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Cardiac Tuberculosis: A Case Series from Ethiopia, Italy, and Uganda and a Literature Review
Sergio Cotugno
Sergio Cotugno
Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;
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Giacomo Guido
Giacomo Guido
Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;
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Giorgia Manco Cesari
Giorgia Manco Cesari
Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;
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Jerry Ictho
Jerry Ictho
Doctors with Africa CUAMM, Kampala, Uganda;
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Peter Lochoro
Peter Lochoro
Doctors with Africa CUAMM, Kampala, Uganda;
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James Amone
James Amone
St. John’s XXIII Hospital Aber, Jaber, Uganda;
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Francesco Vladimiro Segala
Francesco Vladimiro Segala
Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;
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Elda De Vita
Elda De Vita
Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;
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Rossana Lattanzio
Rossana Lattanzio
Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;
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Samuel Okori
Samuel Okori
St. John’s XXIII Hospital Aber, Jaber, Uganda;
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Giuseppina De Iaco
Giuseppina De Iaco
Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;
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Adisu Girma
Adisu Girma
Doctors with Africa CUAMM, Wolisso, Ethiopia;
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Abata Sura
Abata Sura
Doctors with Africa CUAMM, Wolisso, Ethiopia;
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Eriballo Tariku Hessebo
Eriballo Tariku Hessebo
Doctors with Africa CUAMM, Wolisso, Ethiopia;
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Franco Balsemin
Franco Balsemin
Doctors with Africa CUAMM, Wolisso, Ethiopia;
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Giovanni Putoto
Giovanni Putoto
Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy;
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Luigi Ronga
Luigi Ronga
Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
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Fabio Manenti
Fabio Manenti
Doctors with Africa CUAMM, Wolisso, Ethiopia;
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Enzo Facci
Enzo Facci
Doctors with Africa CUAMM, Wolisso, Ethiopia;
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Annalisa Saracino
Annalisa Saracino
Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;
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Francesco Di Gennaro
Francesco Di Gennaro
Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy;
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ABSTRACT.
Extrapulmonary tuberculosis (TB) is estimated to account for up to 20% of active cases of TB disease, but its prevalence is difficult to ascertain because of the difficulty of diagnosis. Involvement of the heart is uncommon, with constrictive pericarditis being the most common cardiac manifestation. Diagnostic research for cardiac disease is frequently lacking, resulting in a high mortality rate. In addition to direct cardiac involvement, instances of cardiac events during antitubercular therapy are described. This case series describes five cases of TB affecting the heart (cardiac TB) from Italy and high-burden, low-income countries (Ethiopia and Uganda), including a case of Loeffler syndrome manifesting as myocarditis in a patient receiving antitubercular therapy. Our study emphasizes how cardiac TB, rare but important in high-burden areas, is a leading cause of pericardial effusion or pericarditis. Timely diagnosis and a comprehensive approach, including imaging and microbiological tools, are crucial. Implementing high-sensitivity methods and investigating alternative samples, such as detection of tuberculosis lipoarabinomannan or use of the GeneXpert assay with stool, is recommended in TB control programs.
Author Notes
Authors’ addresses: Sergio Cotugno, Giacomo Guido, Giorgia Manco Cesari, Francesco Vladimiro Segala, Elda De Vita, Rossana Lattanzio, Giuseppina De Iaco, Annalisa Saracino, and Francesco Di Gennaro, Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy, E-mails: sergiocotugno@gmail.com, giacguido@gmail.com, mancocesarigiorgia@gmail.com, fvsegala@gmail.com, devitaelda@gmail.com, rossana.lattanzio@gmail.com, giusideiaco@gmail.com, annalisa.saracino@uniba.it, and francesco.digennaro1@uniba.it. Jerry Ictho and Peter Lochoro, Doctors with Africa CUAMM, Kampala, Uganda, E-mails: j.ictho@cuamm.org and p.lochoro@cuamm.org. James Amone and Samuel Okori, St. John’s XXIII Hospital Aber, Jaber, Uganda, E-mails: jamnet5@gmail.com and drokori@gmail.com. Adisu Girma, Abata Sura, Eriballo Tariku Hessebo, Franco Balsemin, Fabio Manenti, and Enzo Facci, Doctors with Africa CUAMM, Wolisso, Ethiopia, E-mails: girmaadisu21@gmail.com, abatasura@gmail.com, hessebotariku7@gmail.com, f.balsemin@cuamm.org, f.manenti@cuamm.org, and e.facci@cuamm.org. Giovanni Putoto, Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy, E-mail: g.putoto@cuamm.org. Luigi Ronga, Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy, E-mail: rongalu@yahoo.it.
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-
1.
WHO , 2022. Global Tuberculosis Report 2022. Geneva, Switzerland; World Health Organization. Available at: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022.
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2.
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3.
Martinez L et al., 2022. Infant BCG vaccination and risk of pulmonary and extrapulmonary tuberculosis throughout the life course: a systematic review and individual participant data meta-analysis. Lancet Glob Health 10: e1307–e1316.
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4.
Steingart KR , Henry M , Laal S , Hopewell PC , Ramsay A , Menzies D , Cunningham J , Weldingh K , Pai M , 2007. A systematic review of commercial serological antibody detection tests for the diagnosis of extrapulmonary tuberculosis. Postgrad Med J 83: 705–712.
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