Bacterial Pericarditis due to Providencia stuartii

Abstract

HomeCirculationVol. 122, No. 4Bacterial Pericarditis due to Providencia stuartii Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBBacterial Pericarditis due to Providencia stuartiiAn Atypical Case of Relapsing Pericarditis Caterina Simon, MD, Maria Dieli, MD, Antonio Brucato, MD, Patrizia Pedrotti, MD, Paolo Brambilla, MD, Silvia Flaminia Curri, MD, Michele Senni, MD, Sergio Pericotti, MD, Fredy Suter, MD and Paolo Ferrazzi, MD Caterina SimonCaterina Simon From the Department of Internal Medicine (M.D., A.B., S.F.C., M.S., F.S.), Radiology (P.B.), Pathology (S.P.), and Cardiovascular Surgery (C.S., P.F.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and CRM Unit Cardiology Department (P.P.), Ospedale Niguarda Ca' Granda, Milano, Italy. Search for more papers by this author , Maria DieliMaria Dieli From the Department of Internal Medicine (M.D., A.B., S.F.C., M.S., F.S.), Radiology (P.B.), Pathology (S.P.), and Cardiovascular Surgery (C.S., P.F.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and CRM Unit Cardiology Department (P.P.), Ospedale Niguarda Ca' Granda, Milano, Italy. Search for more papers by this author , Antonio BrucatoAntonio Brucato From the Department of Internal Medicine (M.D., A.B., S.F.C., M.S., F.S.), Radiology (P.B.), Pathology (S.P.), and Cardiovascular Surgery (C.S., P.F.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and CRM Unit Cardiology Department (P.P.), Ospedale Niguarda Ca' Granda, Milano, Italy. Search for more papers by this author , Patrizia PedrottiPatrizia Pedrotti From the Department of Internal Medicine (M.D., A.B., S.F.C., M.S., F.S.), Radiology (P.B.), Pathology (S.P.), and Cardiovascular Surgery (C.S., P.F.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and CRM Unit Cardiology Department (P.P.), Ospedale Niguarda Ca' Granda, Milano, Italy. Search for more papers by this author , Paolo BrambillaPaolo Brambilla From the Department of Internal Medicine (M.D., A.B., S.F.C., M.S., F.S.), Radiology (P.B.), Pathology (S.P.), and Cardiovascular Surgery (C.S., P.F.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and CRM Unit Cardiology Department (P.P.), Ospedale Niguarda Ca' Granda, Milano, Italy. Search for more papers by this author , Silvia Flaminia CurriSilvia Flaminia Curri From the Department of Internal Medicine (M.D., A.B., S.F.C., M.S., F.S.), Radiology (P.B.), Pathology (S.P.), and Cardiovascular Surgery (C.S., P.F.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and CRM Unit Cardiology Department (P.P.), Ospedale Niguarda Ca' Granda, Milano, Italy. Search for more papers by this author , Michele SenniMichele Senni From the Department of Internal Medicine (M.D., A.B., S.F.C., M.S., F.S.), Radiology (P.B.), Pathology (S.P.), and Cardiovascular Surgery (C.S., P.F.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and CRM Unit Cardiology Department (P.P.), Ospedale Niguarda Ca' Granda, Milano, Italy. Search for more papers by this author , Sergio PericottiSergio Pericotti From the Department of Internal Medicine (M.D., A.B., S.F.C., M.S., F.S.), Radiology (P.B.), Pathology (S.P.), and Cardiovascular Surgery (C.S., P.F.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and CRM Unit Cardiology Department (P.P.), Ospedale Niguarda Ca' Granda, Milano, Italy. Search for more papers by this author , Fredy SuterFredy Suter From the Department of Internal Medicine (M.D., A.B., S.F.C., M.S., F.S.), Radiology (P.B.), Pathology (S.P.), and Cardiovascular Surgery (C.S., P.F.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and CRM Unit Cardiology Department (P.P.), Ospedale Niguarda Ca' Granda, Milano, Italy. Search for more papers by this author and Paolo FerrazziPaolo Ferrazzi From the Department of Internal Medicine (M.D., A.B., S.F.C., M.S., F.S.), Radiology (P.B.), Pathology (S.P.), and Cardiovascular Surgery (C.S., P.F.), Ospedali Riuniti di Bergamo, Bergamo, Italy, and CRM Unit Cardiology Department (P.P.), Ospedale Niguarda Ca' Granda, Milano, Italy. Search for more papers by this author Originally published27 Jul 2010https://doi.org/10.1161/CIRCULATIONAHA.110.943118Circulation. 2010;122:e401–e403A 58-year-old man was admitted for relapsing pericarditis. His past medical history included a transient ischemic attack when he was 47 years old, radical right nephrectomy for neoplasia 8 years earlier, and hypertension.One year earlier, a diagnosis of pleuropericarditis was made in another hospital. The patient was febrile and complained of chest pain; an echocardiogram showed thickening of parietal pericardium, hyperechoic matter on visceral pericardium, and the presence of pericardial and pleural effusion, without hemodynamic impairment. Concomitantly, the patient had a dental abscess; cultures from this abscess were negative during antibiotic therapy. He was treated empirically with piperacillin/tazobactam for 15 days and then with amoxicillin/clavulanate for ≈1 month and aspirin 500 mg 3 times daily for maintenance.The patient experienced 2 further relapses, which were treated successfully with aspirin, but