clove and Pericarditis--Tuberculous

Vaccination against tuberculosis is not an obligation anymore in France, except for children at risk, but this disease remains not so rare, including its extrapulmonary forms. The authors report the case of a 27-year-old Madagascan HIV seronegative patient, who developed a pericardial effusion when coming back from a long stay in Madagascar. An anti-inflammatory treatment and then a probabilistic antibiotic treatment were ineffective, and at the same time echocardiographic signs of tamponade appeared. As a consequence, it was decided to perform a surgical pericardial drainage and a biopsy, and to introduce an antituberculosis chemotherapy, given the epidemiologic status. The course was then quickly favorable. The presence of granulomatous inflammation on the biopsy and an elevated pericardial adenosine deaminase activity level retrospectively supported the diagnosis of tuberculous pericarditis.

Topics: Adult; Antitubercular Agents; France; Humans; Madagascar; Male; Pericarditis, Tuberculous; Treatment Outcome

A 56 months retrospective study, from October 1990 to May 1995, at the Centre Hospitalier de Soavinandriana in Antananarivo pointed out 29 tuberculous pericarditis among the 97 pericardial effusions discovered by the echocardiography of 5600 patients. The sex-ratio was 0,81 and the mean age 38,6 years old (+/- 14,3). Hospitalization was justified by dyspnea (18 cases), thoracic pain (18 cases), lower limbs edema (6 cases) and ascitis (3 cases). Moreover, electrocardiography showed microvoltage in 18 cases and thoracic radiography showed one heart enlargement. Even if for 15 cases a pleural effusion was associated, only 2 patients had a pulmonary image suggestive of tuberculosis. Tuberculous pericarditis has been proved by the following examinations: pericardium puncture (21 cases), pericardium and pleural biopsy (respectively 11 and 13 cases), ganglionic biopsy and search of alcohol-acid-fast bacilli in sputum: 1 case. Histologic proof has been obtained 8 times out of 9 pericardial biopsies and 6 times out of 7 pleural biopsies. Bacteriological proof has been obtained 11 times by pathological samples cultivation: twice from fresh caseous material taken from the pericardium, once from 13 pleural fluids, 5 times from 6 pericardial biopsies, 3 times from 3 pleural biopsies. The patients have been put under antituberculous treatment associated with prednisone. 20 patients have been declared cured at the end of the treatment, 5 were dead and 4 were lost out of sight. Tuberculous pericarditis has become rare in developed countries but it is still challenging in Madagascar. In spite of the antituberculous treatment associated with corticoids, prognosis is severe (evolution towards pericardial constriction death.

Topics: Adult; Antitubercular Agents; Biopsy; Female; Hospitalization; Humans; Madagascar; Male; Middle Aged; Pericarditis, Tuberculous; Retrospective Studies; Sex Distribution; Treatment Outcome; Urban Health