse effects / Q000295:instrumentation; D010495:Pericarditis, Tuberculous / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D011241:Prednisone / Q000627:therapeutic use; D013019:South Africa; D016019:Survival Analysis; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011241:Prednisone