Cardiac tamponade revealing tuberculous pericarditis: A case report
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2. Abstract Tuberculosis remains a major public health issue in Morocco. Pulmonary tuberculosis is the most common form, but various extrapulmonary forms exist. Tuberculous pericarditis is a rare form of extrapulmonary tuberculosis that can be complicated by cardiac tamponade, pericardial constriction, or their combination, which can threaten the patient's life. Its clinical and radiological signs are nonspecific, and the clinical presentation can be misleading and incomplete, sometimes even with an initial tamponade. We report the case of a 68-year-old patient admitted for intense retrosternal chest pain associated with acute dyspnea, evolving in the context of weight loss and general deterioration. Additionally, she reported a history of fever and night sweats. Clinical examination revealed a conscious, febrile, hypotensive, tachycardic, polypneic patient with good oxygen saturation, signs of right heart failure, and muffled heart sounds on auscultation. Chest X-ray revealed cardiomegaly, and the electrocardiogram showed diffuse low voltage. Given the presence of Beck's triad suggestive of cardiac tamponade, a transthoracic echocardiogram was performed, revealing a large pericardial effusion with "swinging heart." A chest CT scan also confirmed the large pericardial effusion. The diagnosis of cardiac tamponade was made based on the clinical and radiological findings, and pericardial drainage was performed, after which the patient showed clinical improvement. PCR GenXpert MTB/RIF detected the presence of Mycobacterium tuberculosis on the pericardial fluid, with no resistance to rifampicin. Culture was positive for Mycobacterium tuberculosis. The diagnosis of tuberculous pericarditis was thus confirmed, and the patient was started on quadruple antituberculosis therapy with good clinical progress.
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Thank you very much submitting your manuscript to Access Microbiology. It has now been reviewed by two experts in the field, whose comments are attached at the bottom of this email. In general, they both agree that this is a valuable contribution to the tuberculosis case report record. However, they suggest the English needs to be revised and the literature analysis needs to be taken a bit further to contextualise the results. They have provided further comments that need to be addressed and additional points that will be of great interest to enrich the contextualisation of the results and their discussion. Please provide a revised version of the manuscript (including a tracked changes document) along with a point-by-point response to the reviewers' comments within one month.
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Comments to Author
00014-Cardiac tamponade revealing tuberculous pericarditis: A case report. The case study manuscript is described well although there are few obvious English grammar mistakes The presentation of results is well presented. Literature analysis is poor and need to be improved to support the discussion of the findings. Other relevant comments are as follows: Line 98 - Is this the GeneXpert MTB/RIF assay (the old version of the assay) or the GeneXpert MTB/RIF Ultra (new assay) the authors need to be mindful of writing correct name for the test and be consistent in writing the test Line 103 - was the ZN done on direct clinical specimen or on the culture positive isolate because the manner it is here, its as if ZN was done from the direct specimen, and if not, it needs to be clearly stated. Line 132 …
Comments to Author
00014-Cardiac tamponade revealing tuberculous pericarditis: A case report. The case study manuscript is described well although there are few obvious English grammar mistakes The presentation of results is well presented. Literature analysis is poor and need to be improved to support the discussion of the findings. Other relevant comments are as follows: Line 98 - Is this the GeneXpert MTB/RIF assay (the old version of the assay) or the GeneXpert MTB/RIF Ultra (new assay) the authors need to be mindful of writing correct name for the test and be consistent in writing the test Line 103 - was the ZN done on direct clinical specimen or on the culture positive isolate because the manner it is here, its as if ZN was done from the direct specimen, and if not, it needs to be clearly stated. Line 132 Figure 4 : Culture images showing Mycobacterium tuberculosis colonies - The authors need to indicate which media was Mtb cultured from?
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
The authors describe a case of tuberculous pericarditis causing cardiac tamponade. This is a rare clinical problem and a very interesting case reminding Doctors of this important complication of tuberculosis. The paper is well written and gives all essential details, but taking care of a few points will considerably improve the value of the paper: - line 72 blood pressure values are not plausible; mistyped ? - the microbiological workup should be described in more detail: results of the ZN-stain should be given first. Then, the volume of pericardial liquid cultured should be given: directly inoculated on LJ or centrifuged first ? Any decontamination (of course not needed on "sterile" fluid, but sometimes practiced) ? The colony count per mL is of course an essential detail for the workup of …
Comments to Author
The authors describe a case of tuberculous pericarditis causing cardiac tamponade. This is a rare clinical problem and a very interesting case reminding Doctors of this important complication of tuberculosis. The paper is well written and gives all essential details, but taking care of a few points will considerably improve the value of the paper: - line 72 blood pressure values are not plausible; mistyped ? - the microbiological workup should be described in more detail: results of the ZN-stain should be given first. Then, the volume of pericardial liquid cultured should be given: directly inoculated on LJ or centrifuged first ? Any decontamination (of course not needed on "sterile" fluid, but sometimes practiced) ? The colony count per mL is of course an essential detail for the workup of tuberculous pericardial fluid. - it is sufficient to say that the standard culture of the liquid gave no growth (lines 104 to 108) - shorten Discussion - omit lines 156 to 167 and 175 to 184 unrelated to the present problem - replace "BK" by M. tuberculosis or other standard names, outside French speaking countries BK is not used - give precise name of the PCR assay used: was it GeneXpert MTB/RIF or GeneXpert MTB/RIF Ultra ? - the GeneXpert MTB/RIF test is intended only for sputum or processed sputum per manufacturers procedure. Therefore, it is of great interest that this fact is clearly mentioned, insisting at the same time that the assay gave the expected result in this case (which is not a surprise, but can help other labs justifying the use of GeneXpert MTB/RIF for liquids other than sputum). The authors should give the details of the procedure used: volume of pericardial fluid used in the GeneXpert MTB/RIF assay and other relevant details. The GeneXpert MTB/RIF was obviously able to detect a small quantity of tuberculous bacteria in pericardial fluid, which is important for the patient - it is intriguing that almost half of tuberculosis cases in Morocco are extrapulmonary (line 143, reference 1) and that further investigations of the patient did not reveal a pulmonary site of infection. We would of course appreciate to know what the further investigations were. We still believe that the primary site of infection in the vast majority of tuberculosis cases are the lungs; of course showing traces of past primary tuberculosis in the lungs is not always easy.
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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