To the Editor.
—Tuberculous pericarditis in tropical countries poses problems that are entirely different from those described by Fowler.1 We have found that about 80% of all pericardial effusions are due to tuberculosis.2 The greatest difficulty encountered by the clinician is in establishing that tuberculosis is the cause of the pericardial effusion. Despite the use of concentration methods, the isolation of acid-fast bacilli on stained smear from various body fluids has been reported to be 40% to 50%.3 For unknown reasons, workers from tropical countries, despite careful attempts, obtain bacteriologic proof in only 10% to 20% of cases.4 Guinea pig inoculation has been shown to have a poor sensitivity in the diagnosis of tuberculosis in tropical countries where it is prevalent, probably because of acquired immunity by the guinea pigs.5In our own experience, the yield from pericardial biopsy specimens for documenting a caseating granuloma
Dalvi B. Tuberculous Pericarditis. JAMA. 1992;267(7):931-932. doi:10.1001/jama.1992.03480070047018