Tuberculous Dilated Cardiomyopathy with Myocarditis

Paediatrica Indonesiana

Tuberculosis (TB) is one of the major causes of childhood mortality, especially in endemic areas. In 2013, the World Health Organization (WHO) estimated 550,000 new cases and 80,000 deaths due to TB among children. Around 70-80% of the cases were pulmonary TB, while the rest were extra-pulmonary TB.1 Tuberculous pericarditis accounts for only 8% of all TB cases, however, tuberculosis is the main cause of pericarditis in high-TB-burden countries, including Indonesia.2 The mortality rate reached 17-40% and is affected by treatment adequacy.3 Without adequate therapy, the mean life expectancy is 3.7 months, with only 20% surviving to the sixth month.4 A 2004 study reported that successful treatment of TB in children depends on several factors, such as treatment compliance, timing and accuracy of diagnosis, concurrent human immunodeficency virus (HIV) infection and its clinical stage of disease, malnutrition, and drug resistance.5 Adolescents and young adults are at the highest risks of...

Nepalese Heart Journal

Background and Aims: Tuberculosis remains an important etiological cause of pericarditis and pericardial effusion in developing countries like Nepal. The objective of this study is to identify the various presentations of tuberculous pericarditis along with the demographic profile in our context and their short term outcome.Methods: We studied 53 patients from September 2015 to August 2017 regardless of age and gender who presented to Manmohan Cardiothoracic Vascular and Transplant Center with pericarditis of tubercular origin. The various manifestations of the disease were categorized with 2D echocardiography. Pericardiocentesis was done in patients with large pericardial effusion especially in cardiac tamponade and pericardiectomy done in chronic constrictive pericarditis(CCP). Antitubercular therapy with steroids was instituted.Results: Out of 53 patients, 62% were male and 38% were female. The ages ranged from 6-71 years (42±19.5). Twenty three percent of patients were from the ...

Pediatric Cardiology, 1995

Children with low-flow congenital heart lesions are reported to have an increased incidence of pulmonary tuberculosis. The aim of this study was to investigate if children with congenital heart disease have an increased incidence of pulmonary tuberculosis and to determine if patients with certain heart conditions are more susceptible to pulmonary tuberculosis than others. This retrospective study over a 6-year period showed that pulmonary tuberculosis was 2.5-fold more common in children with congenital heart disease than in normal children from the same community. Children with congenital pulmonary stenosis had a prevalence equal to those with acyanotic (ventricular and atrial septal defects) and cyanotic (transposition of the great arteries) high-flow heart lesions, whereas there were no cases of tuberculosis in children with low-flow cyanotic heart lesions such as tetralogy of Fallot. Cardiac surgery had to be postponed as a result of pulmonary tuberculosis in 7.2% of all patients in whom it was required. Over the 6-year period of the study, cardiac surgery had to be delayed in 60% of cases with pulmonary tuberculosis and congenital heart lesions so antituberculosis therapy could be completed. Physicians treating children with congenital heart lesions should maintain a high index of suspicion for the development of pulmonary tuberculosis, especially in those with acyanotic and cyanotic high-flow lesions and pulmonary stenosis,

Indian pediatrics, 1994

Children with evidence of tuberculous disease registered at the TB Clinic, Institute of Child Health, Madras during the years 1977 to 1992 were analyzed. Progressive primary complex, is the commonest thoracic form of tuberculosis while tuberculous meningitis is the commonest extra thoracic form. The overall prevalence of various clinical forms of tuberculosis has decreased over the last 16 years. There is an increasing trend in the prevalence of progressive primary complex among the BCG vaccinated group. The prevalence of pleural effusion, bone tuberculosis and abdominal tuberculosis is almost same over the last 16 years and is more in the BCG non vaccinated children. In tuberculous adenitis there is no significant variation between the two groups. The occurrence of tuberculous meningitis is in the ratio of 1:3 among BCG vaccinated and non-BCG vaccinated children. Though the prevalence of miliary tuberculosis is negligible, it is significantly more in BCG non-vaccinated children. Th...

BMC Infectious Diseases, 2014

Background Pulmonary tuberculosis (PTB) is an infectious disease that involves the lungs and can be lethal in many cases. Tuberculosis (TB) in children represents 5 to 20% of the total TB cases. However, there are few updated information on pediatric TB, reason why the objective of the present study is to know the real situation of PTB in the population of children in terms of its diagnosis and treatment in a third level pediatric hospital. Methods A retrospective study based on a revision of clinical files of patients less than 18 years old diagnosed with PTB from January 1994 to January 2013 at Instituto Nacional de Pediatria, Mexico City was carried out. A probable diagnosis was based on 3 or more of the following: two or more weeks of cough, fever, tuberculin purified protein derivative (PPD) +, previous TB exposure, suggestive chest X-ray, and favorable response to treatment. Definitive diagnosis was based on positive acid-fast bacilli (AFB) or culture. Results In the 19-year p...

BMC Infectious Diseases, 2005

Background: Tuberculosis (TB) is a common public health problem in many parts of the world. TB is generally believed to spare these four organs-heart, skeletal muscle, thyroid and pancreas. We describe a rare case of myocardial TB diagnosed on a post-mortem cardiac biopsy.

