Buscar en
Revista Colombiana de Cardiología
Toda la web
Inicio Revista Colombiana de Cardiología Pericarditis tuberculosa: presentación de un caso y revisión de la literatura
Información de la revista
Vol. 18. Núm. 5.
Páginas 282-287 (Agosto - Octubre 2011)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 18. Núm. 5.
Páginas 282-287 (Agosto - Octubre 2011)
Open Access
Pericarditis tuberculosa: presentación de un caso y revisión de la literatura
Tuberculous pericarditis: a case report and review of the literature
Visitas
7784
María C. Florián1, Sergio Franco1, David Santacruz1,
Autor para correspondencia
david_santacruz_p@yahoo.es

Correspondencia: Dirección: Manzana 3 No. 21. Urbanización La Quinta -La Linda, Manizales, Caldas, Colombia. Teléfono: (57-6) 870 80 78. Celular: 312-2864532.
, Kevin F. Montoya1
1 Hospital Departamental Santa Sofía, Universidad de Caldas, Manizales
Este artículo ha recibido

Under a Creative Commons license
Información del artículo

La pericarditis constrictiva crónica es un síndrome clínico causado por la compresión cardíaca ejercida por un pericardio engrosado o rígido. La tuberculosis es una causa rara de pericarditis constrictiva en los países desarrollados. Sin embargo, ésta es una importante condición a considerar en países en desarrollo y en pacientes con infección por VIH. La pericarditis tuberculosa es una forma de tuberculosis extra-pulmonar que puede conducir a la muerte. La dificultad en su diagnóstico y las serias consecuencias de la infección no tratada hacen de esta condición un importante problema de salud tanto en países industrializados como en aquellos en vía de desarrollo.

Ayudas diagnósticas como la ecocardiografía son esenciales en el diagnóstico, y ante la sospecha de afección tuberculosa del pericardio se indica la realización de estudios del líquido o del tejido pericárdico. El tratamiento antituberculoso se realiza durante seis meses y se considera la pericardiectomía en pacientes con pericarditis constrictiva calcificada o en quienes la constricción empeora después de seis a ocho semanas de tratamiento.

Palabras clave:
pericarditis constrictiva
pericarditis tuberculosa
tuberculosis extra-pulmonar
pericardiectomía

Constrictive pericarditis is a clinical syndrome caused by the cardiac compression of a thickened or rigid pericardium. Tuberculosis is a rare cause of constrictive pericarditis in developed countries. However, this is an important condition to consider in developing countries and in patients with HVI infection. Tuberculous pericarditis is a form of extra-pulmonary tuberculosis that may lead to death. The difficulty in its diagnosis and the serious consequences of this non-treated infection make this condition an important health problem both in industrialized and developing countries.

Diagnostic aids such as echography are essential in the diagnosis, and in front of the suspicion of tuberculous infection of the pericardium, the performance of pericardial fluid or pericardial tissue studies is indicated. Anti TB treatment is carried out for six months and pericardiectomy is considered in patients with calcified constrictive pericarditis or in those in whom the constriction worsens after six to eight weeks of treatment.

