Tuberculous Pericarditis: A Complex Puzzle to Put Together

Pericardial disorders constitute a relatively common cause of heart research. Recently, two more interventions have been added to the disease accounting for 0.1–0.2% of all hospital admissions (Kytö et al., 2014; Lange and Hillis, 2004). From a clinical point of view pericardial syndromes encompass acute pericarditis (including relapses in the setting of recurrent forms), chronic constrictive pericarditis and isolated chronic pericardial effusion (Imazio and Adler, 2015). With specific respect to etiology, idiopathic and secondary forms are described, with the contribution of each form depending largely to the local epidemiology (Lazaros et al., 2009). Namely, in the Western world the great majority of acute pericarditis cases remain idiopathic (presumably viral), with secondary forms accounting for ~15–20% of the overall pericarditis cases (Imazio et al., 2010; Adler et al., 2015). On the contrary, in developing countries the most common etiology of acute pericarditis is tuberculous (TB) pericarditis. It represents 70–80% of cases in immunocompetent patients in certain regions such as subSaharan areas, rising to 90% in HIV-infected subjects (Imazio et al., 2010; Adler et al., 2015). The relevant percentage in the Western world is estimated at 4–5% (Imazio et al., 2010). From all of the above, it is clear that in the diagnostic work-up in pericarditis cases, the local epidemiology should be strongly considered. However, in the specific context of TB, in recent years the high rates of immigration from regions with high prevalence towards Western Europe and North America, may alter local trends in acute pericarditis etiology, a circumstance that physicians should be aware of (Imazio et al., 2010). TB pericarditis is a particular form of pericarditis for several reasons. First, regarding prognosis, it is associated with a high short-term mortality rates which approximates 16–40% in 6-month time period, a rate which only in malignant pericardial disease may be recorded (Mayosi et al., 2008; Lazaros and Stefanadis, 2013). Second, TB pericarditis is among the forms of pericarditis with the fastest evolution towards constrictive or effusive-constrictive forms. The rate of progression is 50% without treatment and it has been reduced to 17–40% upon the introduction of effective TB chemotherapy, including rifampicinbased treatment (Mayosi et al., 2008). Third, the most effective treatment of TB pericarditis is still a subject of controversy and intensive