Tuberculosis infection of the membrane around the heart is uncommon but life threatening. There is little reliable research on best practice in relation to what drugs to give and when and how to operate.

Mayosi BM

Published Online:

January 21, 2009

Currently doctors prescribe antituberculous drugs and remove the membrane if it is making the patient ill. However, doctors vary in the way they manage this condition in terms of what antituberculous drugs to give and when to operate. We found no clinical trials that tackled the length of anti-TB treatment needed. Trials of steroids given with antituberculous drugs suggest possible benefit, but this was not demonstrated conclusively. Open surgical drainage of the fluid accumulating between the heart and the membrane using general anaesthesia was associated with less life threatening re-accumulation of fluid (cardiac tamponade), but with more deaths, but conclusions are not possible as the numbers of patients studied was too small.

Abstract (click to read)

Background:

Tuberculous pericarditis – tuberculosis infection of the pericardial membrane (pericardium) covering the heart – is becoming more common. The infection can result in fluid around the heart or fibrosis of the pericardium, which can be fatal.

Objectives:

In people with tuberculous pericarditis, to evaluate the effects on death, life-threatening conditions, and persistent disability of: 1. 6-month antituberculous drug regimens compared with regimens of 9 months or more; 2. corticosteroids; 3. pericardial drainage; and 4. pericardiectomy.

Search strategy:

We searched the Cochrane Infectious Diseases Group trials register (January 2005); the Cochrane Controlled Trials Register (Issue 4, 2004); MEDLINE (1966 to January 2005); EMBASE (1980 to January 2005); and checked the reference lists of existing reviews. We also contacted organizations and individuals working in the field.

Selection criteria:

Randomized and quasi-randomized controlled trials of treatments for tuberculous pericarditis.

Data collection and analysis:

Two reviewers independently assessed trial quality and extracted data. Meta-analysis using fixed effects models calculated summary statistics, provided there was no statistically significant heterogeneity, and expressed results as risk ratio. Study authors were contacted for additional information.

Main results:

Four trials met the inclusion criteria, with a total of 469 participants. Treatments tested were adjuvant steroids and surgical drainage.

Two trials with a total of 383 participants tested adjuvant steroids in participants with suspected tuberculous pericarditis in the pre-HIV era. Fewer participants died in the intervention group, but numbers were small (risk ratio [RR] 0.65; 95% confidence interval [CI] 0.36 to 1.16, n = 350). One small trial tested steroids in HIV positive participants with effusion showed a similar pattern (RR 0.50; 95% CI 0.19 to 1.28, n = 58).

One trial examined open surgical drainage compared with conservative management, and showed surgery relieved cardiac tamponade.

Authors' conclusions:

Steroids could have important clinical benefits, but the trials published to date are too small to demonstrate an effect. This requires large placebo controlled trials. Subgroup analysis could explore whether effusion or fibrosis modify the effects. Therapeutic pericardiocentesis under local anaesthesia and pericardiectomy also require further evaluation.

This record should be cited as:

Mayosi BM. Interventions for treating tuberculous pericarditis. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD000526. DOI: 10.1002/14651858.CD000526

Assessed as up to date:

June 17, 2002

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Primary Review Group:

Infectious Diseases Group

Health topics:

Infectious disease > Tuberculosis > Treatment: drugs

Lungs & airways > Respiratory infections > Tuberculosis treatment: drugs

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Tuberculosis infection of the membrane around the heart is uncommon but life threatening. There is little reliable research on best practice in relation to what drugs to give and when and how to operate.

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