Cardiac Tuberculosis: A Case Series from Ethiopia, Italy, and Uganda and a Literature Review

Sergio Cotugno Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;

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Giacomo Guido Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;

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Giorgia Manco Cesari Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;

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Jerry Ictho Doctors with Africa CUAMM, Kampala, Uganda;

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Peter Lochoro Doctors with Africa CUAMM, Kampala, Uganda;

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James Amone St. John’s XXIII Hospital Aber, Jaber, Uganda;

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Francesco Vladimiro Segala Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;

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Elda De Vita Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;

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Rossana Lattanzio Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;

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Samuel Okori St. John’s XXIII Hospital Aber, Jaber, Uganda;

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Giuseppina De Iaco Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;

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Adisu Girma Doctors with Africa CUAMM, Wolisso, Ethiopia;

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Abata Sura Doctors with Africa CUAMM, Wolisso, Ethiopia;

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Eriballo Tariku Hessebo Doctors with Africa CUAMM, Wolisso, Ethiopia;

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Franco Balsemin Doctors with Africa CUAMM, Wolisso, Ethiopia;

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Giovanni Putoto Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy;

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Luigi Ronga Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy

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Fabio Manenti Doctors with Africa CUAMM, Wolisso, Ethiopia;

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Enzo Facci Doctors with Africa CUAMM, Wolisso, Ethiopia;

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Annalisa Saracino Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;

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Francesco Di Gennaro Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;

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ABSTRACT.

Extrapulmonary tuberculosis (TB) is estimated to account for up to 20% of active cases of TB disease, but its prevalence is difficult to ascertain because of the difficulty of diagnosis. Involvement of the heart is uncommon, with constrictive pericarditis being the most common cardiac manifestation. Diagnostic research for cardiac disease is frequently lacking, resulting in a high mortality rate. In addition to direct cardiac involvement, instances of cardiac events during antitubercular therapy are described. This case series describes five cases of TB affecting the heart (cardiac TB) from Italy and high-burden, low-income countries (Ethiopia and Uganda), including a case of Loeffler syndrome manifesting as myocarditis in a patient receiving antitubercular therapy. Our study emphasizes how cardiac TB, rare but important in high-burden areas, is a leading cause of pericardial effusion or pericarditis. Timely diagnosis and a comprehensive approach, including imaging and microbiological tools, are crucial. Implementing high-sensitivity methods and investigating alternative samples, such as detection of tuberculosis lipoarabinomannan or use of the GeneXpert assay with stool, is recommended in TB control programs.

Author Notes

Authors’ addresses: Sergio Cotugno, Giacomo Guido, Giorgia Manco Cesari, Francesco Vladimiro Segala, Elda De Vita, Rossana Lattanzio, Giuseppina De Iaco, Annalisa Saracino, and Francesco Di Gennaro, Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy, E-mails: sergiocotugno@gmail.com, giacguido@gmail.com, mancocesarigiorgia@gmail.com, fvsegala@gmail.com, devitaelda@gmail.com, rossana.lattanzio@gmail.com, giusideiaco@gmail.com, annalisa.saracino@uniba.it, and francesco.digennaro1@uniba.it. Jerry Ictho and Peter Lochoro, Doctors with Africa CUAMM, Kampala, Uganda, E-mails: j.ictho@cuamm.org and p.lochoro@cuamm.org. James Amone and Samuel Okori, St. John’s XXIII Hospital Aber, Jaber, Uganda, E-mails: jamnet5@gmail.com and drokori@gmail.com. Adisu Girma, Abata Sura, Eriballo Tariku Hessebo, Franco Balsemin, Fabio Manenti, and Enzo Facci, Doctors with Africa CUAMM, Wolisso, Ethiopia, E-mails: girmaadisu21@gmail.com, abatasura@gmail.com, hessebotariku7@gmail.com, f.balsemin@cuamm.org, f.manenti@cuamm.org, and e.facci@cuamm.org. Giovanni Putoto, Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy, E-mail: g.putoto@cuamm.org. Luigi Ronga, Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy, E-mail: rongalu@yahoo.it.

Address correspondence to Giacomo Guido, Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy. E-mail: giacguido@gmail.com
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