VALUE OF POLYMERASE CHAIN REACTION IN PATIENTS WITH PRESUMPTIVELY DIAGNOSED AND TREATED AS TUBERCULOUS PERICARDIAL EFFUSION

Abstract

Objective: To know the sensitivity of polymerase chain reaction (PCR) in
pericardial fluid and response to antituberculous treatment (ATT) in PCR positive
patients who were presumptively diagnosed and treated as tuberculous
pericardial effusion.

Methodology: This was a descriptive cross sectional study carried out
st th from1 June 2009 to 31 May 2010 at Cardiology Department, Lady Reading
Hospital, Peshawar. Patients with presumptive diagnosis and receiving treatment
for tuberculous pericardial effusion were included. Pericardial fluid sample was
aspirated under fluoroscopy for the routine work up. The specimens were
subjected to PCR detection of mycobacterium tuberculous DNA.

Results: During 12 month study period, a total of 54 patients with large
pericardial effusion presented to Cardiology department, Lady Reading Hospital,
Peshawar. Of them, 46 patients fulfilled the criteria for presumptive diagnosis of
tuberculous pericardial effusion. PCR for mycobacterium tuberculous DNA in
pericardial fluid was positive in 45.7%(21).Patients were followed for three
months. In PCR positive group, 01 patient while in PCR negative group 3 patients
were lost to follow up. Among PCR positive patients 17(85%) while in PCR
negative group 11(47.82%) patient responded to ATT both clinically and echocardiographically. We found that patients who were PCR positive responded
better to therapy than those who were PCR negative and this finding was
statistically significant (p=0.035).

Conclusion: PCR, with all its limitations, is potentially a useful diagnostic test in
patients with presumptively diagnosed tuberculous pericardial effusion. A PCR
positive patient responds better to therapy as compared to PCR negative patient.