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

 

Show simple item record

dc.contributor.author Mayosi, Bongani en_ZA
dc.contributor.author Wiysonge, Charles en_ZA
dc.contributor.author Ntsekhe, Mpiko en_ZA
dc.contributor.author Volmink, Jimmy en_ZA
dc.contributor.author Gumedze, Freedom en_ZA
dc.contributor.author Maartens, Gary en_ZA
dc.contributor.author Aje, Akinyemi en_ZA
dc.contributor.author Thomas, Baby en_ZA
dc.contributor.author Thomas, Kandathil en_ZA
dc.contributor.author Awotedu, Abolade en_ZA
dc.contributor.author Thembela, Bongani en_ZA
dc.contributor.author Mntla, Phindile en_ZA
dc.contributor.author Maritz, Frans en_ZA
dc.contributor.author Blackett, Kathleen en_ZA
dc.contributor.author Nkouonlack, en_ZA
dc.date.accessioned 2015-10-12T10:52:26Z
dc.date.available 2015-10-12T10:52:26Z
dc.date.issued 2006 en_ZA
dc.identifier.citation Mayosi, B. M., Wiysonge, C. S., Ntsekhe, M., Volmink, J. A., Gumedze, F., Maartens, G., ... & Commerford, P. J. (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 infectious diseases, 6(1), 2. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/14170
dc.identifier.uri http://dx.doi.org/10.1186/1471-2334-6-2
dc.description.abstract BACKGROUND:The incidence of tuberculous pericarditis has increased in Africa as a result of the human immunodeficiency virus (HIV) epidemic. However, the effect of HIV co-infection on clinical features and prognosis in tuberculous pericarditis is not well characterised. We have used baseline data of the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry to assess the impact of HIV co-infection on clinical presentation, diagnostic evaluation, and treatment of patients with suspected tuberculous pericarditis in sub-Saharan Africa. METHODS: Consecutive adult patients in 15 hospitals in three countries in sub-Saharan Africa were recruited on commencement of treatment for tuberculous pericarditis, following informed consent. We recorded demographic, clinical, diagnostic and therapeutic information at baseline, and have used the chi-square test and analysis of variance to assess probabilities of significant differences (in these variables) between groups defined by HIV status. RESULTS: A total of 185 patients were enrolled from 01 March 2004 to 31 October 2004, 147 (79.5%) of whom had effusive, 28 (15.1%) effusive-constrictive, and 10 (5.4%) constrictive or acute dry pericarditis. Seventy-four (40%) had clinical features of HIV infection. Patients with clinical HIV disease were more likely to present with dyspnoea (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.4 to 7.4, P = 0.005) and electrocardiographic features of myopericarditis (OR 2.8, 95% CI 1.1 to 6.9, P = 0.03). In addition to electrocardiographic features of myopericarditis, a positive HIV serological status was associated with greater cardiomegaly (OR 3.89, 95% CI 1.34 to 11.32, P = 0.01) and haemodynamic instability (OR 9.68, 95% CI 2.09 to 44.80, P = 0.0008). However, stage of pericardial disease at diagnosis and use of diagnostic tests were not related to clinical HIV status. Similar results were obtained for serological HIV status. Most patients were treated on clinical grounds, with microbiological evidence of tuberculosis obtained in only 13 (7.0%) patients. Adjunctive corticosteroids were used in 109 (58.9%) patients, with patients having clinical HIV disease less likely to be put on them (OR 0.37, 95% CI 0.20 to 0.68). Seven patients were on antiretroviral drugs. CONCLUSION: Patients with suspected tuberculous pericarditis and HIV infection in Africa have greater evidence of myopericarditis, dyspnoea, and haemodynamic instability. These findings, if confirmed in other studies, may suggest more intensive management of the cardiac disease is warranted in patients with HIV-associated pericardial disease. en_ZA
dc.language.iso eng en_ZA
dc.publisher BioMed Central Ltd en_ZA
dc.rights This is an Open Access article distributed under the terms of the Creative Commons Attribution License en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_ZA
dc.source BMC Infectious Diseases en_ZA
dc.source.uri http://www.biomedcentral.com/1471-2334 en_ZA
dc.subject.other Tuberculous pericarditis en_ZA
dc.subject.other HIV en_ZA
dc.title 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 en_ZA
