1. Cardiovasc J Afr. 2012 Mar;23(2):90-7. doi: 10.5830/CVJA-2011-060. Epub 2012 Feb 13.

Echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania.Chillo P, Bakari M, Lwakatare J.Muhimbili National Hospital, Dar es Salaam, Tanzania. pchillo2000@yahoo.co.uk

Abstract

OBJECTIVE:

To determine the pattern of echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania.

METHODS:

Patients known to be HIV positive and with cardiac complaints were prospectively recruited from the Hospital's care and treatment centre as well as from the medical wards. Clinical assessment, laboratory tests and echocardiography were performed.

RESULTS:

A total of 102 patients were recruited from September 2009 to April 2010. The patients' mean age was 42.4 years and 68.6% were women. The most common diagnosis was pericardial effusion present in 41.2% of the patients. The effusion was large in 5.9% and small in 35.3% of the patients. Hypertensive heart disease was diagnosed in 34.3%, while pulmonary hypertension and dilated cardiomyopathy were present in 12.7 and 9.8%, respectively.

CONCLUSION:

Cardiac abnormalities are common in HIV-infected patients, particularly when they present with symptoms.Free ArticlePMID: 22331234 [PubMed - indexed for MEDLINE]Related citations

2. Heart Fail Rev. 2013 May;18(3):367-73. doi: 10.1007/s10741-012-9310-6.

Tuberculous pericarditis with and without HIV.Ntsekhe M, Mayosi BM.The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, E-17 New Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa, mpiko.ntsekhe@uct.ac.za.

Abstract

The human immunodeficiency virus (HIV) has altered the epidemiology, clinical manifestations, treatment considerations and natural history of tuberculous (TB) pericarditis with significant implications for clinicians. The caseload of TB pericarditis has risen sharply in TB endemic areas of the world where co-infection with HIV is common. Furthermore, TB is the cause in greater than 85 % of cases of pericardial effusion in HIV-infected cohorts. In the absence of HIV, the morbidity of TB pericarditis is primarily related to the ferocity of the immune response to TB antigens within the pericardium. In patients with HIV, because TB pericarditis more often occurs as part of a disseminated process, the infection itself has a greater impact on the morbidity and mortality. HIV-associated TB pericarditis is a more aggressive disease with a greater degree of myocardial involvement. Patients have larger pericardial effusions with more frequent hemodynamic compromise and more significant ST segment changes in the electrocardiogram. HIV alters the natural history and outcomes of TB pericarditis. Immunocompromised participants appear less likely to develop constrictive pericarditis and have a significantly higher mortality compared with their immunocompetent counterparts. Finally co-infection with HIV has resulted in a number of areas of uncertainty. The mechanisms of myocardial dysfunction are unclear, new methods of improving the yield of TB culture and establishing a rapid bacterial diagnosis remain a major challenge, the optimal duration of anti-TB therapy has yet to be established, and the role of corticosteroids has yet to be resolved.PMID: 22427006 [PubMed - in process]Related citations

3. Ethn Dis. 2012 Spring;22(2):136-9.

Dominance of hypertensive heart disease in a tertiary hospital in southern Nigeria: an echocardiographic study.James OO, Efosa JD, Romokeme AM, Zuobemi A, Sotonye DM.Department of Internal Medicine, University of Port-Harcourt Teaching Hospital, Port

Harcourt, Nigeria.

Abstract

BACKGROUND:

Echocardiography is a noninvasive technique for the investigation of cardiac disease with reliable levels of accuracy. Echocardiographic services commenced in the cardiac unit of the University of Port-Harcourt teaching hospital in southern Nigeria in April 2000. This study aims to report our experience with the procedure over a 12 month period as well as the spectrum of clinical cases diagnosed at our center.

METHODS:

This is a cross-sectional study carried out at the cardiology unit of the department of internal medicine of the University of Port-Harcourt teaching hospital in southern Nigeria between May 2009 and April 2010. This was performed with the ALOKA- 400R machine using two dimensional, M-mode, color flow and tissue Doppler protocols.