Key words:
constrictive pericarditis
tuberculous pericarditis
extra-pulmonary tuberculosis
pericardiectomy
El Texto completo está disponible en PDF
Bibliografía
[1.]
W.C. Little, G.L. Freeman.
Pericardial disease.
Circulation, 113 (2006), pp. 1622-1632
[2.]
B. Maisch, P.M. Seferovic, A.D. Ristic.
Guidelines on the diagnosis and management of pericardial diseases Executive summary.
Eur Heart J, 25 (2004), pp. 587-610
[3.]
S.C. Bertog, S.K. Thambidorai, K. Parakh.
Constrictive pericarditis: etiology and causespecific survival after pericardiectomy.
J Am Coll Cardiol, 44 (2004), pp. 1445-1452
[4.]
L.H. Ling, J.K. Oh, H.V. Schaff.
Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy.
Circulation, 100 (1999), pp. 1380-1386
[5.]
B.W. Trautner, R.O. Darouiche.
Tuberculous pericarditis: optimal diagnosis and management.
Clin Infect Dis, 33 (2001), pp. 954-961
[6.]
B. Maisch.
Pericardial diseases, with a focus on etiology, pathogenesis, pathophysiology, new diagnostic imaging methods and treatment.
Curr Opin Cardiol, 9 (1994), pp. 379-388
[7.]
P.E. Chaparro, I. García, M. Guerrero, C. León.
Situación de la tuberculosis en Colombia 2002.
Revista Biomédica de Colombia, 24 (2004), pp. 102-114
[8.]
M. Bongani, L. Mayosi, F. Burgess.
Tuberculous-pericarditis.
Circulation, 112 (2005), pp. 3609-3610
[9.]
H. Reuter, L. Burgess, W. Van Vuuren, A. Doubell.
Diagnosing tuberculous pericarditis.
QJM, 99 (2006), pp. 827-839
[10.]
R. Long, M. Younes, N. Patton, E. Hershfield.
Tuberculous pericarditis: long-term outcome in patients who received medical therapy alone.
Am Heart J, 117 (1989), pp. 1133-1139
[11.]
N.O. Fowler.
Tuberculous pericarditis.
JAMA, 266 (1991), pp. 99-103
[12.]
P.K. Suwan, S. Potjalongsilp.
Predictors of constrictive pericarditis after tuberculous pericarditis.
BMJ, 73 (1995), pp. 187-189
[13.]
N.O. Fowler.
Constrictive pericarditis Its history and current status.
Clin Cardiol, 18 (1995), pp. 341-350
[14.]
E. Gladych, S. Goland, M. Attali, M. Somin, S.D. Malnick.
Cardiac tamponade as a manifestation of tuberculosis.
South Med J, 94 (2001), pp. 525-528
[15.]
C.C. Yang, M.H. Lee, J.W. Liu, H.S. Leu.
Diagnosis of tuberculous pericarditis and treatment without corticosteroids at a tertiary teaching hospital in Taiwan. A 14 year experience.
J Microbiol Immunol Infect, 38 (2005), pp. 47-52
[16.]
B. Cinar, Y. Enç, O. Göksel, et al.
Chronic constrictive tuberculous pericarditis: risk factors and outcome of pericardiectomy.
Int J Tuberc Lung Dis, 10 (2006), pp. 701-706
[17.]
J. Sagrista-Sauleda, G. Permanyer-Miralda, J. Soler-Soler.
Tuberculous pericarditis: ten-year experience with a prospective protocol for diagnosis and treatment.
J Am Coll Cardiol, 11 (1988), pp. 724-728
[18.]
J. Sagristá, L. Bonet, J. Ferrer, et al.
Guías de práctica clínica de la Sociedad Española de Cardiología en patología pericárdica.
Rev Esp Cardiol, 53 (2000), pp. 394-412
[19.]
G. Cherian, A.G. Habashy, B. Uthaman, R.M. Hanna.
Tuberculous pericardial effusionmediastinal lymph glands The cause and clue to the etiology.
Indian Heart J, 55 (2003), pp. 228-233
[20.]
G. Cherian, B. Uthaman, A. Salama, A.G. Habashy, N.A. Khan, J.M. Cherian.
Tuberculous pericardial effusion: features, tamponade and computed tomography.
Angiology, 55 (2004), pp. 431-440
[21.]
A. Afzal, M. Keohane, E. Keeley, S. Borzak, C.W. Callender, M. Iannuzzi.
Myocarditis and pericarditis with tamponade associated with disseminated tuberculosis.
Can J Cardiol, 16 (2000), pp. 519-521
[22.]
J. Glockner.
Image of pericardial disease.
Magn Reson Imaging Clin N Am, 11 (2003), pp. 149-162
[23.]
L.J. Burgess, H. Reuter, M.E. Carstens, J.J. Taljaard, A.F. Doubell.
The use of adenosine deaminase and interferon-gamma as diagnostic tools for tuberculous pericarditis.
Chest, 122 (2002), pp. 900-905
[24.]
G. Cherian.
Diagnosis of tuberculous aetiology in pericardial effusions.
Postgrad Med J, 80 (2004), pp. 262-266
[25.]
J.P. Cegielski, B.H. Devlin, A.J. Morris, et al.
Comparison of PCR, culture, and histopathology for diagnosis of tuberculous pericarditis.
J Clin Microbiol, 35 (1997), pp. 3254-3257
[26.]
B. Komsuoglu, O. Göldelï, K. Kulan, S.S. Komsuoglu.
The diagnostic and prognostic value of adenosine deaminase in tuberculous pericarditis.
Eur Heart J, 16 (1995), pp. 1126-1130
