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Tuberculous pericarditis in children: a review of 44 cases
C T Hugo-Hamman1, H Scher, M M De Moor
1Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Insights
Tuberculous pericardial disease in children is common in high-prevalence areas. Early diagnosis and treatment lead to excellent outcomes, with recovery in most cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Pericardial tuberculosis (TB) is a significant cause of morbidity and mortality globally.
- Diagnosis can be challenging due to low yields from microbiological tests.
Purpose of the Study:
- To report the clinical experience with pericardial TB in children.
- To evaluate diagnostic methods and treatment outcomes.
Main Methods:
- Retrospective analysis of 44 children with pericardial TB from 1986-1991.
- Review of clinical presentation, diagnostic tests (echocardiography, Mantoux), and treatment regimens (steroids, anti-TB medication).
Main Results:
- 90% presented with cardiac tamponade; 91% had cardiomegaly.
- Echocardiography was diagnostic for pericardial effusion (PE).
- Low yield for Mycobacterium tuberculosis (18%), but 75% had a positive Mantoux test. Steroid use did not show statistically significant differences in outcomes.
Conclusions:
- Tuberculous pericardial disease is prevalent in high-TB areas and affects children.
- Prognosis is excellent with appropriate management, despite previous high morbidity and mortality.
- Early diagnosis and treatment are crucial for favorable outcomes.
Abstract:
This retrospective study reports experience in 44 children with pericardial tuberculosis seen during a 6-year period, 1986 to 1991. Thirty-seven children presented with pericardial effusion (PE), 4 with constrictive pericarditis and 3 with effusive constrictive disease. Features of cardiac tamponade were present in 90%, and in 91% radiologic cardiomegaly was found. A two-dimensional echocardiogram is diagnostic for PE. Culture and biopsy yields for Mycobacterium tuberculosis were low (18%). The Mantoux test was positive (> 10 mm) in 75%. In 14 patients doubt about etiology necessitated treatment for possible pyogenic infection with anterior pericardiotomy as opposed to diagnostic pericardiocentesis with catheter drainage. Twelve cases with PE were treated with steroids and the other 25 received only anti-tuberculous medication. Five cases of PE developed constrictive pericarditis during treatment of whom none received steroids. No statistically significant differences were demonstrated between the two groups. Only 5 of the 12 cases with constrictive pericarditis required pericardiectomy. There were no deaths and recovery has been complete in 43 cases. This study shows that tuberculous pericardial disease is common in areas with a high prevalence of tuberculosis. Prognosis is excellent for a condition in which morbidity and mortality have previously been high.