Tuberculous Pericarditis

· Usually represents reactivation disease

· Symptoms of tuberculous pericarditis are nonspecific: fever, weight loss, and night sweats generally precede cardiopulmonary complaints

·Can separate TB pericarditis into 4 stages:
o Dry stage
o Effusive stage
o Absorptive stage
o Constrictive phase

· Goal of treatment is to stabilize acute symptoms, treat the infection and prevent chronic complications from constrictive pericarditis

· In highly endemic areas, pericardiocentesis is not necessary unless indicated for acute tamponade physiology or diagnostically for culture/sens in an area with highly resistant strains (XDR TB)

· Treatment regimen involves 4-drug therapy (ie. RIPE) +/- steroids (controversial, but has been shown in several studies to decrease mortality and need for subsequent pericardiectomy)

· If the effusion does not respond after 6 weeks of medical therapy, pericardiectomy should be considered
Brief summary of TB pericarditis on UCSF HIV site: http://hivinsite.ucsf.edu/InSite?page=md-ccl-br-01

(Victoria Kelly MD, 11/16/10)