Evidence map›Paper›PMID 26870789›Full record

ArticleEBioMedicine2015

Tuberculous Pericarditis is Multibacillary and Bacterial Burden Drives High Mortality.

Jotam G Pasipanodya, Mwenya Mubanga, Mpiko Ntsekhe, Shaheen Pandie, Beki T Magazi, Freedom Gumedze, Landon Myer, Tawanda Gumbo, Bongani M Mayosi

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EBioMedicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 3 pooled it
3.0field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 3 syntheses or guidelines pooled it, 59 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Interventions for treating tuberculous pericarditis.The Cochrane database of systematic reviews · 2017
    Pooled it
  4. Artificial intelligence-derived 3-Way Concentration-dependent Antagonism of Gatifloxacin, Pyrazinamide, and Rifampicin During Treatment of Pulmonary Tuberculosis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018
    Trial
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  12. Observational
  13. Review
  14. Review
  15. Corticosteroids as an adjunct to tuberculosis therapy.Expert review of respiratory medicine · 2018
    Review
  16. Tuberculosis Associated with HIV Infection.Microbiology spectrum · 2017
    Review
  17. A Faropenem, Linezolid, and Moxifloxacin Regimen for Both Drug-Susceptible and Multidrug-Resistant Tuberculosis in Children: FLAME Path on the Milky Way.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016
    Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 2 countries.

Jotam G PasipanodyaCenter for Infectious Diseases Research & Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, TX, USA.
Mwenya MubangaThe Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Mpiko NtsekheThe Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Shaheen PandieThe Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Beki T MagaziNational Health Laboratory Services (Tshwane Academic Division), Department of Medical Microbiology, University of Pretoria, South Africa.
Freedom GumedzeDepartment of Statistical Sciences, University of Cape Town, Cape Town, South Africa.
Landon MyerSchool of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Tawanda GumboThe Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Center for Infectious Diseases Research & Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, TX, USA.
Bongani M MayosiThe Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
University of Cape Town · ZABaylor University Medical Center · USGroote Schuur Hospital · ZAUniversity of Pretoria · ZA

Funding

PK-PD of combination antituberculosis therapy for suppression of drug-resistanceR01AI079497 · NIAID · UT SOUTHWESTERN MEDICAL CENTER · PI GUMBO, TAWANDA · 2008 to 2011
$2.3M
NIAID NIH HHS R01AI079497
6 · The paper itself

Abstract

backgroundTuberculous pericarditis is considered to be a paucibacillary process; the large pericardial fluid accumulation is attributed to an inflammatory response to tuberculoproteins. Mortality rates are high. We investigated the role of clinical and microbial factors predictive of tuberculous pericarditis mortality using the artificial intelligence algorithm termed classification and regression tree (CART) analysis.

methodsPatients were prospectively enrolled and followed in the Investigation of the Management of Pericarditis (IMPI) registry. Clinical and laboratory data of 70 patients with confirmed tuberculous pericarditis, including time-to-positive (TTP) cultures from pericardial fluid, were extracted and analyzed for mortality outcomes using CART. TTP was translated to log10 colony forming units (CFUs) per mL, and compared to that obtained from sputum in some of our patients.

findingsSeventy patients with proven tuberculous pericarditis were enrolled. The median patient age was 35 (range: 20-71) years. The median, follow up was for 11.97 (range: 0·03-74.73) months. The median TTP for pericardial fluid cultures was 22 (range: 4-58) days or 3.91(range: 0·5-8·96) log10CFU/mL, which overlapped with the range of 3.24-7.42 log10CFU/mL encountered in sputum, a multi-bacillary disease. The overall mortality rate was 1.43 per 100 person-months. CART identified follow-up duration of 5·23 months on directly observed therapy, a CD4 + count of ≤ 199.5/mL, and TTP ≤ 14 days (bacillary load ≥ 5.53 log10 CFU/mL) as predictive of mortality. TTP interacted with follow-up duration in a non-linear fashion.

interpretationPatients with culture confirmed tuberculous pericarditis have a high bacillary burden, and this bacterial burden drives mortality. Thus proven tuberculosis pericarditis is not a paucibacillary disease. Moreover, the severe immunosuppression suggests limited inflammation. There is a need for the design of a highly bactericidal regimen for this condition.

Indexed as

Bacterial LoadMycobacterium tuberculosisAdultAgedAntitubercular AgentsArtificial IntelligenceCD4 Lymphocyte CountComorbidityFemaleFollow-Up StudiesHumansLogistic ModelsMaleMiddle AgedPericardial EffusionPericarditis, TuberculousAntitubercular AgentsAgeBacterial burdenCD4 + countsHIVTherapy failure

Identifiers

PMID26870789
PMCPMC4740299
OpenAlexW1788584893

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.