Moamen AL Zoubi is affiliated to the Advocate Illinois Masonic Medical Center, USA.
Cardiac tamponade is a life threatening condition often requiring urgent or emergent pericardiocentesis and close monitoring in the ICU. We report a 51 year-old spanish speaking female with a history of hypothyroidism who presented with facial swelling, SOB and orthopnea for 3 weeks. She denies joint pain, rash, fever, chills, weight loss. She had travelled to Mexico 6 years ago but did not remember exposure to TB patients. She had not received BCG vaccine as a child. In the ER her vitals were stable. Labs were remarkable for Alk phos 230, AST 63 and ALT 102. Otherwise, unremarkable including normal thyroid function test. ANA comprehensive panel and HIV test were negative. The ECG showed sinus rhythm and low QRS amplitude. Chest X-ray demonstrated bilateral pleural effusion. Echocardiogram showed large pericardial effusion with features consistent with tamponade physiology. Urgent pericardiocentesis was done with 450 ml fluid withdrawn. Thoracentesis was done as well and samples were sent for analysis. The fluids was an exudate.AFB smears and fungal culture came back negative. Repeated Echo showed complete resolution of pericardial effusion. Patient was discharged on colchicine 0.6 mg by mouth twice a day x2 weeks. Two weeks later the patient presented again with dyspnea and found to have cardiac tamponade after performing Echocardiography. Patient was taken to the operating room and a pericardial window was performed. TB quantiferon test found to be positive from the previous admission and she was started empirically on anti-TB medication as recommended by infectious diseases service. The results of pericardial biopsy showed no evidence of TB or sarcoidosis. No granulomas or malignant cells were seen. AFB smear was negative in three consecutive samples and Anti-TB medication were discontinued. Viral serology sent and came back elevated as high as 320:1 for coxsackie B type 4. Repeated Echocardiogram showed no pericardial effusion and patient reported improvement of her symptoms. The patient was discharged on indomethacin 50 mg BID with a cardiology follow up in 2 weeks. To the best of our knowledge, this is the first reported case of cardiac tamponade secondary to group B coxsackieviruses. We encourage considering viral causes as a probable etiology for cardiac tamponade of unknown etiology.
Anamika Gupta has completed her PhD from Banaras Hindu University, India and Postdoctoral studies from National AIDS Research Institute, India. Currently, she is working with Boston University School of Medicine as a Visiting Researcher. She has published 13 papers in peer reviewed journals and 5 manuscripts are in process. She has also published 3 chapters in the books of international repute.
Beijing genotype of Mycobacterium tuberculosis has attracted special attention due to its association with multi drug resistance and rapid transmission. The present study was undertaken to investigate the prevalence of Beijing genotype of M. tuberculosis and their association with drug resistance and clinical characteristics of TB patients. A total of 381 clinical isolates were cultured from more than 4000 TB patients’ sputum samples from 2008 to 2014, of which the genetic profile was determined by using multiplex-PCR and Spoligotyping methods and the drug susceptibility testing to first-line anti-TB drugs was performed by using proportion method and MGIT960. Detection of mutations at rpoB codons (516, 526 and 531), katG codon 315 and embB codon 306 in Beijing and non-Beijing-strains were determined by MAS-PCR and DNA-sequencing. We also characterized a collection of M. tuberculosis isolates to see if Beijing strains had a higher rate of mutations in katG315, rpoB-RRDR region and embB306 gene. Multidrug-resistance was observed to be significantly associated with Beijing strains (p=0.03) and a strong correlation between Beijing strains and specific resistance mutations in katG315, rpoB531 and embB306 gene segments was also found (p=<0.0001, <0.0001 & 0.0014 respectively). These findings will help to understand the transmission and drug resistance related genetic characteristics of the Beijing/W genotype of M. tuberculosis and may provide a scientific basis for the development of new TB diagnostic tool for effective management and control of TB in countries with higher prevalence of Beijing strains.