WHO , 2022. Global Tuberculosis Report 2022. Geneva, Switzerland; World Health Organization. Available at: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022.
Sharma SK , Mohan A , Sharma A , Mitra DK , 2005. Miliary tuberculosis: new insights into an old disease. Lancet Infect Dis 5: 415–430.
Martinez L et al., 2022. Infant BCG vaccination and risk of pulmonary and extrapulmonary tuberculosis throughout the life course: a systematic review and individual participant data meta-analysis. Lancet Glob Health 10: e1307–e1316.
Steingart KR , Henry M , Laal S , Hopewell PC , Ramsay A , Menzies D , Cunningham J , Weldingh K , Pai M , 2007. A systematic review of commercial serological antibody detection tests for the diagnosis of extrapulmonary tuberculosis. Postgrad Med J 83: 705–712.
López-López JP , Posada-Martínez EL , Saldarriaga C , Wyss F , Ponte-Negretti CI , Alexander B , Miranda-Arboleda AF , Martínez-Sellés M , Baranchuk A ; Neglected Tropical Diseases, Other Infectious Diseases Affecting the Heart (the NET‐Heart Project) , 2021. Tuberculosis and the heart. J Am Heart Assoc 10: e019435.
Golzarian J , Cheng J , Giron F , Bilfinger TV , 1999. Tuberculous pseudoaneurysm of the descending thoracic aorta: successful treatment by surgical excision and primary repair. Tex Heart Inst J 26: 232–235.
Khera S , Kumar V , Ramamurthy R , Ramar P , 2020. Favourable outcome in a child with presumed tubercular pancarditis treated with empirical antitubercular therapy. BMJ Case Rep 13: e235125.
Mayosi BM , 2007. Contemporary trends in the epidemiology and management of cardiomyopathy and pericarditis in sub-Saharan Africa. Heart 93: 1176–1183.
Ntsekhe M , Wiysonge CS , Commerford PJ , Mayosi BM , 2012. The prevalence and outcome of effusive constrictive pericarditis: a systematic review of the literature. Cardiovasc J Afr 23: 281–285.
Awasthy N , Garg R , Goel A , Bhatia M , Radhakrishnan S , 2019. Ventricular arrhythmia: a feature of tubercular myocarditis. Ann Pediatr Cardiol 12: 53.
Michira BN , Alkizim FO , Matheka DM , 2015. Patterns and clinical manifestations of tuberculous myocarditis: a systematic review of cases. Pan Afr Med J 21: 118.
Spodick DH , 1956. Tuberculous pericarditis. Arch Intern Med 98: 737.
Choudhary N , Abera H , Naik RB , 2021. Tuberculosis presenting with acute myocarditis and systolic heart failure. Cureus 13: e13229.
Mayosi BM et al., 2006. 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 6: 2.
Gautam M , Sogunuru G , Subramanyam G , Viswanath R , 2012. Tuberculous myocarditis presenting as a refractory ventricular tachycardia of biventricular origin. J Coll Med Sci-Nepal 7: 60–66.
du Toit-Prinsloo L , Saayman G , 2016. “Death at the wheel” due to tuberculosis of the myocardium: a case report. Cardiovasc Pathol 25: 271–274.
Lancellotti P , Zamorano JL , Habib G , Badano LP , European Association of Cardiovascular Imaging (ed), 2017. The EACVI Textbook of Echocardiography, 2nd edition. Oxford, United Kingdom: Oxford University Press.
Adler Y et al., 2015. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J Case Rep 36: 2921–2964.
Trautner BW , Darouiche RO , 2001. Tuberculous pericarditis: optimal diagnosis and management. Clin Infect Dis 33: 954–961.
Dong A , Dong H , Wang Y , Cheng C , Zuo C , Lu J , 2013. 18F-FDG PET/CT in differentiating acute tuberculous from idiopathic pericarditis: preliminary study. Clin Nucl Med 38: e160–e165.
Dixit R , Chowdhury V , Singh S , 2009. Case report: myocardial tuberculosis-MRI. Indian J Radiol Imaging 19: 57–59.