RESULTS:

Two hundred and thirty-four consecutive patients, 119 males and 115 females, were examined during the study period. Their ages ranged from 10 to 96 years with a mean of 49.69 +/- 16.5 years. One hundred and twenty-four patients (53%) had hypertensive heart disease, 20 (9%) had rheumatic heart disease while 13 (6%) had dilated cardiomyopathy. Hypertrophic cardiomyopathy, pericardial effusion, intracardiac tumors, cor pulmonale, arrhythmogenic right ventricular dysplasia, infective endocarditis, prosthetic heart valve, aortic arch aneurysm were present in less than 5% of the participants. The echocardiography was inconclusive in 3 (1%) while 49 (21%) had a normal study.

CONCLUSION:

Hypertensive heart disease was the largest echocardiographic diagnosis at our center and is one of the most important noncommunicable diseases responsible for increased morbidity and mortality among our patients in Nigeria. More work needs to be done to increase awareness about, and treatement for, hypertension in order to prevent its complications.PMID: 22764633 [PubMed - indexed for MEDLINE]Related citations

4. Eur Heart J. 2012 Apr;33(7):866-74. doi: 10.1093/eurheartj/ehr398. Epub 2011 Nov 1.

Contribution of the human immunodeficiency virus/acquired

immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort.Sliwa K, Carrington MJ, Becker A, Thienemann F, Ntsekhe M, Stewart S.Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa and IIDMM, University of Cape Town, Cape Town, South Africa.

Comment in

Novel insights on HIV/AIDS and cardiac disease: shedding light on the HAART of Darkness. [Eur Heart J. 2012]

Novel insights on HIV/AIDS and cardiac disease: shedding light on the HAART of Darkness.Biondi-Zoccai G, D'Ascenzo F, Modena MG. Eur Heart J. 2012 Apr; 33(7):813-5. Epub 2011 Nov 21.

Abstract

AIMS:

The contemporary impact of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic on heart disease in South Africa (>5 million people affected) is unknown. The Heart of Soweto Study provides a unique opportunity to identify the contribution of cardiac manifestations of this epidemic to de novo presentations of heart disease in an urban African community in epidemiological transition.

METHODS AND RESULTS:

Chris Hani Baragwanath Hospital services the >1 million people living in Soweto, South Africa. A prospective, clinical registry captured data from all de novo cases of heart disease presenting to the Cardiology Unit during 2006-08. We describe all cases where HIV/AIDS was concurrently diagnosed. Overall, 518 of 5328 de novo cases of heart disease were identified as HIV-positive (9.7%) with 54% of these prescribed highly active anti-retroviral therapies on presentation. Women (62%) and Africans (97%) predominated with women being significantly younger than men 38 ± 13 vs. 42 ± 13 years (P = 0.002). The most common primary diagnosis attributable to HIV/AIDS was HIV-related cardiomyopathy (196 cases, 38%); being prescribed more anti-retroviral therapy (127/196 vs. 147/322; odds ratio 2.85, 95% confidence interval 1.81-3.88) with higher viral loads [median 110 000 (inter-quartile range 26 000-510 000) vs. 19 000 (3200-87 000); P = 0.018] and a lower CD4 count [median 180 (71-315) vs. 211 (96-391); P = 0.019] than the rest. An additional 128 cases (25%) were diagnosed with pericarditis/pericardial effusion with a range of other concurrent diagnoses

evident, including 42 cases (8.1%) of HIV-related pulmonary arterial hypertension. Only 14 of all 581 cases of coronary artery disease (CAD) (2.4%, mean age 41 ± 13 years) were confirmed HIV-positive.

