[Pericardial tuberculosis complicated with heart tamponade as presentation form of acquired immunodeficiency syndrome]

Abstract

Background: Pericardial tuberculosis is an unusual presentation form of extrapulmonary tuberculosis, even in HIV-1 infected patients. When complicated with cardiac tamponade the prognosis worsens; therefore, early diagnosis and therapy are essential.

Methods: A cross-sectional and descriptive study was carried out of cases with documented diagnosis of tuberculous pericarditis in a cohort of prisoner patients with tuberculosis in the Comunidad Autónoma de Madrid, during a 4-year period (March 1991-March 1995). The recovery and identification of Mycobacterium tuberculosis in our clinic were made on the basis of standard techniques and DNA probes. The clinical and microbiological features of patients with documented diagnosis of tuberculous pericarditis are reported and a bibliographic review on this topic is made (MEDLINE 1985-July 1996).

Results: A total of 483 patients were diagnosed of tuberculosis, and 90% were HIV-1 positive. Only four patients, all coinfected with HIV-1, developed tuberculous pericarditis complicated with cardiac tamponade which required drainage and allowed the visualization of acid-fast bacilli and culture of M. tuberculosis in pericardial fluid (in three cases associated with recovery from other specimens). All isolates were initially susceptible to first-line antituberculous drugs. No patient had previously had opportunist infections, although all of them had severe immunosuppression (< 0.200 x 10(9)/l CD4+ lymphocytes). The clinical outcome was favorable with pericardial drainage and the drug regime prescribed; the survival times were 8, 12, 13 and 28 months. The latter patient, on account of inadequate therapy compliance developed multi-resistant tuberculosis.

Conclusions: Tuberculous pericarditis in HIV-1 infected patients usually appears in situations of advanced immunosuppression and usually in the context of disseminated tuberculosis and as a first opportunist infection. Its presentation with cardiac tamponade is unusual and its high morbidity and mortality demand early diagnosis and therapy.