HIV induced pericarditis pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD [2]

Overview

Pericardial effusion is common among asymptomatic HIV positive patients, it may cause large tamponade. Heart involvement is one of the most co-morbidity of HIV patients because. Since the improvement of anti retro viral therapies, other causes of AIDS mortality have decreased, and pericarditis began to be the leading cause.

Pathophysiology

Pathogenesis

Pericardial effusion is common among asymptomatic HIV positive patients.
Large effusions causing tamponade is rare.^[1]
HAART therapy regimen of HIV positive patients has decreased the incidence of pericarditis and pericardial effusion considerably.
HIV related pericarditis is usually caused by tuberculosis.^[2]
associated myocarditis is present in approximately one -third of cases.
It has high mortality.^[3]
pericardiocentesis is essential in order to a diagnosis of the main cause of pericardial effusion^[4]^[5].
However, majority of the cases of pericarditis are of unknown etiology. Other causes of pericarditis in AIDS include ^[6]^[7]^[8]^[9]:
- Staphylococcal infection
- Streptococcal infection
- Lymphoma
- Kaposi sarcoma
- Atypical mycobacteria
- Nocardia asteroides
- Listeria monocytogenes
- Rhodococcus equi
- Chlamydia trachomatis
- Rarely Cryptococcus, and Aspergillus

a) tuberculoma in the left atrium (black arrow); b numerous small foci of granulomatous inflammation diffusely scattered thorough the liver; c) numerous subcapsular small foci of granulomatous inflammation in the kidney (black arrow), note irregular shape of the organ^[10]

Bread and butter appearance upon opening the pericardium. The “bread and butter” appearance seen upon separating the visceral and parietal surfaces of the pericardium during surgery is typical for fibrinous pericarditis.^[11]

Microscopic Pathology

On microscopic histopathological analysis, acid fast bacilli is a characteristic findings of tuberculous pericarditis.

(A) A pink, amorphous meshwork of threads admixed with degenerated red blood cells and leukocytes (H&E stain, × 400). (B) Numerous acid-fast bacilli (Ziehl-Neelsen stain, × 1,000)^[12]

Kaposi’s sarcoma induced pericarditis is defined if the pathology exists in organs as described below:(pericarditis may be the first manifestation)

Elongated spindle cells are separated by slits containing red blood cells in lymph node with Kaposi’s sarcoma (hematoxylin and eosin stain, ×200) (a), anti-HHV-8 antibody immunostaining positivity detected in the lymph node (×400) (b).^[13]