CONCLUSION:

Cardiac manifestations of HIV/AIDS identified within this cohort were relatively infrequent. While HIV-related cardiomyopathy and pericardial disease remain important targets for early detection and treatment in this setting, HIV-related cases of CAD remain at historically low levels.PMCID: PMC3345551 Free PMC ArticlePMID: 22048682 [PubMed - indexed for MEDLINE]Related citations

5. S Afr Med J. 2008 Jan;98(1):36-40.

Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa.Mayosi BM, Wiysonge CS, Ntsekhe M, Gumedze F, Volmink JA, Maartens G, Aje A, Thomas BM, Thomas KM, Awotedu AA, Thembela B, Mntla P, Maritz F, Blackett KN, Nkouonlack DC, Burch VC, Rebe K, Parrish A, Sliwa K, Vezi BZ, Alam N, Brown BG, Gould T, Visser T, Magula NP, Commerford PJ.Department of Medicine, University of Cape Town. bongani.mayosi@uct.ac.za

Comment in

Tuberculous pericarditis and HIV infection in Africa. [S Afr Med J. 2008]

Tuberculous pericarditis and HIV infection in Africa.Reuter H. S Afr Med J. 2008 Jan; 98(1):29-30.

Abstract

OBJECTIVE:

To determine the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa.

DESIGN:

Between 1 March 2004 and 31 October 2004, we enrolled 185 consecutive patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon, Nigeria and South

Africa, and observed them during the 6-month course of antituberculosis treatment for the major outcome of mortality. This was an observational study, with the diagnosis and management of each patient left at the discretion of the attending physician. Using Cox regression, we have assessed the effect of clinical and therapeutic characteristics (recorded at baseline) on mortality during follow-up.

RESULTS:

We obtained the vital status of 174 (94%) patients (median age 33; range 14 - 87 years). The overall mortality rate was 26%. Mortality was higher in patients who had clinical features of HIV infection than in those who did not (40% v. 17%, p=0.001). Independent predictors of death during followup were: (i) a proven non-tuberculosis final diagnosis (hazard ratio (HR) 5.35, 95% confidence interval (CI) 1.76 - 16.25), (ii) the presence of clinical signs of HIV infection (HR 2.28, CI 1.14 - 4.56), (iii) coexistent pulmonary tuberculosis (HR 2.33, CI 1.20 - 4.54), and (iv) older age (HR 1.02, CI 1.01 - 1.05). There was also a trend towards an increase in death rate in patients with haemodynamic instability (HR 1.80, CI 0.90 - 3.58) and a decrease in those who underwent pericardiocentesis (HR 0.34, CI 0.10 - 1.19).

CONCLUSION:

A presumptive diagnosis of tuberculous pericarditis is associated with a high mortality in sub-Saharan Africa. Attention to rapid aetiological diagnosis of pericardial effusion and treatment of concomitant HIV infection may reduce the high mortality associated with the disease.Free ArticlePMID: 18270639 [PubMed - indexed for MEDLINE]Related citations

6. Prog Cardiovasc Dis. 2007 Nov-Dec;50(3):218-36.

A modern approach to tuberculous pericarditis.Syed FF, Mayosi BM.Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.

Abstract

The human immunodeficiency virus (HIV) epidemic has been associated with an increase in all forms of extrapulmonary tuberculosis including tuberculous pericarditis. Tuberculosis is responsible for approximately 70% of cases of large pericardial effusion and most cases of constrictive pericarditis in developing countries, where most of the world's population live. However, in industrialized countries, tuberculosis accounts for only 4% of cases of pericardial effusion and an even smaller proportion of instances of constrictive pericarditis. Tuberculous

pericarditis is a dangerous disease with a mortality of 17% to 40%; constriction occurs in a similar proportion of cases after tuberculous pericardial effusion. Early diagnosis and institution of appropriate therapy are critical to prevent mortality. A definite or proven diagnosis is based on demonstration of tubercle bacilli in pericardial fluid or on histologic section of the pericardium. A probable or presumed diagnosis is based on proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis, a lymphocytic pericardial exudate with elevated biomarkers of tuberculous infection, and/or appropriate response to a trial of antituberculosis chemotherapy. Treatment consists of 4-drug therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) for 2 months followed by 2 drugs (isoniazid and rifampicin) for 4 months regardless of HIV status. It is uncertain whether adjunctive corticosteroids are effective in reducing mortality or pericardial constriction, and their safety in HIV-infected patients has not been established conclusively. Surgical resection of the pericardium is indicated for those with calcific constrictive pericarditis or with persistent signs of constriction after a 6 to 8 week trial of antituberculosis treatment in patients with noncalcific constrictive pericarditis.PMID: 17976506 [PubMed - indexed for MEDLINE]Related citations

