Key result
Histopathological evaluation of pericardial biopsies for tuberculous pericarditis yielded a sensitivity of 64% and specificity of 100%, with HIV co-infection decreasing test sensitivity.
Why the study?
Does HIV co-infection influence the diagnostic accuracy of histopathology for tuberculous pericarditis in patients with large pericardial effusions?
Observational (n=36)
No
Does HIV co-infection influence the diagnostic accuracy of histopathology for tuberculous pericarditis in patients with large pericardial effusions?
HIV co-infection decreases the sensitivity of pericardial biopsy histopathology for diagnosing tuberculous pericarditis, suggesting that a combination of clinical features, chest X-ray, and adenosine deaminase may be more efficient in high-prevalence areas.
HIV co-infection may reduce pericardial biopsy sensitivity; leaves open optimal diagnostic strategies in high-prevalence settings.
AIMS: To establish the influence of human immunodeficiency virus (HIV) infection on the histopathological features of patients presenting with tuberculous pericarditis. METHODS AND RESULTS: A prospective study was carried out at Tygerberg Academic Hospital, South Africa; 36 patients with large pericardial effusions had open pericardial biopsies under general anaesthesia and were included in the study. Patients underwent pericardiocentesis, followed by daily intermittent catheter drainage; a comprehensive diagnostic work-up (including histopathology of the pericardial tissue) was also performed. Histological tuberculous pericarditis was diagnosed according to predetermined criteria. Tuberculous pericarditis was identified in 25 patients, five of whom were HIV+. The presence of granulomatous inflammation (with or without necrosis) and/or Ziehl-Neelsen positivity yielded the best test results (sensitivity 64%, specificity 100% and diagnostic efficiency 75%). CONCLUSIONS: Co-infection with HIV impacts on the histopathological features of pericardial tuberculosis and leads to a decrease in the sensitivity of the test. In areas which have a high prevalence of tuberculosis, the combination of a sensitive test such as adenosine deaminase, chest X-ray and clinical features has a higher diagnostic efficiency than pericardial biopsy in diagnosing tuberculous pericarditis.
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Reuter et al. (2006) conducted an observational in Tuberculous pericardial effusions (n=36). Histopathology of pericardial tissue (pericardial biopsy) was evaluated on Diagnostic accuracy of granulomatous inflammation and/or Ziehl-Neelsen positivity (Sensitivity 64%, Specificity 100%). Histopathological evaluation of pericardial biopsies for tuberculous pericarditis yielded a sensitivity of 64% and specificity of 100%, with HIV co-infection decreasing test sensitivity.
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