Esmail H , Macpherson L , Coussens AK , Houben RMGJ , 2022. Mind the gap – managing tuberculosis across the disease spectrum. EBioMedicine 78: 103928.
Naidoo D , Laurence G , Sartorius B , Ponnusamy S , 2019. The effects of HIV/AIDS on the clinical profile and outcomes post pericardiectomy of patients with constrictive pericarditis: a retrospective review. Cardiovasc J Afr 30: 251–257.
Syed FF , Mayosi BM , 2007. A modern approach to tuberculous pericarditis. Prog Cardiovasc Dis 50: 218–236.
Moreno P , Lang G , Taghavi S , Aigner C , Marta G , De Palma A , Klepetko W , 2011. Right-sided approach for management of left-main-bronchial stump problems. Eur J Cardiothorac Surg 40: 926–930.
Loizzi M , De Palma A , Pagliarulo V , Loizzi D , Sollitto F , 2012. Pulmonary infections of surgical interest in childhood. Thorac Surg Clin 22: 387–401.
Yadav S , Shah S , Iqbal Z , Alharbi MG , Kalra HS , Suri M , Soni N , Okpaleke N , Hamid P , 2021. Pericardiectomy for constrictive tuberculous pericarditis: a systematic review and meta-analysis on the etiology, patients’ characteristics, and the outcomes. Cureus 13: e18252.
Amonkar G , Rupani A , Shah V , Parmar H , 2009. Sudden death in tuberculous myocarditis. Cardiovasc Pathol 18: 247–248.
Kumar P , Sharma S , Bisht D , Panwar R , 2020. Tuberculous dilated cardiomyopathy with myocarditis. Indian J Pediatr 87: 161.
Shi Y et al., 2022. Aortic involvement in disseminated tuberculosis – challenges beyond the diagnosis. Infect Drug Resist 15: 2633–2638.
Delaval L et al., 2017. New insights on tuberculous aortitis. J Vasc Surg 66: 209–215.
Xue J , Yao Y , Liu L , 2018. Treatment of tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis: a case series and a literature review. Medicine (Baltimore) 97: e0382.
Altoijry A , 2022. Tuberculous aortic aneurysm – a review. Rev Bras Cir Cardiovasc 37: 385–393.
Gamble N , Blair R , Gray S , Hunter M , Harkin D , 2022. Tuberculosis aortitis and mycotic pseudo-aneurysm of the infra-renal aorta after intravesicular BCG therapy. Ulster Med J 91: 92–94.
Palmier M , Monnot A , Tenière T , Cohen Q , Plissonnier D , 2022. Mycotic arterial aneurysm secondary to BCG intravesical instillation: a review. J Med Vasc 47: 94–105.
Raavi L , Garg P , Hussain MWA , Wadiwala IJ , Mateen NT , Elawady MS , Alomari M , Alamouti-Fard E , Pham SM , Jacob S , 2022. Mycotic thoracic aortic aneurysm: epidemiology, pathophysiology, diagnosis, and management. Cureus 14: e31010.
Yi S , Sheng L , Li W , 2022. Therapeutic effectiveness of tuberculous aneurysm and risk factors for mortality: a systematic review. Gen Thorac Cardiovasc Surg 70: 515–525.
Ikeda S , Shih M , Likourezos A , Flom P , Rhee RY , Youdelman BA , 2018. The treatment of tuberculous aortic pseudoaneurysm. J Card Surg 33: 840–852.
Marcu DTM , Adam CA , Mitu F , Cumpat C , Aursulesei Onofrei V , Zabara ML , Burlacu A , Crisan Dabija R , 2023. Cardiovascular involvement in tuberculosis: from pathophysiology to diagnosis and complications – a narrative review. Diagnostics (Basel) 13: 432.
Chung W-S , Lin C-L , Hung C-T , Chu Y-H , Sung F-C , Kao C-H , Yeh J-J , 2014. Tuberculosis increases the subsequent risk of acute coronary syndrome: a nationwide population-based cohort study. Int J Tuberc Lung Dis 18: 79–83.
Khoufi EAA , 2021. Association between latent tuberculosis and ischemic heart disease: a hospital-based cross-sectional study from Saudi Arabia. Pan Afr Med J 38: 362.