7. Heart. 2007 Oct;93(10):1176-83.

Contemporary trends in the epidemiology and management of cardiomyopathy and pericarditis in sub-Saharan Africa.Mayosi BM.Department of Medicine, J Floor Old Main Building, Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa. bongani.mayosi@uct.ac.za

Comment in

Global burden of cardiovascular disease. [Heart. 2007]

Global burden of cardiovascular disease.Sanderson JE, Mayosi B, Yusuf S, Reddy S, Hu S, Chen Z, Timmis A. Heart. 2007 Oct; 93(10):1175.

Abstract

Heart failure in sub-Saharan Africans is mainly due to non-ischaemic causes, such as hypertension, rheumatic heart disease, cardiomyopathy and pericarditis. The two endemic diseases that are major contributors to the clinical syndrome of heart failure in Africa are cardiomyopathy and pericarditis. The major forms of endemic cardiomyopathy are idiopathic dilated cardiomyopathy, peripartum cardiomyopathy and endomyocardial fibrosis. Endomyocardial fibrosis, which affects children, has the worst prognosis. Other

cardiomyopathies have similar epidemiological characteristics to those of other populations in the world. HIV infection is associated with occurrence of HIV-associated cardiomyopathy in patients with advanced immunosuppression, and the rise in the incidence of tuberculous pericarditis. HIV-associated tuberculous pericarditis is characterised by larger pericardial effusion, a greater frequency of myopericarditis, and a higher mortality than in people without AIDS. Population-based studies on the epidemiology of heart failure, cardiomyopathy and pericarditis in Africans, and studies of new interventions to reduce mortality, particularly in endomyocardial fibrosis and tuberculous pericarditis, are needed.PMCID: PMC2000928 Free PMC ArticlePMID: 17890693 [PubMed - indexed for MEDLINE]Related citations

8. Cardiovasc J S Afr. 2007 Jan-Feb;18(1):20-5.

The management of tuberculous pericardial effusion: experience in 233 consecutive patients.Reuter H, Burgess LJ, Louw VJ, Doubell AF.TREAD Research/Cardiology Unit, Tygerberg Hospital and University of Stellenbosch, Parow, Western Cape, South Africa.

Abstract

AIM:

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.

METHODS AND 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.

CONCLUSION:

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.Free ArticlePMID: 17392991 [PubMed - indexed for MEDLINE]Related citations

9. Br J Radiol. 2007 May;80(953):302-6. Epub 2006 Sep 27.

Comparison of plain chest radiography and high-resolution CT in human immunodeficiency virus infected patients with community-acquired pneumonia: a sub-Saharan Africa study.Nyamande K, Lalloo UG, Vawda F.Department of Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.

Abstract

The objective of the study was to determine the proportion of patients with missed lesions on plain chest radiographs compared with high-resolution computed tomography (HRCT) in 49 human immunodeficiency virus (HIV) infected patients with community-acquired pneumonia (CAP). Patients underwent plain chest radiography and HRCT scans of the chest at admission. Microbiological investigations for CAP were performed. An experienced radiologist, without knowledge of clinical or pathological data, reported the chest radiographs and HRCT scans. The study group included 26 females and 23 males, aged 18-53 years (mean age 36 years). Organisms were isolated from 26 patients (53%). In 40 patients (82%), the HRCT scans demonstrated lesions not visualized on the plain chest radiographs. There was 100% correlation between plain radiographic and HRCT scan findings in nine cases (18%). Lesions that were not visualized on the plain radiographs but elucidated on HRCT included: pleural effusion (n = 14), ground-glass opacification (n = 20), pericardial effusion (n = 8), cavitation (n = 4), cysts (n = 4), bullae (n = 4), abscess (n = 1) and pneumothorax (n = 1). In 20 of 23 cases, hilar lymphadenopathy, identified on HRCT, was not recognized on plain chest radiographs. In patients in whom an organism was isolated, a correct HRCT diagnosis of pulmonary tuberculosis, bacterial pneumonia and Pneumocystis carinii pneumonia (PCP) was

