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

Simple item page
dc.contributor.authorMayosi, Bonganien_ZA
dc.contributor.authorWiysonge, Charlesen_ZA
dc.contributor.authorNtsekhe, Mpikoen_ZA
dc.contributor.authorVolmink, Jimmyen_ZA
dc.contributor.authorGumedze, Freedomen_ZA
dc.contributor.authorMaartens, Garyen_ZA
dc.contributor.authorAje, Akinyemien_ZA
dc.contributor.authorThomas, Babyen_ZA
dc.contributor.authorThomas, Kandathilen_ZA
dc.contributor.authorAwotedu, Aboladeen_ZA
dc.contributor.authorThembela, Bonganien_ZA
dc.contributor.authorMntla, Phindileen_ZA
dc.contributor.authorMaritz, Fransen_ZA
dc.contributor.authorBlackett, Kathleenen_ZA
dc.contributor.authorNkouonlack,en_ZA
dc.date.accessioned2015-10-12T10:52:26Z
dc.date.available2015-10-12T10:52:26Z
dc.date.issued2006en_ZA
dc.description.abstractBACKGROUND: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.identifier.apacitationMayosi, 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/11427/14170en_ZA
dc.identifier.chicagocitationMayosi, 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/11427/14170en_ZA
dc.identifier.citationMayosi, 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.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
dc.identifier.urihttp://hdl.handle.net/11427/14170
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-6-2
dc.identifier.vancouvercitationMayosi 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.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDivision of Cardiologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/1471-2334en_ZA
dc.subject.otherTuberculous pericarditisen_ZA
dc.subject.otherHIVen_ZA
dc.titleClinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registryen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Mayosi_Clinical_characteristics_tuberculous_pericarditis_2006.pdf
Size:
266.93 KB
Format:
Adobe Portable Document Format
Description:
Download
Collections
Journal Articles