dc.type Journal Article en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Cardiology en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Mayosi, B., Wiysonge, C., Ntsekhe, M., Volmink, J., Gumedze, F., Maartens, G., ... (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. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14170 en_ZA
dc.identifier.chicagocitation Mayosi, Bongani, Charles Wiysonge, Mpiko Ntsekhe, Jimmy Volmink, Freedom Gumedze, Gary Maartens, Akinyemi Aje, et al "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." <i>BMC Infectious Diseases</i> (2006) http://hdl.handle.net/11427/14170 en_ZA
dc.identifier.vancouvercitation Mayosi B, Wiysonge C, Ntsekhe M, Volmink J, Gumedze F, Maartens G, et al. 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 Infectious Diseases. 2006; http://hdl.handle.net/11427/14170. en_ZA
dc.identifier.ris TY - Journal Article AU - Mayosi, Bongani AU - Wiysonge, Charles AU - Ntsekhe, Mpiko AU - Volmink, Jimmy AU - Gumedze, Freedom AU - Maartens, Gary AU - Aje, Akinyemi AU - Thomas, Baby AU - Thomas, Kandathil AU - Awotedu, Abolade AU - Thembela, Bongani AU - Mntla, Phindile AU - Maritz, Frans AU - Blackett, Kathleen AU - Nkouonlack, AB - BACKGROUND:The incidence of tuberculous pericarditis has increased in Africa as a result of the human immunodeficiency virus (HIV) epidemic. However, the effect of HIV co-infection on clinical features and prognosis in tuberculous pericarditis is not well characterised. We have used baseline data of the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry to assess the impact of HIV co-infection on clinical presentation, diagnostic evaluation, and treatment of patients with suspected tuberculous pericarditis in sub-Saharan Africa. METHODS: Consecutive adult patients in 15 hospitals in three countries in sub-Saharan Africa were recruited on commencement of treatment for tuberculous pericarditis, following informed consent. We recorded demographic, clinical, diagnostic and therapeutic information at baseline, and have used the chi-square test and analysis of variance to assess probabilities of significant differences (in these variables) between groups defined by HIV status. RESULTS: A total of 185 patients were enrolled from 01 March 2004 to 31 October 2004, 147 (79.5%) of whom had effusive, 28 (15.1%) effusive-constrictive, and 10 (5.4%) constrictive or acute dry pericarditis. Seventy-four (40%) had clinical features of HIV infection. Patients with clinical HIV disease were more likely to present with dyspnoea (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.4 to 7.4, P = 0.005) and electrocardiographic features of myopericarditis (OR 2.8, 95% CI 1.1 to 6.9, P = 0.03). In addition to electrocardiographic features of myopericarditis, a positive HIV serological status was associated with greater cardiomegaly (OR 3.89, 95% CI 1.34 to 11.32, P = 0.01) and haemodynamic instability (OR 9.68, 95% CI 2.09 to 44.80, P = 0.0008). However, stage of pericardial disease at diagnosis and use of diagnostic tests were not related to clinical HIV status. Similar results were obtained for serological HIV status. Most patients were treated on clinical grounds, with microbiological evidence of tuberculosis obtained in only 13 (7.0%) patients. Adjunctive corticosteroids were used in 109 (58.9%) patients, with patients having clinical HIV disease less likely to be put on them (OR 0.37, 95% CI 0.20 to 0.68). Seven patients were on antiretroviral drugs. CONCLUSION: Patients with suspected tuberculous pericarditis and HIV infection in Africa have greater evidence of myopericarditis, dyspnoea, and haemodynamic instability. These findings, if confirmed in other studies, may suggest more intensive management of the cardiac disease is warranted in patients with HIV-associated pericardial disease. DA - 2006 DB - OpenUCT DO - 10.1186/1471-2334-6-2 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2006 T1 - 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 TI - 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 UR - http://hdl.handle.net/11427/14170 ER - en_ZA


Files in this item

This item appears in the following Collection(s)

Show simple item record

This is an Open Access article distributed under the terms of the Creative Commons Attribution License Except where otherwise noted, this item's license is described as This is an Open Access article distributed under the terms of the Creative Commons Attribution License