Paediatric Respiratory Reviews, 2004

Intrathoracic tuberculosis (TB) usually develops after a child has been in contact with an adult index case with newly diagnosed pulmonary TB. The child may present with chronic non-specific or respiratory symptoms, and have a positive tuberculin skin test, while on a chest radiograph mediastinal lymphadenopathy is normally seen with or without complications of the lymphadenopathy. The most common radiological features are mediastinal lymphadenopathy (49-70%), lobar opacification (56%), lobar or segmental collapse (17%), pleural effusion (12%), miliary opacification (6%) and lung cavities (6%). 1,2,3 There are a number of unusual presentations, the incidence of which is difficult to estimate. The cases presented in this paper have occurred in a region where the incidence of TB is extremely high (>700 new cases/100000 annum) but the prevalence of HIV is relatively low. None of the cases described were HIV seropositive.

Journal of the Pediatric Infectious Diseases Society, 2017

Current data on tuberculous pericardial effusion in children are limited. In this study, the cases of 30 children with tuberculous pericardial effusion were reviewed retrospectively. The prevalence of human immunodeficiency virus and of culture-confirmed tuberculosis was high. Chest radiography provided lower diagnostic sensitivity than sonography but detected all large and complicated effusions. Outcomes were generally good, and residual complications were mainly due to comorbidity.

Current Cardiology Reports, 2020

Purpose of Review This review provides an update on the immunopathogenesis of tuberculous pericarditis (TBP), investigations to confirm tuberculous etiology, the limitations of anti-tuberculous therapy (ATT), and recent efficacy trials. Recent Findings A profibrotic immune response characterizes TBP, with low levels of AcSDKP, high levels of γ-interferon and IL-10 in the pericardium, and high levels of TGF-β and IL-10 in the blood. These findings may have implications for future therapeutic targets. Despite advances in nucleic acid amplification approaches, these tests remain disappointing for TBP. Trials of corticosteroids and colchicine have had mixed results, with no impact on mortality, evidence of a reduction in rates of constrictive pericarditis and potential harm in those with advanced HIV. Small studies suggest that ATT penetrates the pericardium poorly. Given that there is a close association between high bacillary burden and mortality, a rethink about the optimal drug doses and duration may be required. Summary The high mortality and morbidity from TBP despite use of anti-tuberculous drugs call for researches targeting hostdirected immunological determinants of treatment outcome. There is also a need for the identification of steps in clinical management where interventions are needed to improve outcomes. Keywords Tuberculous pericarditis. Mycobacterium tuberculosis Case Vignette A 33-year-old woman, HIV positive with a CD4 count of 21 cells/μL, presented with weight loss, night sweats, and shortness of breath. At presentation, recorded examination findings were temperature of 35.5°C, peripheral oxygen saturation 100%, respiratory rate 22/min, heart rate 112 beats/ min, blood pressure 106/62 mmHg with a pulsus paradoxus of 16 mmHg, and distant heart sounds. Her admission electrocardiogram (ECG), chest radiograph (CXR), and point of This article is part of the Topical Collection on Pericardial Disease

بنام خداوند جان و خرد دانشگاه تهران درس‌نامه آموزش نرم‌افزار SPSS فصل هشتم آزمون «آر پیرسون» (Pearson R-test) و «رگرسیون» (Regression) «برای بررسی همبستگی بین دو متغیر مقیاسی» دکتر یحیی علی بابایی دانشیار گروه جامعه‌شناسی دانشکده علوم اجتماعی درس: کاربرد رایانه در علوم اجتماعی تهیه و تنظیم: اصغر رستم زاده دانشجوی دکتری جامعه‌شناسی مسائل اجتماعی پیام نور تهران با بازبینی نهایی و اضافات استاد تابستان 96 مقدمه: متغیر مستقل ممکن است شامل سه حالت «اسمی»، «رتبه‌ای» و یا «مقیاسی» باشد و متغیر وابسته نیز می‌تواند دارای سه حالت «اسمی»، «رتبه‌ای» و یا «مقیاسی» باشد. جدول زیر از تقاطع این دو نوع متغیر سه وضعیتی حاصل می‌گردد. 1- در جدول زیر، خانه‌های با رنگ سبز (خانه‌های 1 و 5) نشان‌دهنده موارد اصلی (اورجینال) می‌باشند. شرایطی که هردو متغیر جدول دوبعدی، یا اسمی هستند و یا هردو رتبه‌ای می‌باشند. 2- چهارتا از خانه‌ها به رنگ آجری هستند (خانه‌های 2، 3، 6 و 8). این خانه‌ها شرایطی دارند که اگر بخواهیم جدول دوبعدی از آن‌ها فراهم کنیم ابتدا باید با ایجاد تغییراتی، شرایط آنان را به شرایط خانه‌های یک و پنج تبدیل نماییم. با نگاه ساده به خانه‌های آجری رنگ جدول، می‌توان شرایط این تبدیل را مشاهده کرد. 3- اما سه تا از خانه‌ها به رنگ زرد می‌باشند (خانه‌های 4، 7 و 9) که توصیه می‌شود درصدد استخراج جدول دوبعدی در آن نباشیم؛ مانند خانه شماره 9 که درصدد بررسی آن در این فصل هستیم.