Pneumologie 2009; 63 - P166
DOI: 10.1055/s-0029-1213943

Does tuberculous pericardial disease severity have distinct immunological features?

J Wolske 1, K van Veen 2, F Syed 2, J Russell 2, K Tibazarwa 2, M Ntsekhe 2, B Mayosi 2, R Wilkinson 2, C Lange 1, K Wilkinson 2
  • 1Research Center Borstel
  • 2IIDMM, UCT

Objective: The incidence of tuberculous pericarditis in Africa is rising which is believed to be a direct result of the HIV epidemic. Approximately 50% of patients presenting with tuberculous pericardial effusion in the Western Cape (South Africa) are co-infected with HIV. However pathophysiology of tuberculous pericarditis is still incompletely understood. In this study we sought to find immunological substrates of disease severity by relating clinical data with cytokine levels in the blood and pericardial fluid of patients with tuberculous pericarditis.

Methods: A prospective recruitment of 44 patients presenting with tuberculous pericardial effusions (PE) was carried out in Cape Town, South Africa. Concentrations of following cytokines in serum and cell free pericardial fluid were measured by Enzyme-linked immunosorbent assays: TNF, IFN-γ, IL-1β, IL-6, IL-10, IL-22 and TGF-β. Cytokine levels were correlated to clinical data indicative of ventricular dysfunction and pericardial disease severity such as ejection fraction, effusion size, right atrial pressure, degree of arterial paradox, E/A-ratio, NYHA-stage, opening pressure at pericardiocentesis and left ventricular shortening fraction (LVSF).

Results: Pro-inflammatory cytokines (IFN-γ, TNF, IL-1β IL-6 and IL-22) dominated the pericardial effusion whereas anti-inflammatory cytokines (TGF-β and IL-10) were elevated in serum. A higher concentration of TGF-β in serum and Il-6 in pericardial fluid of HIV infected patients was detected compared to HIV uninfected patients (p=0.0007, p=0.047 respectively). The IFN-γ concentration in pericardial fluid positively correlated with the size of the effusion (Spearman r=0.47, p=0.0024).

Discussion: Results of this study indicate an unchecked inflammatory reaction in the pericardial space that contributes to pathology. Whilst IFN-γ forms a crucial part of the protective response to tuberculosis, high levels appear to associate with more severe pericardial disease.