The role of histopathology in establishing the diagnosis of tuberculous pericardial effusions in the presence of HIV

Histopathology. 2006 Feb;48(3):295-302. doi: 10.1111/j.1365-2559.2005.02320.x.


Aims: To establish the influence of human immunodeficiency virus (HIV) infection on the histopathological features of patients presenting with tuberculous pericarditis.

Methods and results: A prospective study was carried out at Tygerberg Academic Hospital, South Africa; 36 patients with large pericardial effusions had open pericardial biopsies under general anaesthesia and were included in the study. Patients underwent pericardiocentesis, followed by daily intermittent catheter drainage; a comprehensive diagnostic work-up (including histopathology of the pericardial tissue) was also performed. Histological tuberculous pericarditis was diagnosed according to predetermined criteria. Tuberculous pericarditis was identified in 25 patients, five of whom were HIV+. The presence of granulomatous inflammation (with or without necrosis) and/or Ziehl-Neelsen positivity yielded the best test results (sensitivity 64%, specificity 100% and diagnostic efficiency 75%).

Conclusions: Co-infection with HIV impacts on the histopathological features of pericardial tuberculosis and leads to a decrease in the sensitivity of the test. In areas which have a high prevalence of tuberculosis, the combination of a sensitive test such as adenosine deaminase, chest X-ray and clinical features has a higher diagnostic efficiency than pericardial biopsy in diagnosing tuberculous pericarditis.

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis
  • AIDS-Related Opportunistic Infections / pathology
  • Adenosine Deaminase / analysis
  • Biopsy
  • HIV Infections / complications*
  • HIV Infections / diagnosis
  • HIV Infections / pathology
  • HIV Infections / virology
  • HIV-1 / isolation & purification*
  • Humans
  • Mycobacterium tuberculosis / isolation & purification
  • Pericarditis, Tuberculous / complications
  • Pericarditis, Tuberculous / diagnosis*
  • Pericarditis, Tuberculous / microbiology
  • Pericarditis, Tuberculous / pathology*
  • Pericardium / microbiology
  • Pericardium / pathology
  • Pericardium / virology
  • Prospective Studies
  • Sensitivity and Specificity


  • Adenosine Deaminase