References

↑ Remick, Joshua; Georgiopoulou, Vasiliki; Marti, Catherine; Ofotokun, Igho; Kalogeropoulos, Andreas; Lewis, William; Butler, Javed (2014). “Heart Failure in Patients With Human Immunodeficiency Virus Infection”. Circulation. 129 (17): 1781–1789. doi:10.1161/CIRCULATIONAHA.113.004574. ISSN 0009-7322.
↑ Moreno, Raùl; Villacastín, Julián P; Bueno, Héctor; López de Sá, Esteban; López-Sendón, José L; Bobadilla, Jaime F; García-Fernández, Miguel A; Delcán, Juan L. (1997). “Clinical and Echocardiographic Findings in HIV Patients with Pericardial Effusion”. Cardiology. 88 (5): 397–400. doi:10.1159/000177367. ISSN 1421-9751.
↑ Sudano, Isabella; Spieker, Lukas E.; Noll, Georg; Corti, Roberto; Weber, Rainer; Lüscher, Thomas F. (2006). “Cardiovascular disease in HIV infection”. American Heart Journal. 151 (6): 1147–1155. doi:10.1016/j.ahj.2005.07.030. ISSN 0002-8703.
↑ Maher D, Harries AD (1997). “Tuberculous pericardial effusion: a prospective clinical study in a low-resource setting–Blantyre, Malawi”. The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union against Tuberculosis and Lung Disease. 1 (4): 358–64. PMID 9432393. Unknown parameter |month= ignored (help)
↑ Dronda F, Suzacq C (1997). “[Pericardial tuberculosis complicated with heart tamponade as presentation form of acquired immunodeficiency syndrome]”. Revista Clínica Española (in Spanish; Castilian). 197 (7): 502–6. PMID 9411548. Unknown parameter |month= ignored (help)
↑ Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999). “Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature”. American Heart Journal. 137 (3): 516–21. PMID 10047635. Unknown parameter |month= ignored (help)
↑ Flum DR, McGinn JT, Tyras DH (1995). “The role of the ‘pericardial window’ in AIDS”. Chest. 107 (6): 1522–5. PMID 7781340. Unknown parameter |month= ignored (help)
↑ Gouny P, Lancelin C, Girard PM, Hocquet-Cheynel C, Rozenbaum W, Nussaume O (1998). “Pericardial effusion and AIDS: benefits of surgical drainage”. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 13 (2): 165–9. PMID 9583822. Unknown parameter |month= ignored (help)
↑ Eisenberg MJ, Gordon AS, Schiller NB (1992). “HIV-associated pericardial effusions”. Chest. 102 (3): 956–8. PMID 1516433. Unknown parameter |month= ignored (help)
↑ Szaluś-Jordanow, Olga; Augustynowicz-Kopeć, Ewa; Czopowicz, Michał; Olkowski, Arkadiusz; Łobaczewski, Andrzej; Rzewuska, Magdalena; Sapierzyński, Rafał; Wiatr, Elżbieta; Garncarz, Magdalena; Frymus, Tadeusz (2016). “Intracardiac tuberculomas caused by Mycobacterium tuberculosis in a dog”. BMC Veterinary Research. 12 (1). doi:10.1186/s12917-016-0731-7. ISSN 1746-6148.
↑ Woudstra, Odilia I.; Boink, Gerard J. J.; Winkelman, Jacobus A.; van Stralen, Ron (2016). “A Rare Case of Primary Meningococcal Myopericarditis in a 71-Year-Old Male”. Case Reports in Cardiology. 2016: 1–3. doi:10.1155/2016/1297869. ISSN 2090-6404.
↑ Yoon, Shin-Ae; Hahn, Youn-Soo; Hong, Jong Myeon; Lee, Ok-Jun; Han, Heon-Seok (2012). “Tuberculous Pericarditis Presenting as Multiple Free Floating Masses in Pericardial Effusion”. Journal of Korean Medical Science. 27 (3): 325. doi:10.3346/jkms.2012.27.3.325. ISSN 1011-8934.
↑ Aydin, Seniz Ongoren; Eskazan, Ahmet Emre; Aki, Hilal; Ozguroglu, Mustafa; Baslar, Zafer; Soysal, Teoman (2011). “Synchronous Detection of Hairy Cell Leukemia and HIV-Negative Kaposi’s Sarcoma of the Lymph Node: A Diagnostic Challenge and a Rare Coincidence”. Case Reports in Oncology. 4 (3): 439–444. doi:10.1159/000331894. ISSN 1662-6575.

Template:WH Template:WS

[RemickGeorgiopoulou2014-1] Remick, Joshua; Georgiopoulou, Vasiliki; Marti, Catherine; Ofotokun, Igho; Kalogeropoulos, Andreas; Lewis, William; Butler, Javed (2014). “Heart Failure in Patients With Human Immunodeficiency Virus Infection”. Circulation. 129 (17): 1781–1789. doi:10.1161/CIRCULATIONAHA.113.004574. ISSN 0009-7322.

[MorenoVillacastín1997-2] Moreno, Raùl; Villacastín, Julián P; Bueno, Héctor; López de Sá, Esteban; López-Sendón, José L; Bobadilla, Jaime F; García-Fernández, Miguel A; Delcán, Juan L. (1997). “Clinical and Echocardiographic Findings in HIV Patients with Pericardial Effusion”. Cardiology. 88 (5): 397–400. doi:10.1159/000177367. ISSN 1421-9751.