soon after aspirin discontinuation, pain and fever recurred. One year after the original attack, he was admitted to our hospital for pericardial pain and fever with chills. Blood cultures were persistently negative. Laboratory tests were remarkable for neutrophilia and an increase of C-reactive protein (32 mg/dL). The echocardiogram showed a lesion in the anterior pericardial space (Figure 1; Movie I in the online-only Data Supplement). A computed tomography scan (Figure 2) revealed a polylobated lesion in the anterior pericardial space with peripheral contrast enhancement and a necrotic core. Computed tomography-positron emission tomography showed intense uptake at the level of the anterior wall of the right ventricle (Figure 3). Magnetic resonance imaging confirmed that the mass was confined to the pericardial space (Figures 4 and 5; Movies II through V in the online-only Data Supplement).1 Because of progressive hemodynamic impairment, the patient underwent total pericardiectomy; at sternotomy, a mass 4×8 cm in diameter was evident (Figure 6), which was almost totally excised. All of the surgical specimens were positive for Providencia stuartii, a Gram-negative germ; the histological examination did not reveal the presence of neoplastic cells, but only a suppurative process (Figure 7). The patient was then treated with cefepime and amikacin for 8 weeks and made a full recovery. This is the first report of bacterial pericarditis due to P stuartii.2,3 The clinical course resembled that of recurrent “idiopathic” pericarditis, with the exception that fever and pain recurred soon after aspirin discontinuation. Download figureDownload PowerPointFigure 1. Transthoracic echocardiography (4-chamber off-axis view). Lobulated mass in the pericardial space, with compression of the right ventricle.Download figureDownload PowerPointFigure 2. Computed tomography scan. Polylobated mass with necrotic cores and calcifications in the anterior pericardial space associated with thickening of the anterior pericardium, presenting a diffuse contrast enhancement.Download figureDownload PowerPointFigure 3. Computed tomography-positron emission tomography shows abnormal uptake due to high glucose metabolism in the pericardial mass.Download figureDownload PowerPointFigure 4. Magnetic resonance imaging (steady state free-precession cine image frame, 4-chamber off-axis view) shows mass expanding in the pericardial space and infiltrating the right ventricular free wall.Download figureDownload PowerPointFigure 5. Cardiac magnetic resonance late-enhancement image shows enhancement of the pericardium; no late enhancement is visible within the pericardial mass.Download figureDownload PowerPointFigure 6. Macroscopic view of the pericardial mass before (A), during (B), and after (C) surgery.Download figureDownload PowerPointFigure 7. Histological picture of diffuse inflammation mainly composed of granulocytes and histiocytes associated with focal necrosis and hemorrhage. Hematoxylin and eosin stain, original magnification ×200.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/122/4/e401/DC1.DisclosuresNone.FootnotesCorrespondence to Antonio Brucato, Ospedali Riuniti di Bergamo, Largo Barozzi 1, 24128 Bergamo. E-mail [email protected]uniti.bergamo.itReferences1 Rao SK, Protopapas Z, Vikram HR. Unusual presentation of purulent pericarditis: diagnostic contribution of MRI. Emerg Radiol. 2003; 10: 152–154.CrossrefMedlineGoogle Scholar2 Parick SV, Memon N, Echols M, Shah J, McGuire DK, Keeley EC. Purulent pericarditis: report of 2 cases and review of the literature. Medicine. 2009; 88: 52–65.CrossrefMedlineGoogle Scholar3 Leoncini G, Iurilli L, Queirolo A, Catrambone G. Primary and secondary purulent pericarditis in otherwise healthy adults. Interact Cardiovasc Thorac Surg. 2006; 5: 652–654.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Zhang Z, Zhao L, Song M, Luo J, Liu H, Xue K, Huang C, Chen H and Ge J (2021) Providencia heimbachae Associated with Post-weaning Diarrhea in Piglets: Identification, Phenotype, and Pathogenesis, Current Microbiology, 10.1007/s00284-021-02697-1, 79:1, Online publication date: 1-Jan-2022. Sharma S, Bora P, Singla N, Gupta V and Chander J Isolation of Morganella Morganii and Providencia Species from Clinical Samples in a Tertiary Care Hospital in North India, Infectious Disorders - Drug Targets, 10.2174/1871526520666200128162646, 21:1, (84-89) Kurmasheva N, Vorobiev V, Sharipova M, Efremova T and Mardanova A (2018) The Potential Virulence Factors of Providencia stuartii : Motility, Adherence, and Invasion , BioMed Research International, 10.1155/2018/3589135, 2018, (1-8), . 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Behera A and Kulkarni S (2018) Chemical Synthesis of Rare, Deoxy-Amino Sugars Containing Bacterial Glycoconjugates as Potential Vaccine Candidates, Molecules, 10.3390/molecules23081997, 23:8, (1997) July 27, 2010Vol 122, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.110.943118PMID: 20660810 Originally publishedJuly 27, 2010 PDF download Advertisement SubjectsCardiovascular SurgeryImagingPericardial Disease