Browsing by Author "Pandie, Shaheen"

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    Open Access
    Diagnostic accuracy of quantitative PCR (Xpert MTB/RIF) for tuberculous pericarditis compared to adenosine deaminase and unstimulated interferon-γ in a high burden setting: a prospective study
    (2014-06-18) Pandie, Shaheen; Peter, Jonathan G; Kerbelker, Zita S; Meldau, Richard; Theron, Grant; Govender, Ureshnie; Ntsekhe, Mpiko; Dheda, Keertan; Mayosi, Bongani M
    Background: Tuberculous pericarditis (TBP) is associated with high morbidity and mortality, and is an important treatable cause of heart failure in developing countries. Tuberculous aetiology of pericarditis is difficult to diagnose promptly. The utility of the new quantitative PCR test (Xpert MTB/RIF) for the diagnosis of TBP is unknown. This study sought to evaluate the diagnostic accuracy of the Xpert MTB/RIF test compared to pericardial adenosine deaminase (ADA) and unstimulated interferon-gamma (uIFNγ) in suspected TBP. Methods: From October 2009 through September 2012, 151 consecutive patients with suspected TBP were enrolled at a single centre in Cape Town, South Africa. Mycobacterium tuberculosis culture and/or pericardial histology served as the reference standard for definite TBP. Receiver-operating-characteristic curve analysis was used for selection of ADA and uIFNγ cut-points. Results: Of the participants, 49% (74/151) were classified as definite TBP, 33% (50/151) as probable TBP and 18% (27/151) as non TBP. A total of 105 (74%) participants were human immunodeficiency virus (HIV) positive. Xpert-MTB/RIF had a sensitivity and specificity (95% confidence interval (CI)) of 63.8% (52.4% to 75.1%) and 100% (85.6% to 100%), respectively. Concentration of pericardial fluid by centrifugation and using standard sample processing did not improve Xpert MTB/RIF accuracy. ADA (≥35 IU/L) and uIFNγ (≥44 pg/ml) both had a sensitivity of 95.7% (88.1% to 98.5%) and a negative likelihood ratio of 0.05 (0.02 to 0.10). However, the specificity and positive likelihood ratio of uIFNγ was higher than ADA (96.3% (81.7% to 99.3%) and 25.8 (3.6 to 183.4) versus 84% (65.4% to 93.6%) and 6.0 (3.7 to 9.8); P = 0.03) at an estimated background prevalence of TB of 30%. The sensitivity and negative predictive value of both uIFNγ and ADA were higher than Xpert-MT/RIF (P < 0.001). Conclusions: uIFNγ offers superior accuracy for the diagnosis of microbiologically confirmed TBP compared to the ADA assay and the Xpert MTB/RIF test.
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    Mycobacterium W immunotherapy for treating pulmonary tuberculosis : a systematic review
    (2011) Pandie, Shaheen; Mayosi, Bongani M
    Tuberculosis (TB) remains a major health problem in the developing world, accounting for approximately 2 million deaths per year. The search for appropriate and applicable therapies to reduce the burden of TB is essential. Mycobacterium w (M w) is a heat-killed immune-modulating vaccine designed to attenuate the effects of TB infection and reduce the time to sputum negativity, thereby improving cure rates and decreasing transmission rates.
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    The prevalence, determinants, natural history and impact of atrial fibrillation and atrial flutter in patients with tuberculosis pericarditis - insights from the IMPI trial
    (2016) Chishala, Chishala; Pandie, Shaheen; Gumedze, Freedom; Mayosi, Bongani M
    Tuberculosis is the most common cause of pericarditis in Africa. The dual human immunodeficiency virus (HIV)-tuberculosis epidemics are major contributors to the burden of extra-pulmonary tuberculosis, including tuberculous pericarditis. Mortality rates remain unacceptably high. Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. It is associated with increased cardiovascular mortality and morbidity, as well as complications related to thromboembolic disease and haemodynamic instability. Similarly, atrial flutter (AFL) is a common macro-reentry arrhythmia, often associated with AF and its complications. While there is a recognized association between atrial fibrillation and / or atrial flutter (AF/AFL) and tuberculous pericarditis, there are limited data regarding the prevalence, determinants, natural history, and outcomes of AF/AFL in tuberculous pericarditis. Hypothesis: In patients with tuberculous pericarditis, AF/AFL is common, and when compared to tuberculous pericarditis patients that are in sinus rhythm, is associated with increased morbidity and mortality. Aims In participants with tuberculous pericarditis enrolled into the Investigation of the Management of Pericarditis (IMPI) trial, we intend to: 1. Estimate the prevalence of AF/AFL 2. Describe the natural history of AF/AFL 3. Identify clinical, biochemical and, echocardiographic predictors of AF/AFL 4. Determine the clinical impact of AF/AFL.