made in 80%, 84% and 100% of cases, respectively. The proportion of patients with missed lesions on plain chest radiographs in HIV infected patients with CAP was high. This has important implications for management and prognosis. HRCT scans correlate well with the microbiological diagnosis when reported by an experienced radiologist.Free ArticlePMID: 17005518 [PubMed - indexed for MEDLINE]Related citations

10. Tuberculosis (Edinb). 2006 Mar;86(2):125-33. Epub 2005 Dec 19.

Characterization of the immunological features of tuberculous pericardial effusions in HIV positive and HIV negative patients in contrast with non-tuberculous effusions.Reuter H, Burgess LJ, Carstens ME, Doubell AF.Cardiology Unit/TREAD Research, P.O. Box 19174, Tygerberg 7505, South Africa.

Abstract

OBJECTIVE:

To investigate the immunopathogenesis of pericardial tuberculosis (TB) and the influence of human immunodeficiency virus (HIV) on the anti-tuberculous immune response.

DESIGN:

Consecutive patients presenting with large pericardial effusions were subjected to a full clinical examination and pericardiocentesis. Aspirated fluid was sent for biochemistry, differential leukocyte count, flow cytometric analysis and determination of cytokine levels. Pericardial tissue was sent for TB culture and histopathological evaluation. Diagnoses were made according to pre-determined criteria.

RESULTS:

Fifty-six patients were included and divided into HIV positive TB (n = 22), HIV negative TB (n = 21) and non-tuberculous effusions (n = 13). Peripheral blood neutrophil, lymphocyte and monocyte counts were significantly lower in HIV positive TB patients. Lymphocytes were the dominant cell type in tuberculous pericardial effusions. CD4+ cells dominated in HIV negative tuberculous effusions, whereas CD8+ cells dominated in HIV positive TB. The

difference in the concentration of IFN-gamma levels in the tuberculous and non-tuberculous pericardial effusions was statistically significant. Despite significant differences in pericardial CD4+ cell counts, IFN-gamma levels were similarly elevated in HIV negative and HIV positive tuberculous effusions. Highest levels of pericardial IL-10 were observed in samples associated with least tissue necrosis, suggesting the possibility of a tissue protective immunoregulatory role for IL-10.

CONCLUSIONS:

Tuberculous pericardial effusions result from a T helper1 (Th1)-dominant immune response. IFN-gamma producing CD4+ lymphocytes dominate in HIV negative patients, whereas CD8+ seem to play a more important role in HIV positive patients. Infection with HIV leads to the depletion of immunocompetent cells such as monocytes, NK cells and neutrophils.PMID: 16360340 [PubMed - indexed for MEDLINE]Related citations

11. Circulation. 2005 Dec 6;112(23):3608-16.

Tuberculous pericarditis.Mayosi BM, Burgess LJ, Doubell AF.The Cardiac Clinic, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa. bmayosi@uctgsh1.uct.ac.za

Abstract

BACKGROUND:

The incidence of tuberculous pericarditis is increasing in Africa as a result of the human immunodeficiency virus (HIV) epidemic. The primary objective of this article was to review and summarize the literature on the pathogenesis, diagnosis, and management of tuberculous pericarditis.

