Interventions for treating tuberculous pericarditis

September 14, 2017, Liverpool School of Tropical Medicine

Researchers from South Africa and Canada have carried out a Cochrane review update to assess the safety and effectiveness of corticosteroids for treating tuberculous pericarditis.

Tuberculosis (TB) infection of the pericardium, the membrane around the heart, is not common but can restrict the function of the heart and is fatal in some cases. Current treatment involves doctors prescribing anti-TB drugs for six months, draining fluid from the pericardium or removing it in some situations, and in some cases are prescribed to reduce inflammation. However, there has been some concern that steroids have the potential to cause harm to patients with HIV, a common TB co-infection.

The review authors included seven trials, six looking at the use of corticosteroids and the other at different treatments. All trials were based in sub-Saharan Africa and included 1959 participants in total.

"Given the seriousness of TB pericarditis it was important that we were able to assess the effectiveness of using corticosteroids as a treatment," said Professor Charles Shey Wiysonge, Director of Cochrane South Africa and lead author of the review, "it was also especially important to look at their safety in cases of HIV coinfections, as there has previously been an impression that treatment could cause a rise in HIV-related cancers."

The review authors found that in people without HIV, corticosteroids drugs may reduce the number of people dying overall by 20 percent, as well as probably reducing deaths from pericarditis, although the confidence intervals include the possibility of both large beneficial effects and small increases in harm. The results also show that in HIV-positive patients, corticosteroids may reduce constriction of the pericardium membrane, but the confidence intervals include the possibility of both large beneficial effects and small increases in harm.

"This systematic review, which stratified patients into HIV-positive and HIV-negative participants and excluded those who received dual immunotherapy with corticosteroids and Mycobacterium indicus pranii, showed promising effects of corticosteroids on major outcomes but generally the confidence intervals include the possibility of both large beneficial effects and small increases in harm, and there was no evidence of an increase in cancer" added Professor Bongani Mayosi, senior author of the review and lead author of the largest trial carried out on this topic. The patients on a combination of corticosteroids and Mycobacterium indicus pranii were excluded from the analysis because of the possibility of an interaction between the two agents resulting in the increased incidence of cancer in this group.

Explore further: Updated Cochrane Review: Corticosteroids for managing tuberculous meningitis

More information: Charles S Wiysonge et al. Interventions for treating tuberculous pericarditis, Cochrane Database of Systematic Reviews (2017). DOI: 10.1002/14651858.CD000526.pub2

Related Stories

Updated Cochrane Review: Corticosteroids for managing tuberculous meningitis

May 3, 2016
The Cochrane Infectious Diseases Group (CIDG) have carried out a review update to evaluate the effects of corticosteroids being used alongside anti-tuberculosis medication to treat people suffering from tuberculous meningitis.

Old bones vulnerable to long-term use of oral corticosteroids

April 20, 2017
A review of data by University of South Australia researchers has found many older people taking oral corticosteroids long-term are not having the recommended bone density tests or fracture prevention therapy, leaving them ...

Inhaled steroids may increase pneumonia risk in people with asthma

April 20, 2017
Use of inhaled corticosteroids was linked with an increased risk of pneumonia in a study of individuals with asthma.

Review supports early multimodal Tx for infantile hemangioma

May 17, 2017
(HealthDay)—Early multimodality treatment seems to achieve best results for children with infantile hemangiomas of the nose, according to research published online May 11 in JAMA Facial Plastic Surgery.

Steroids may do more harm than good in some cases of severe asthma

July 6, 2017
Researchers from the University of Pittsburgh Schools of the Health Sciences and UPMC have uncovered the molecular mechanism underlying corticosteroid resistance in severe asthma. The new findings have important clinical ...

Asthma drugs suppress growth

July 16, 2014
Corticosteroid drugs that are given by inhalers to children with asthma may suppress their growth, evidence suggests. Two new systematic reviews published in The Cochrane Library focus on the effects of inhaled corticosteroid ...

Recommended for you

A synthetic approach to helping the immune system thwart infections

February 22, 2018
Yale researchers have developed a set of synthetic molecules that may help boost the strength of a key, virus-fighting protein.

Scientists find molecular link between Vitamin A derivative and mouse intestinal health

February 22, 2018
New research shows that all-trans-retinoic acid (atRA), the active form of vitamin A, regulates immune system responses in the mouse intestine by controlling expression of the protein HIC1 in cells known as innate lymphoid ...

Animal study shows how to retrain the immune system to ease food allergies

February 21, 2018
Treating food allergies might be a simple matter of teaching the immune system a new trick, researchers at Duke Health have found.

Preventive treatment for peanut allergies succeeds in study

February 20, 2018
The first treatment to help prevent serious allergic reactions to peanuts may be on the way. A company said Tuesday that its daily capsules of peanut powder helped children build tolerance in a major study.

'Icebreaker' protein opens genome for T cell development, researchers find

February 20, 2018
Almost all cells in the human body have identical DNA sequences, yet there are 200-plus cell types with different sizes, shapes, and chemical compositions. Determining what parts of the genome are read to make protein and ...

Infection site affects how a virus spreads through the body

February 20, 2018
A person is more likely to get infected by HIV through anal intercourse than vaginal, but no one knows quite why. A new study by scientists at the Gladstone Institutes shows that infection sites could affect the immune system's ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.