Tuberculous Pericarditis: Understanding the Differences Between Acute and Chronic Forms

Tuberculous pericarditis presents a significant challenge in clinical diagnosis and requires prolonged treatment. It can manifest in two primary forms: acute and chronic. Each has distinct characteristics and symptoms that help differentiate them.

Acute Tuberculous Pericarditis

Acute tuberculous pericarditis typically presents with more pronounced and sudden symptoms. Common clinical signs include high fever, sharp chest pain, and difficulty breathing. During a physical examination, tachycardia (rapid heartbeat) may be observed, and in cases with minimal pericardial effusion, a pericardial friction rub can often be heard using a stethoscope. Laboratory tests may reveal elevated white blood cell counts, a significantly increased erythrocyte sedimentation rate (ESR), and higher C-reactive protein (CRP) levels. Some patients may also experience mild liver or kidney dysfunction.

Chronic Tuberculous Pericarditis

Chronic tuberculous pericarditis is characterized by persistent or recurrent pericardial effusion. Symptoms tend to develop gradually and may include shortness of breath, fatigue, and progressive difficulty in breathing. In more severe cases, patients may develop swelling in the lower extremities or even generalized edema due to fluid retention. Unlike the acute form, the chronic variant may lead to long-term complications such as constrictive pericarditis if not managed properly.

Key Considerations for Diagnosis and Treatment

Accurate differentiation between acute and chronic tuberculous pericarditis is crucial for effective management. While both forms require extended anti-tuberculosis therapy, acute cases often demand more aggressive symptomatic and supportive care. Chronic cases, on the other hand, may require monitoring for signs of cardiac constriction and possible surgical intervention if complications arise. Early diagnosis and tailored treatment strategies are essential for improving patient outcomes.