Incomplete Tuberculosis Treatment in Children Can Trigger Heart Inflammation
Tuberculosis (TB) remains one of the most significant health challenges in Indonesia. The country currently holds the second-highest TB burden in the world after India, contributing approximately 10 per cent of total global cases.
Although it typically begins in the lungs, TB—caused by the Mycobacterium tuberculosis bacteria—can spread to other organs, including the heart. This condition is known as extrapulmonary TB.
Paediatric cardiology consultant, Dr Sarah Rafika Nursyirwan, stated that one type of extrapulmonary TB that requires vigilance is tuberculous pericarditis. This is a TB infection that attacks the pericardium, the thin layer surrounding the heart.
“TB is still endemic in Indonesia, affecting both children and adults. Most TB cases do begin in the lungs. However, under certain conditions, the bacteria can spread to other organs such as the intestines, the brain, and even the heart membrane, known as TB pericarditis,” Dr Sarah said during a virtual discussion hosted by the Indonesian Pediatric Society, monitored in Jakarta on Tuesday (2/6/2026).
She explained that the spread of TB to the heart generally occurs when pulmonary infections are not properly managed. For instance, patient non-compliance with medication, irregular therapy, or the emergence of drug resistance can allow the bacteria to continue multiplying and spreading to other organs, including the heart, via the bloodstream.
“If the pericardium undergoes infection and inflammation, tuberculous pericarditis occurs. In this condition, fluid can accumulate in the pericardial space, which can interfere with heart function,” she added.
If the inflammatory process is recurrent or not optimally treated, the condition can develop into constrictive pericarditis. This is a condition where the pericardium thickens and hardens, thereby restricting the movement of the heart as it pumps blood.
“Over time, the muscles at the back of the heart can also become stiff. If left untreated, this can progress into constrictive pericarditis,” said Dr Sarah.
According to Dr Sarah, such cases are not uncommon among hospitalised children, particularly those suffering from malnutrition or severe TB infections with incomplete treatment. Repeated inflammation of the pericardium causes the tissue around the heart to become increasingly stiff, ultimately significantly impairing cardiac function.
In certain circumstances, invasive medical procedures are required to save patients. “For example, in cases of constrictive pericarditis, heart surgery may be performed to peel or remove the hardened pericardial membrane. The objective is to ensure that heart movement is no longer obstructed,” Dr Sarah concluded.