Objective: Tuberculous pericarditis accounts for 60% of all cases of pericarditis in Africa.
We aimed to correlate pericardial disease severity with cytokine expression from blood
and pericardial fluid in patients with tuberculous pericarditis.
Methods: 44 patients presenting with tuberculous pericardial effusions (PE) were prospectively
recruited in Cape Town, Rep South Africa. Enzyme-linked immunosorbent assays were
performed on PE and serum samples for the following cytokines: TNF, IFN-γ, IL-10,
IL-1β, and TGF-β. Correlations were ascertained between PE and serum cytokine levels
and clinical data indicative of ventricular dysfunction and pericardial disease severity
such as ejection fraction, NYHA-stage, right atrial pressure, effusion size, degree
of arterial paradox, E/A-ratio, opening pressure at pericardiocentesis and left ventricular
shortening fraction (LVSF).
Results: Levels of the pro-inflammatory cytokines (IFN-γ, TNF, IL-1β) were higher in PE compared
to serum while levels of the anti-inflammatory cytokines (TGF-β and IL-10) were higher
in serum than in PE. The serum concentration of TGF-β was higher in HIV infected patients
compared to HIV uninfected patients (p=0.0007). There was a positive correlation between
the pericardial IFN-γ level and PE size, atrial pressure and degree of arterial paradox.
Of these the strongest correlation was with effusion size (Spearman r=0.47, p=0.0024).
Discussion: In tuberculous pericarditis the magnitude of the TH1-type immune response against
Mycobacterium tuberculosis is associated with the severity of the clinical pericardial
disease.
