PDF
ePub
Citation
Print
Abstract
Here, we report a case in which the rapid diagnosis of tuberculous pericarditis was made using Mycobacterium tuberculosis (MTB)-specific interferon-γ release assay on peripheral blood and pericardial effusion. Acid-fast bacilli staining, mycobacterial culture, and nucleic acid amplification targeting MTB using pericardial fluid were negative. However, elevated adenosine deaminase (ADA) activity in pericardial fluid and interferon-γ release assay positivity in both pericardial fluid and peripheral blood indicated the presence of tuberculous pericarditis. After anti-tuberculous and steroid treatment, the patient's clinical symptoms improved, and pericardial effusion has not reoccurred.
Figures and Tables
Fig. 2
T-SPOT TB results performed with cellular component of pericardial effusion. (A) Negative control (stimulated with medium alone). (B) Positive control (stimulated with phytohemagglutinin). (C) ESAT-6 (stimulated with MTB-specific peptides ESAT-6). (D) CFP-10 (stimulated with MTB-specific peptides CFP-10).
Table 1
Laboratory results at admission
Abbreviations: WBC, white blood cells; PMN, polymorphonuclear leukocytes; AST, aspartate aminotransferase; ALT, alanine aminotransferase; BUN, blood urea nitrogen; LD, lactate dehydrogenase; CK, creatine kinase; cTnI, cardiac troponin I; NT-proBNP, N-terminal probrain natriuretic peptide; RBC, red blood cells.
Table 2
Mycobacterium tuberculosis-specific interferon-γ release assay results
*Test results of QFT-GIT and T-SPOT TB were interpreted according to the manufacturers' guidelines.
Abbreviations: QFT-GIT, QuantiFERON-TB Gold in-tube (Cellestis, Carnegie, Australia); T-SPOT, T-SPOT TB (Oxford Immunotec, Abingdon, UK); ESAT-6, early secretory antigenic target 6; CFP-10, culture filtrate protein 10; SFU, spot forming unit; ISL, no. of IFN-γ secreting lymphocytes/106 lymphocytes in pericardial fluid.
References
1. Burgess LJ, Reuter H, Taljaard JJ, Doubell AF. Role of biochemical tests in the diagnosis of large pericardial effusions. Chest. 2002; 121:495–499.
2. Ortbals DW, Avioli LV. Tuberculous pericarditis. Arch Intern Med. 1979; 139:231–234.
3. Syed FF, Mayosi BM. A modern approach to tuberculous pericarditis. Prog Cardiovasc Dis. 2007; 50:218–236.
4. Mayosi BM, Wiysonge CS, Ntsekhe M, Volmink JA, Gumedze F, Maartens G, et al. Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry. BMC Infect Dis. 2006; 6:2.
5. Hageman JH, D Esopo ND, Glenn WW. Tuberculosis of the Pericardium. A Long-Term Analysis of Forty-Four Proved Cases. N Engl J Med. 1964; 270:327–332.
6. World Health Organization. Global tuberculosis report 2012. Geneva, Switzerland: WHO.
7. Jain S, Sharma N, Varma S, Rajwanshi A, Verma JS, Sharma BK. Profile of cardiac tamponade in the medical emergency ward of a North Indian hospital. Can J Cardiol. 1999; 15:671–675.
8. Quraishi Au, Khan AA, Kazmi KA, Najaf SM, Basir MN, Shafquat A, et al. Clinical and echocardiographic characteristics of patients with significant pericardial effusion requiring pericardiocentesis. J Pak Med Assoc. 2005; 55:66–70.
9. Reuter H, Burgess LJ, Doubell AF. Epidemiology of pericardial effusions at a large academic hospital in South Africa. Epidemiol Infect. 2005; 133:393–399.
10. Zayas R, Anguita M, Torres F, Giménez D, Bergillos F, Ruiz M, et al. Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol. 1995; 75:378–382.
11. Sagristá-Sauleda J, Permanyer-Miralda G, Soler-Soler J. Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment. J Am Coll Cardiol. 1988; 11:724–728.
12. Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis. Circulation. 2005; 112:3608–3616.
13. Fowler NO. Tuberculous pericarditis. JAMA. 1991; 266:99–103.
14. Strang G, Latouf S, Commerford P, Roditi D, Duncan-Traill G, Barlow D, et al. Bedside culture to confirm tuberculous pericarditis. Lancet. 1991; 338:1600–1601.
15. Komsuoğlu B, Göldelï O, Kulan K, Komsuoğlu SS. The diagnostic and prognostic value of adenosine deaminase in tuberculous pericarditis. Eur Heart J. 1995; 16:1126–1130.
16. Lee JH, Lee CW, Lee SG, Yang HS, Hong MK, Kim JJ, et al. Comparison of polymerase chain reaction with adenosine deaminase activity in pericardial fluid for the diagnosis of tuberculous pericarditis. Am J Med. 2002; 113:519–521.
17. Tuon FF, Litvoc MN, Lopes MI. Adenosine deaminase and tuberculous pericarditis--a systematic review with meta-analysis. Acta Trop. 2006; 99:67–74.
18. Burgess LJ, Reuter H, Carstens ME, Taljaard JJ, Doubell AF. The use of adenosine deaminase and interferon-gamma as diagnostic tools for tuberculous pericarditis. Chest. 2002; 122:900–905.
19. Jiménez Castro D, Díaz Nuevo G, Pérez-Rodríguez E, Light RW. Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions. Eur Respir J. 2003; 21:220–224.
20. Fan L, Chen Z, Hao XH, Hu ZY, Xiao HP. Interferon-gamma release assays for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis. FEMS Immunol Med Microbiol. 2012; 65:456–466.
21. Liao CH, Chou CH, Lai CC, Huang YT, Tan CK, Hsu HL, et al. Diagnostic performance of an enzyme-linked immunospot assay for interferon-gamma in extrapulmonary tuberculosis varies between different sites of disease. J Infect. 2009; 59:402–408.
22. Pai M, Riley LW, Colford JM Jr. Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis. 2004; 4:761–776.
23. Wilkinson KA, Wilkinson RJ, Pathan A, Ewer K, Prakash M, Klenerman P, et al. Ex vivo characterization of early secretory antigenic target 6-specific T cells at sites of active disease in pleural tuberculosis. Clin Infect Dis. 2005; 40:184–187.
24. Jafari C, Ernst M, Kalsdorf B, Greinert U, Diel R, Kirsten D, et al. Rapid diagnosis of smear-negative tuberculosis by bronchoalveolar lavage enzyme-linked immunospot. Am J Respir Crit Care Med. 2006; 174:1048–1054.
25. Kobashi Y, Abe M, Mouri K, Obase Y, Miyashita N, Oka M. Rapid diagnosis of tuberculous pericarditis by ELISPOT assay. Scand J Infect Dis. 2010; 42:712–715.
26. Biglino A, Crivelli P, Concialdi E, Bolla C, Montrucchio G. Clinical usefulness of ELISPOT assay on pericardial fluid in a case of suspected tuberculous pericarditis. Infection. 2008; 36:601–604.
27. Bathoorn E, Limburg A, Bouwman JJ, Bossink AW, Thijsen SF. Diagnostic potential of an enzyme-linked immunospot assay in tuberculous pericarditis. Clin Vaccine Immunol. 2011; 18:874–877.
XML Download