METHODS AND RESULTS:

We searched MEDLINE (January 1966 to May 2005) and the Cochrane Library (Issue 1, 2005) for information on relevant references. A "definite" diagnosis of tuberculous pericarditis is based on the demonstration of tubercle bacilli in pericardial fluid or on a histological section of the pericardium; "probable" tuberculous pericarditis is based on the proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis, a lymphocytic pericardial exudate with elevated adenosine deaminase levels, and/or appropriate response to a trial of antituberculosis chemotherapy. Treatment consists of the standard 4-drug antituberculosis regimen for 6 months. It is uncertain whether adjunctive corticosteroids are effective in reducing mortality or progression to constriction. Surgical resection of the pericardium remains the appropriate treatment for constrictive pericarditis.

The timing of surgical intervention is controversial, but many experts recommend a trial of medical therapy for noncalcific pericardial constriction, and pericardiectomy in nonresponders after 4 to 8 weeks of antituberculosis chemotherapy.

CONCLUSIONS:

Research is needed to improve the diagnosis, assess the effectiveness of adjunctive steroids, and determine the impact of HIV infection on the outcome of tuberculous pericarditis.Free ArticlePMID: 16330703 [PubMed - indexed for MEDLINE]Related citations

12. Cardiovasc J S Afr. 2005 May-Jun;16(3):143-7.

Adenosine deaminase activity--more than a diagnostic tool in tuberculous pericarditis.Reuter H, Burgess LJ, Carstens ME, Doubell AF.Cardiology Unit/TREAD Research, Tygerberg Hospital and Stellenbosch University, Parow.

Abstract

AIM:

To improve the understanding of factors that influence adenosine deaminase ( ADA) activity in large pericardial effusions.

METHODS:

A prospective study was carried out at Tygerberg Academic Hospital, South Africa. Patients underwent echocardiographically guided pericardiocentesis. ADA activity, as well as biochemistry, haematology, cytology, and in some cases, histology, were determined. Human immunodeficiency virus (HIV) status was assessed in all patients.

RESULTS:

Two hundred and thirty-three patients presented to Tygerberg Hospital with large pericardial effusions requiring pericardiocentesis. Tuberculous pericarditis accounted for 162 effusions (69.5%). An ADA cut-off level of 40 U/l resulted in a test sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic efficiency of 84.0%, 80.0%, 91.0%, 66.0% and 83.0%, respectively. Pericardial exudates with an ADA activity > or = 40 U/l were associated with increased total leukocyte and neutrophil counts. Patients with tuberculous pericarditis and ADA > or = 40 U/l also had increased lymphocyte counts. Pericardial ADA activity < 30 U/l was associated with severe depletion of CD4 cell counts in

HIV-positive patients. ADA levels were higher in cases with histological evidence of granulomatous inflammation than in cases with serofibrinous pericarditis.

CONCLUSIONS:

An ADA cut-off level of 40 U/l results in best diagnostic test results. ADA production appears to be influenced by factors associated with the antituberculous immune response.Free ArticlePMID: 16049586 [PubMed - indexed for MEDLINE]Related citations

13. Epidemiol Infect. 2005 Jun;133(3):393-9.

Epidemiology of pericardial effusions at a large academic hospital in South Africa.Reuter H, Burgess LJ, Doubell AF.Cardiology Unit/TREAD Research, Tygerberg Hospital and Stellenbosch University, South Africa.

Abstract

The aim was to establish the prevalence of large pericardial effusions in the Western Cape Province of South Africa, and to determine the incidence of various types of effusions. A total of 233 patients presented with large pericardial effusions. Each patient underwent tests for HIV, sputum smear and culture, blood culture, blood biochemistry and serological testing. Tuberculous pericardial effusions were diagnosed according to pre-determined criteria. Eighty-four patients (36.1%) were found to be HIV positive; 81 of these (96.4 %) had tuberculous pericarditis. More than 65% of the study population was aged between 15 and 39 years. The prevalence of HIV amongst unemployed individuals was 49.0% compared to 30.0% amongst employed individuals. Tuberculous pericarditis was the most common cause of pericardial effusions (69.5%, n=162). It was concluded that tuberculosis (TB) is a leading cause of pericarditis in this province of South Africa. The prevalence of TB confounded by HIV co-infection is steadily increasing, burdening the health-care facilities.PMCID: PMC2870262 Free PMC ArticlePMID: 15962545 [PubMed - indexed for MEDLINE]Related citations

14. Cardiovasc J S Afr. 2005 Mar-Apr;16(2):108-11.

Role of chest radiography in diagnosing

patients with tuberculous pericarditis.Reuter H, Burgess LJ, Doubell AF.TREAD Research and Cardiology Unit, Tygerberg Hospital and Stellenbosch University, Parow.

