Tuberculous Pericarditis is Multibacillary and Bacterial Burden Drives High Mortality
| Autor: | Tawanda Gumbo, Shaheen Pandie, Mwenya Mubanga, Jotam G. Pasipanodya, Freedom Gumedze, Bongani M. Mayosi, Mpiko Ntsekhe, Landon Myer, Beki Themba Magazi |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Antitubercular Agents Human immunodeficiency virus (HIV) lcsh:Medicine Comorbidity medicine.disease_cause Pericardial Effusion General Biochemistry Genetics and Molecular Biology Young Adult Age Therapy failure Artificial Intelligence medicine Humans Registries Bacterial burden Aged lcsh:R5-920 business.industry Tuberculous pericarditis lcsh:R High mortality Sputum Follow up studies HIV Mycobacterium tuberculosis Pericarditis Tuberculous General Medicine Middle Aged medicine.disease Bacterial Load CD4 Lymphocyte Count 3. Good health Logistic Models CD4+ counts Family medicine Immunology Commentary Female lcsh:Medicine (General) business Follow-Up Studies |
| Zdroj: | EBioMedicine EBioMedicine, Vol 2, Iss 11, Pp 1634-1639 (2015) |
| ISSN: | 2352-3964 |
| Popis: | Background: Tuberculous pericarditis is considered to be a paucibacillary process; the large pericardial fluid accumulation is attributed to an inflammatory response to tuberculoproteins. Mortality rates are high. We investigated the role of clinical and microbial factors predictive of tuberculous pericarditis mortality using the artificial intelligence algorithm termed classification and regression tree (CART) analysis. Methods: Patients were prospectively enrolled and followed in the Investigation of the Management of Pericarditis (IMPI) registry. Clinical and laboratory data of 70 patients with confirmed tuberculous pericarditis, including time-to-positive (TTP) cultures from pericardial fluid, were extracted and analyzed for mortality outcomes using CART. TTP was translated to log10 colony forming units (CFUs) per mL, and compared to that obtained from sputum in some of our patients. Findings: Seventy patients with proven tuberculous pericarditis were enrolled. The median patient age was 35 (range: 20–71) years. The median, follow up was for 11.97 (range: 0·03–74.73) months. The median TTP for pericardial fluid cultures was 22 (range: 4–58) days or 3.91(range: 0·5–8·96) log10CFU/mL, which overlapped with the range of 3.24–7.42 log10CFU/mL encountered in sputum, a multi-bacillary disease. The overall mortality rate was 1.43 per 100 person-months. CART identified follow-up duration of 5·23 months on directly observed therapy, a CD4+ count of ≤199.5/mL, and TTP ≤ 14 days (bacillary load ≥ 5.53 log10 CFU/mL) as predictive of mortality. TTP interacted with follow-up duration in a non-linear fashion. Interpretation: Patients with culture confirmed tuberculous pericarditis have a high bacillary burden, and this bacterial burden drives mortality. Thus proven tuberculosis pericarditis is not a paucibacillary disease. Moreover, the severe immunosuppression suggests limited inflammation. There is a need for the design of a highly bactericidal regimen for this condition. |
| Databáze: | OpenAIRE |
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