Barreto-Neto N , Segre AW , Guedes LKN , Seguro LPC , Pereira RMR , 2022. Resolution of coronary arteritis following tuberculosis treatment. J Clin Tuberc Other Mycobact Dis 26: 100295.
Chang S-A , 2017. Tuberculous and infectious pericarditis. Cardiol Clin 35: 615–622.
Sagristà-Sauleda J , Permanyer-Miralda G , Soler-Soler J , 1988. Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment. J Am Coll Cardiol 11: 724–728.
Onguema JRI , Raoul F , Marchais A , Amoura AA , Girodet B , Dacunka M , Chapoutot L , Maillier B , 2023. Fibrillation atriale symptomatique révélant une péricardite chronique constrictive chez un patient jeune: à propos d’un cas avec revue de la littérature. Ann Cardiol Angeiol (Paris) 72: 101594.
Adler Y et al., 2015. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 36: 2921–2964.
Gladych E , Goland S , Attali M , Somin M , Malnick SD , 2001. Cardiac tamponade as a manifestation of tuberculosis. South Med J 94: 525–528.
Imazio M , Gaita F , LeWinter M , 2015. Evaluation and treatment of pericarditis: a systematic review. JAMA 314: 1498.
Latifi Y , Gugelmann R , Rigger J , Preiswerk B , Eriksson U , Eberli FR , Bernheim AM , 2021. Effusive-constrictive pericarditis due to immune reconstitution inflammatory syndrome following tuberculous pericarditis. CASE (Phila) 5: 67–72.
Appleton C , Gillam L , Koulogiannis K , 2017. Cardiac tamponade. Cardiol Clin 35: 525–537.
Biedrzycki OJ , Baithun SI , 2006. TB-related sudden death (TBRSD) due to myocarditis complicating miliary TB: a case report and review of the literature. Am J Forensic Med Pathol 27: 335–336.
Estrera AS , Platt MR , Mills LJ , Nikaidoh N , 1979. Tuberculous aneurysms of the descending thoracic aorta. Chest 75: 386–388.
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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.
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.
WHO , 2022. Global Tuberculosis Report 2022. Geneva, Switzerland; World Health Organization. Available at: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022.
Sharma SK , Mohan A , Sharma A , Mitra DK , 2005. Miliary tuberculosis: new insights into an old disease. Lancet Infect Dis 5: 415–430.
Martinez L et al., 2022. Infant BCG vaccination and risk of pulmonary and extrapulmonary tuberculosis throughout the life course: a systematic review and individual participant data meta-analysis. Lancet Glob Health 10: e1307–e1316.
Steingart KR , Henry M , Laal S , Hopewell PC , Ramsay A , Menzies D , Cunningham J , Weldingh K , Pai M , 2007. A systematic review of commercial serological antibody detection tests for the diagnosis of extrapulmonary tuberculosis. Postgrad Med J 83: 705–712.
López-López JP , Posada-Martínez EL , Saldarriaga C , Wyss F , Ponte-Negretti CI , Alexander B , Miranda-Arboleda AF , Martínez-Sellés M , Baranchuk A ; Neglected Tropical Diseases, Other Infectious Diseases Affecting the Heart (the NET‐Heart Project) , 2021. Tuberculosis and the heart. J Am Heart Assoc 10: e019435.
Golzarian J , Cheng J , Giron F , Bilfinger TV , 1999. Tuberculous pseudoaneurysm of the descending thoracic aorta: successful treatment by surgical excision and primary repair. Tex Heart Inst J 26: 232–235.
Khera S , Kumar V , Ramamurthy R , Ramar P , 2020. Favourable outcome in a child with presumed tubercular pancarditis treated with empirical antitubercular therapy. BMJ Case Rep 13: e235125.
Mayosi BM , 2007. Contemporary trends in the epidemiology and management of cardiomyopathy and pericarditis in sub-Saharan Africa. Heart 93: 1176–1183.