Abstract

AIM:

To describe the abnormalities on chest X-ray (CXR) in patients presenting with tuberculous pericardial effusions.

METHODS:

One hundred and seventy patients presented to Tygerberg Hospital with large pericardial effusions (epi-pericardial separation > 10 mm). All patients had a diagnostic work-up, which included CXR, ECG, two-dimensional echocardiography and HIV serology. Echocardiography was followed by pericardiocentesis and drainage. Pericardial fluid was analysed for adenosine deaminase (ADA), Ziehl Neelsen (ZN) stain, bacterial and mycobacterial cultures. Sputum was sent for ZN stain and mycobacterial cultures. Tuberculous pericardial effusions were diagnosed according to predetermined criteria.

RESULTS:

The diagnosis of tuberculous pericarditis was made in 53% (n = 90) of patients with pericardial effusions. Forty-one of the subjects (45.5%) were HIV positive. All patients had an enlarged cardiac silhouette and in the majority of cases, the cardiac shadow was globular with distinct margins. The cardiothoracic ratio (CTR) exceeded 0.55 in all patients. The amount of fluid drained correlated with the radiographic finding of cardiac enlargement.

CONCLUSION:

In developing countries where TB is very prevalent, CXR plays an important role in the identification of large pericardial effusions. Although sonography will still be required for a definite diagnosis, the results of this study show that CXR is a useful screening tool.Free ArticlePMID: 15915278 [PubMed - indexed for MEDLINE]Related citations

15. Cardiovasc J S Afr. 2003 Sep-Oct;14(5):231-7.

Cardiac involvement in HIV-infected

people living in Africa: a review.Magula NP, Mayosi BM.Infectious Disease Unit, Department of Medicine, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa.

Abstract

The primary objective of this study was to review and summarise the literature on the spectrum and management of cardiac disease in HIV-infected people living in Africa. We searched MEDLINE (January 1980 to February 2003), reference lists of papers, and reviews on the subject, and contacted experts working in the field for information on relevant references. The review was limited to papers that were published in peer-reviewed journals and indexed on MEDLINE. Seventeen of the 21 studies identified met the inclusion criteria for analysis. The studies confirmed that cardiac abnormalities are more common in HIV-infected people, compare to normal controls, and that about half of hospitalized patients and a significant proportion of patients followed up over several years develop cardiac abnormalities. The commonest HIV-related cardiac abnormalities were cardiomyopathy and pericardial disease. Tuberculosis was the major cause of large pericardial effusion in Africa. Myocarditis was the commonest pathological abnormality in HIV-associated cardiomyopathy, and non-viral opportunistic infections such as toxoplasmosis and cryptococcosis may account for up to 50% of cases of HIV-associated cardiomyopathy in Africa. Echocardiography is indicated in HIV-positive patients with cardiac symptoms or signs. If cardiomyopathy or pericardial disease is identified, further investigation must be considered to exclude potentially treatable opportunistic infections. Further research in large numbers of patients is needed to determine the value of endomyocardial biopsy in the management of patients with HIV-associated cardiomyopathy, and to establish the place of adjuvant steroids in the treatment of HIV-associated tuberculous pericarditis.Free ArticlePMID: 14610610 [PubMed - indexed for MEDLINE]Related citations

16. QJM. 2003 Aug;96(8):593-9.

Adjuvant corticosteroids for tuberculous pericarditis: promising, but not proven.Ntsekhe M, Wiysonge C, Volmink JA, Commerford PJ, Mayosi BM.Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.