[SudanoSpieker2006-3] Sudano, Isabella; Spieker, Lukas E.; Noll, Georg; Corti, Roberto; Weber, Rainer; Lüscher, Thomas F. (2006). “Cardiovascular disease in HIV infection”. American Heart Journal. 151 (6): 1147–1155. doi:10.1016/j.ahj.2005.07.030. ISSN 0002-8703.

[pmid9432393-4] Maher D, Harries AD (1997). “Tuberculous pericardial effusion: a prospective clinical study in a low-resource setting–Blantyre, Malawi”. The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union against Tuberculosis and Lung Disease. 1 (4): 358–64. PMID 9432393. Unknown parameter |month= ignored (help)

[pmid9411548-5] Dronda F, Suzacq C (1997). “[Pericardial tuberculosis complicated with heart tamponade as presentation form of acquired immunodeficiency syndrome]”. Revista Clínica Española (in Spanish; Castilian). 197 (7): 502–6. PMID 9411548. Unknown parameter |month= ignored (help)

[pmid10047635-6] Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999). “Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature”. American Heart Journal. 137 (3): 516–21. PMID 10047635. Unknown parameter |month= ignored (help)

[pmid7781340-7] Flum DR, McGinn JT, Tyras DH (1995). “The role of the ‘pericardial window’ in AIDS”. Chest. 107 (6): 1522–5. PMID 7781340. Unknown parameter |month= ignored (help)

[pmid9583822-8] Gouny P, Lancelin C, Girard PM, Hocquet-Cheynel C, Rozenbaum W, Nussaume O (1998). “Pericardial effusion and AIDS: benefits of surgical drainage”. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 13 (2): 165–9. PMID 9583822. Unknown parameter |month= ignored (help)

[pmid1516433-9] Eisenberg MJ, Gordon AS, Schiller NB (1992). “HIV-associated pericardial effusions”. Chest. 102 (3): 956–8. PMID 1516433. Unknown parameter |month= ignored (help)

[Szaluś-JordanowAugustynowicz-Kopeć2016-10] Szaluś-Jordanow, Olga; Augustynowicz-Kopeć, Ewa; Czopowicz, Michał; Olkowski, Arkadiusz; Łobaczewski, Andrzej; Rzewuska, Magdalena; Sapierzyński, Rafał; Wiatr, Elżbieta; Garncarz, Magdalena; Frymus, Tadeusz (2016). “Intracardiac tuberculomas caused by Mycobacterium tuberculosis in a dog”. BMC Veterinary Research. 12 (1). doi:10.1186/s12917-016-0731-7. ISSN 1746-6148.

[WoudstraBoink2016-11] Woudstra, Odilia I.; Boink, Gerard J. J.; Winkelman, Jacobus A.; van Stralen, Ron (2016). “A Rare Case of Primary Meningococcal Myopericarditis in a 71-Year-Old Male”. Case Reports in Cardiology. 2016: 1–3. doi:10.1155/2016/1297869. ISSN 2090-6404.

[YoonHahn2012-12] Yoon, Shin-Ae; Hahn, Youn-Soo; Hong, Jong Myeon; Lee, Ok-Jun; Han, Heon-Seok (2012). “Tuberculous Pericarditis Presenting as Multiple Free Floating Masses in Pericardial Effusion”. Journal of Korean Medical Science. 27 (3): 325. doi:10.3346/jkms.2012.27.3.325. ISSN 1011-8934.

[AydinEskazan2011-13] Aydin, Seniz Ongoren; Eskazan, Ahmet Emre; Aki, Hilal; Ozguroglu, Mustafa; Baslar, Zafer; Soysal, Teoman (2011). “Synchronous Detection of Hairy Cell Leukemia and HIV-Negative Kaposi’s Sarcoma of the Lymph Node: A Diagnostic Challenge and a Rare Coincidence”. Case Reports in Oncology. 4 (3): 439–444. doi:10.1159/000331894. ISSN 1662-6575.

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