[27.]
J.H. Lee, C.W. Lee, S.G. Lee, et al.
Comparison of polymerase chain reaction with adenosine deaminase activity in pericardial fluid for the diagnosis of tuberculous pericarditis.
Am J Med, 113 (2002), pp. 519-521
[28.]
R. Dogan, M. Demircin, A. Sarigül, G. Ciliv, A.Y. Bozer.
Diagnostic value of adenosine deaminase activity in pericardial fluids.
J Cardiovasc Surg (Torino), 40 (1999), pp. 501-504
[29.]
J.M. Martínez-Vázquez, E. Ribera, I. Ocaña, R.M. Segura, R. Serrat, J. Sagrista.
Adenosine deaminase activity in tuberculous pericarditis.
Thorax, 41 (1986), pp. 888-889
[30.]
G. Strang, S. Latouf, P. Commerford, et al.
Bedside culture to confirm tuberculous pericarditis.
Lancet, 338 (1991), pp. 1600-1601
[31.]
J.I. Strang, H.H. Kakaza, D.G. Gibson, et al.
Controlled clinical trial of complete open surgical drainage and of prednisolone in treatment of tuberculous pericardial effusion in Transkei.
Lancet, 2 (1988), pp. 759-764
[32.]
F.F. Syed, B.M. Mayosi.
A modern approach to tuberculous pericarditis.
Prog Cardiovasc Dis, 50 (2007), pp. 218-236
[33.]
T.T. Ng, J.I. Strang, E.G. Wilkins.
Serodiagnosis of pericardial tuberculosis.
QJM, 88 (1995), pp. 317-320
[34.]
K.K. Koh, E.J. Kim, C.H. Cho, et al.
Adenosine deaminase and carcinoembryonic antigen in pericardial effusion diagnosis, especially in suspected tuberculous pericarditis.
Circulation, 89 (1994), pp. 2728-2735
[35.]
B.M. Mayosi, L.J. Burgess, A.F. Doubell.
Tuberculous pericarditis.
Circulation, 112 (2005), pp. 3608-3616
[36.]
A. Lalvani.
Diagnosing tuberculosis infection in the 21st. century: new tools to tackle an old enemy.
Chest, 131 (2007), pp. 1898-1906
[37.]
G. Ferrara, M. Losi, R. D’Amico, et al.
Use in routine clinical practice of two commercial blood tests for diagnosis of infection with Mycobacterium tuberculosis: a prospective study.
Lancet, 367 (2006), pp. 1328-1334
[38.]
P.C. Hopewell, M. Pai, D. Maher.
International standard for tuberculosis care.
Lancet Infect Dis, 6 (2006), pp. 710-725
[39.]
J.I. Strang, pericarditis. Tuberculous.
J Infect, 35 (1997), pp. 215-219
[40.]
B.M. Mayosi, M. Ntsekhe, J.A. Volmink, P.J. Commerford.
Interventions for treating tuberculous pericarditis.
Cochrane Database Syst Rev, (2002),
[41.]
D.J. Evans.
The use of adjunctive corticosteroids in the treatment of pericardial, pleural and meningeal tuberculosis.
Do they improve outcome? Resp Med, 102 (2008), pp. 793-800
[42.]
M. Ntsekhe, C. Wiysonge, J.A. Volmink, P.J. Commerford, B.M. Mayosi.
Adjuvant corticosteroids for tuberculous pericarditis Promising, but not proven.
QJM, 96 (2003), pp. 593-599
[43.]
J.G. Hakim, I. Ternouth, E. Mushangi, S. Siziya, V. Robertson, A. Malin.
Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients.
Heart, 84 (2000), pp. 183-188
[44.]
J.I. Strang, A.J. Nunn, D.A. Johnson, A. Casbard, D.G. Gibson, D.J. Girling.
Management of tuberculous constrictive pericarditis and tuberculous pericardial effusion in Transkei Results at 10 years follow-up.
QJM, 97 (2004), pp. 525-535
[45.]
G. Meintjes, M. Rangaka, G. Maartens.
Novel relationship between tuberculosis immune reconstitution inflammatory syndrome and antitubercular drug resistance.
Clin Infect Dis, 48 (2009), pp. 667-676
[46.]
D.P. Dooley, J.L. Carpenter, S. Rademacher.
Adjunctive corticosteroid therapy for tuberculosis: a critical reappraisal of the literature.
Clin Infect Dis, 25 (1997), pp. 872-887
[47.]
B.C. McCaughan, H.V. Schaff, J.M. Piehler, et al.
Early and late results of pericardectomy for constrictive pericarditis.
J Thorac Cardiovas Surg, 89 (1985), pp. 340-350
[48.]
B. Çýnar, Y. Enç, O. Göksel, et al.
Chronic constrictive tuberculous pericarditis: risk factors and outcome of pericardiectomy.
Int J Tuberc Lung Dis, 10 (2006), pp. 701-706
[49.]
N. Bozbuga, V. Erentug, E. Eren, et al.
Pericardiectomy for chronic constrictive tuberculous pericarditis: risks and predictors of survival.
Tex Heart Inst J, 30 (2003), pp. 180-185
[50.]
U.K. Chowdhury, G.K. Subramaniam, A.S. Kumar, et al.
Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic and hemodynamic evaluation of two surgical techniques.
Ann Thorac Surg, 81 (2006), pp. 522-529
Copyright © 2011. Sociedad Colombiana de Cardiología y Cirugía Cardiovascular
Opciones de artículo
Herramientas