Ntsekhe M , Wiysonge CS , Commerford PJ , Mayosi BM , 2012. The prevalence and outcome of effusive constrictive pericarditis: a systematic review of the literature. Cardiovasc J Afr 23: 281–285.
Awasthy N , Garg R , Goel A , Bhatia M , Radhakrishnan S , 2019. Ventricular arrhythmia: a feature of tubercular myocarditis. Ann Pediatr Cardiol 12: 53.
Michira BN , Alkizim FO , Matheka DM , 2015. Patterns and clinical manifestations of tuberculous myocarditis: a systematic review of cases. Pan Afr Med J 21: 118.
Spodick DH , 1956. Tuberculous pericarditis. Arch Intern Med 98: 737.
Choudhary N , Abera H , Naik RB , 2021. Tuberculosis presenting with acute myocarditis and systolic heart failure. Cureus 13: e13229.
Mayosi BM et al., 2006. 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 6: 2.
Gautam M , Sogunuru G , Subramanyam G , Viswanath R , 2012. Tuberculous myocarditis presenting as a refractory ventricular tachycardia of biventricular origin. J Coll Med Sci-Nepal 7: 60–66.
du Toit-Prinsloo L , Saayman G , 2016. “Death at the wheel” due to tuberculosis of the myocardium: a case report. Cardiovasc Pathol 25: 271–274.
Lancellotti P , Zamorano JL , Habib G , Badano LP , European Association of Cardiovascular Imaging (ed), 2017. The EACVI Textbook of Echocardiography, 2nd edition. Oxford, United Kingdom: Oxford University Press.
Adler Y et al., 2015. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J Case Rep 36: 2921–2964.
Trautner BW , Darouiche RO , 2001. Tuberculous pericarditis: optimal diagnosis and management. Clin Infect Dis 33: 954–961.
Dong A , Dong H , Wang Y , Cheng C , Zuo C , Lu J , 2013. 18F-FDG PET/CT in differentiating acute tuberculous from idiopathic pericarditis: preliminary study. Clin Nucl Med 38: e160–e165.
Dixit R , Chowdhury V , Singh S , 2009. Case report: myocardial tuberculosis-MRI. Indian J Radiol Imaging 19: 57–59.
Esmail H , Macpherson L , Coussens AK , Houben RMGJ , 2022. Mind the gap – managing tuberculosis across the disease spectrum. EBioMedicine 78: 103928.
Naidoo D , Laurence G , Sartorius B , Ponnusamy S , 2019. The effects of HIV/AIDS on the clinical profile and outcomes post pericardiectomy of patients with constrictive pericarditis: a retrospective review. Cardiovasc J Afr 30: 251–257.
Syed FF , Mayosi BM , 2007. A modern approach to tuberculous pericarditis. Prog Cardiovasc Dis 50: 218–236.
Moreno P , Lang G , Taghavi S , Aigner C , Marta G , De Palma A , Klepetko W , 2011. Right-sided approach for management of left-main-bronchial stump problems. Eur J Cardiothorac Surg 40: 926–930.
Loizzi M , De Palma A , Pagliarulo V , Loizzi D , Sollitto F , 2012. Pulmonary infections of surgical interest in childhood. Thorac Surg Clin 22: 387–401.
Yadav S , Shah S , Iqbal Z , Alharbi MG , Kalra HS , Suri M , Soni N , Okpaleke N , Hamid P , 2021. Pericardiectomy for constrictive tuberculous pericarditis: a systematic review and meta-analysis on the etiology, patients’ characteristics, and the outcomes. Cureus 13: e18252.
Amonkar G , Rupani A , Shah V , Parmar H , 2009. Sudden death in tuberculous myocarditis. Cardiovasc Pathol 18: 247–248.
Kumar P , Sharma S , Bisht D , Panwar R , 2020. Tuberculous dilated cardiomyopathy with myocarditis. Indian J Pediatr 87: 161.
Shi Y et al., 2022. Aortic involvement in disseminated tuberculosis – challenges beyond the diagnosis. Infect Drug Resist 15: 2633–2638.
Delaval L et al., 2017. New insights on tuberculous aortitis. J Vasc Surg 66: 209–215.
