Tuberculous Pericarditis and Associated Cardiovascular Complications

Tuberculous pericarditis arises when Mycobacterium tuberculosis invades the pericardial sac, triggering an exudative effusion, intense inflammation and potential haemodynamic compromise. It represents a significant proportion of pericarditis in endemic regions and carries a high risk of progression to life-threatening tamponade or chronic constriction if untreated. Concomitant HIV infection exacerbates pericardial inflammation, promotes effusive-constrictive physiology and increases mortality. Beyond the pericardium, tuberculosis may involve the myocardium or vasculature, leading to myocarditis, dilated cardiomyopathy, arrhythmias and accelerated atherogenesis. Management demands prompt recognition, combination antituberculous chemotherapy, selective use of corticosteroids and timely pericardial drainage. Despite these measures, delays in definitive diagnosis and emerging cardiotoxic effects of treatment sustain considerable morbidity. Current research focuses on refining rapid diagnostics, understanding local immunopathology and developing host-directed therapies to prevent long-term sequelae such as constrictive pericarditis and ventricular dysfunction.

Research from Nature Portfolio

A foundational prospective study evaluated the combined use of a molecular assay and an interferon-γ release test in HIV-negative patients with suspected tuberculous pericarditis. The molecular platform demonstrated high specificity but moderate sensitivity, while the immunodiagnostic assay showed superior sensitivity and negative predictive value. By applying a two-step algorithm—initial molecular testing to confirm disease followed by immunological testing to exclude false negatives—the study achieved an optimal balance of rapid rule-in and rule-out performance, significantly reducing misdiagnosis and supporting streamlined diagnostic pathways.

Tuberculous Pericarditis and Associated Cardiovascular Complications publication trend

The graph below shows the total number of articles in tuberculous pericarditis and associated cardiovascular complications across all publications each year (not limited to Nature Index journals).

Technical terms

Pericardial effusion: Accumulation of fluid in the sac surrounding the heart.

Cardiac tamponade: Severe compression of the heart by rapidly accumulated pericardial fluid, impairing filling.

Constrictive pericarditis: Chronic pericardial thickening that limits ventricular diastolic expansion.

Xpert MTB/RIF: A rapid nucleic acid amplification test for Mycobacterium tuberculosis and rifampicin resistance.

Interferon-γ release assay (T-SPOT.TB): A blood test measuring T-cell release of interferon-γ in response to MTB antigens.

Adenosine deaminase (ADA): An enzyme whose elevated activity in pericardial fluid suggests tuberculous inflammation.

References

1. A description of the elevation of pericardial cortisol: cortisone ratio in patients with tuberculous pericarditis. Frontiers in Endocrinology (2023).
2. Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications—A Narrative Review. Diagnostics (2023).
3. Diagnostic values of Xpert MTB/RIF, T-SPOT.TB and adenosine deaminase for HIV-negative tuberculous pericarditis in a high burden setting: a prospective observational study. Scientific Reports (2020).
4. Tuberculous Pericarditis—Own Experiences and Recent Recommendations. Diagnostics (2022).