Abstract

BACKGROUND:

There is controversy regarding the effectiveness of corticosteroids in tuberculous pericarditis, particularly in patients who are immunocompromised by HIV.

AIM:

To determine the effectiveness of adjuvant corticosteroids in tuberculous pericarditis.

DESIGN:

Systematic review of randomized controlled trials.

METHODS:

We searched the Cochrane Infectious Diseases Group trials register (June 2002), the Cochrane Controlled Trials Register (Issue 2, 2002), MEDLINE (January 1966 to March 2003), EMBASE (1980 to May 2002), and the reference lists of existing reviews, for randomized and quasi-randomized controlled trials of adjuvant corticosteroids in the treatment of suspected tuberculous pericarditis. We also contacted organizations and individuals working in the field. Two reviewers independently assessed trial quality and extracted data. We used meta-analysis with a fixed effects model to calculate the summary statistics, provided there was no statistically significant heterogeneity, and expressed results as relative risk.

RESULTS:

Four trials with a total of 469 participants met our criteria. Three (total n = 411) tested adjuvant steroids in participants with suspected tuberculous pericarditis in the pre-HIV era. Fewer participants died in the intervention group, but the potentially large reduction in mortality was not statistically significant (relative risk RR 0.65, 95%CI 0.36-1.16, n = 350; p = 0.14). One trial with 58 patients that enrolled HIV-positive individuals also showed a promising but non-significant trend on mortality (RR 0.50, 95%CI 0.19-1.28; p = 0.15). There was no significant beneficial effect of steroids on re-accumulation of pericardial effusion or progression to constrictive pericarditis. Patients with pericardial effusion were significantly more likely to be alive with no functional impairment at 2 years following treatment. However, the effect was not sustained in a sensitivity analysis that included patients who were lost to follow-up.

DISCUSSION:

Steroids could have large beneficial effects on mortality and morbidity in tuberculous pericarditis, but published trials are too small to be conclusive. Large placebo-controlled trials are required, and should include sufficient numbers of HIV-positive and HIV-negative participants, and an adequate adjuvant steroid dose.

Free ArticlePMID: 12897345 [PubMed - indexed for MEDLINE]Related citations

17. Sante. 2001 Jul-Sep;11(3):167-72.

[Pericarditis in HIV infected patients: retrospective study of 40 cases in Ouagadougou, Burkina Faso].[Article in French]Niakara A, Kambire Y, Drabo YJ.Service de cardiologie, Centre hospitalier national et universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso. a_niakara_bf@hotmail.com

Abstract

Incidence of pericarditis has increased in sub-Saharan Africa, because of the HIV infection pandemia. We have done a retrospective study in the cardiology unit of the national hospital of Ouagadougou (Burkina Faso), in order to describe epidemiological, clinical, and therapeutic aspects of pericarditis occurring in HIV infected patients. Inclusion criteria were pericarditis proved by echography, and positive HIV serology. We have included forty patients (28 men and 12 women), mean aged of 34.45 years. General signs were fever (87.5%), and weight loss (70%). Thirty-six patients (90%) were in CDC stage C AIDS classification, three (7.5%) in stage B, and one (2.5%) in stage A. The symptoms described by the patients were dyspnea (92.5%), cough 77.5%), chest pain (65%), liver effort pain (27.5%), and palpitations (20%). Heart failure was present in 80% of the patients who had myocarditis. Pericardial effusion was small in 21%, moderate in 31,6%, and large in 47.4% of the patients. Tamponade occurred in for cases (10%). The etiology was tuberculosis in 75% of cases. Pericardial puncture (done in six patients) showed purulent fluid in two cases. Before hospital discharge, eight patients died, giving a mortality rate of 20%. Symptomatic pericardial involvement is frequently associated with stage C of HIV infection. Myocarditis is often associated (37.5%). Mortality rate is high.Free ArticlePMID: 11641080 [PubMed - indexed for MEDLINE]Related citations