Xue J , Yao Y , Liu L , 2018. Treatment of tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis: a case series and a literature review. Medicine (Baltimore) 97: e0382.
Altoijry A , 2022. Tuberculous aortic aneurysm – a review. Rev Bras Cir Cardiovasc 37: 385–393.
Gamble N , Blair R , Gray S , Hunter M , Harkin D , 2022. Tuberculosis aortitis and mycotic pseudo-aneurysm of the infra-renal aorta after intravesicular BCG therapy. Ulster Med J 91: 92–94.
Palmier M , Monnot A , Tenière T , Cohen Q , Plissonnier D , 2022. Mycotic arterial aneurysm secondary to BCG intravesical instillation: a review. J Med Vasc 47: 94–105.
Raavi L , Garg P , Hussain MWA , Wadiwala IJ , Mateen NT , Elawady MS , Alomari M , Alamouti-Fard E , Pham SM , Jacob S , 2022. Mycotic thoracic aortic aneurysm: epidemiology, pathophysiology, diagnosis, and management. Cureus 14: e31010.
Yi S , Sheng L , Li W , 2022. Therapeutic effectiveness of tuberculous aneurysm and risk factors for mortality: a systematic review. Gen Thorac Cardiovasc Surg 70: 515–525.
Ikeda S , Shih M , Likourezos A , Flom P , Rhee RY , Youdelman BA , 2018. The treatment of tuberculous aortic pseudoaneurysm. J Card Surg 33: 840–852.
Marcu DTM , Adam CA , Mitu F , Cumpat C , Aursulesei Onofrei V , Zabara ML , Burlacu A , Crisan Dabija R , 2023. Cardiovascular involvement in tuberculosis: from pathophysiology to diagnosis and complications – a narrative review. Diagnostics (Basel) 13: 432.
Chung W-S , Lin C-L , Hung C-T , Chu Y-H , Sung F-C , Kao C-H , Yeh J-J , 2014. Tuberculosis increases the subsequent risk of acute coronary syndrome: a nationwide population-based cohort study. Int J Tuberc Lung Dis 18: 79–83.
Khoufi EAA , 2021. Association between latent tuberculosis and ischemic heart disease: a hospital-based cross-sectional study from Saudi Arabia. Pan Afr Med J 38: 362.
Barreto-Neto N , Segre AW , Guedes LKN , Seguro LPC , Pereira RMR , 2022. Resolution of coronary arteritis following tuberculosis treatment. J Clin Tuberc Other Mycobact Dis 26: 100295.
Chang S-A , 2017. Tuberculous and infectious pericarditis. Cardiol Clin 35: 615–622.
Sagristà-Sauleda J , Permanyer-Miralda G , Soler-Soler J , 1988. Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment. J Am Coll Cardiol 11: 724–728.
Onguema JRI , Raoul F , Marchais A , Amoura AA , Girodet B , Dacunka M , Chapoutot L , Maillier B , 2023. Fibrillation atriale symptomatique révélant une péricardite chronique constrictive chez un patient jeune: à propos d’un cas avec revue de la littérature. Ann Cardiol Angeiol (Paris) 72: 101594.
Adler Y et al., 2015. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 36: 2921–2964.
Gladych E , Goland S , Attali M , Somin M , Malnick SD , 2001. Cardiac tamponade as a manifestation of tuberculosis. South Med J 94: 525–528.
Imazio M , Gaita F , LeWinter M , 2015. Evaluation and treatment of pericarditis: a systematic review. JAMA 314: 1498.
Latifi Y , Gugelmann R , Rigger J , Preiswerk B , Eriksson U , Eberli FR , Bernheim AM , 2021. Effusive-constrictive pericarditis due to immune reconstitution inflammatory syndrome following tuberculous pericarditis. CASE (Phila) 5: 67–72.
Appleton C , Gillam L , Koulogiannis K , 2017. Cardiac tamponade. Cardiol Clin 35: 525–537.
Biedrzycki OJ , Baithun SI , 2006. TB-related sudden death (TBRSD) due to myocarditis complicating miliary TB: a case report and review of the literature. Am J Forensic Med Pathol 27: 335–336.
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