Purulent Pericarditis Research Articles

44-jähriger Patient mit kulturnegativer, purulenter Perikarditis

We report about a patient with purulent pericarditis due to Neisseria meningitidis pretreated with antibiotics. Clinical signs were suggestive of pericardial tamponade. Cultures from blood and pericardial aspirate remained negative. Broad-range polymerase chain reaction from pericardial fluid detected Neisseria sp.. Latex agglutination assay from pleural fluid showed positive reaction with meningococcal antigen serogroup C. Meningococcal pericarditis without meningitis is a rare manifestation. Non-culture based diagnostic methods in patients with such severe infections and negative cultures play an important role.

Management of purulent pericarditis and esophagopericardial fistula secondary to metastatic colon adenocarcinoma

Purulent pericarditis with esophagopericardial fistula secondary to metastatic colon disease is uncommon. Current reports in the literature describe successful palliation via endoluminal esophageal stent insertion. We present our management strategy for a difficult case in which (complete) esophageal occlusion by tumor burden precluded endoscopic passage of the guide wire required to successfully perform such a procedure. Simple tube pericardiostomy is presented as an alternative procedure that produced a satisfactory outcome. This surgical procedure is an appropriate palliative alternative when an endoscopic procedure is not feasible, and is much less invasive than the surgical palliative procedures reported in the literature.

Bacterial Pericarditis due to Providencia stuartii

A 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 …

An Unnatural History of Left Ventricular Pseudoaneurysm?

We report the case of a 79-year-old woman with a history of methicillin-resistant Staphylococcus aureus bacteremia and purulent pericarditis with subsequent subxiphoid pericardiostomy and formation of a large left ventricular pseudoaneurysm (LVPA) that has been medically managed. Long-term survival after pseudoaneurysm formation has traditionally been thought to be unusual without operative intervention. Computed tomography (CT), three-dimensional reconstructed CT, and echocardiographic images documenting the progression of the LVPA are presented over the course of the patient's follow-up. This case highlights the natural history of LVPA and the utility of multimodal imaging in allowing accurate assessment of LVPA anatomy.

Pericarditis as a rare complication of pneumococcal pneumonia in a young infant

Purulent pericarditis is an exceptionally rare complication of pneumococcal pneumonia in infants but a rapidly fatal disease if left untreated.A previously healthy 4-month-old boy presented at our emergency department with a 10-day history of fever and non-productive cough. No signs of heart failure or cardiac friction rub were evidenced. Chest radiography showed lobar pneumonia, right pleural effusion and cardiomegaly. Echocardiography revealed a massive pericardial effusion, and an emergency drainage was performed. Streptococcus pneumoniae grew up from purulent pericardial fluid and blood cultures. After intravenous antibiotherapy, the outcome was favourable. The introduction of the pneumococcal vaccine may favour an increase in the incidence of non-vaccine serotypes which most commonly cause empyaema and perhaps pericarditis.Therefore, pericarditis should always be considered a possible complication in patients with pneumococcal pneumonia and empyaema.

Diagnostic issues in the clinical management of pericarditis

To review the current major diagnostic issues on the diagnosis of acute and recurrent pericarditis. To review the current available evidence, we performed a through search of several evidence-based sources of information, including Cochrane Database of Systematic Reviews, Clinical Evidence, Evidence-based guidelines from National Guidelines Clearinghouse and a comprehensive Medline search with the MeSH terms 'pericarditis', 'etiology' and 'diagnosis'. The diagnosis of pericarditis is based on clinical criteria including symptoms, presence of specific physical findings (rubs), electrocardiographical changes and pericardial effusion. Although the aetiology may be varied, most cases are idiopathic or viral, even after an extensive diagnostic evaluation. In such cases, the course is often benign following anti-inflammatory treatment, and management would be not affected by a more precise diagnostic evaluation. A triage of pericarditis can be safely performed on the basis of the clinical and echocardiographical presentation. Specific diagnostic tests are not warranted if no specific aetiologies are suspected on the basis of the epidemiological background, history and presentation. High-risk features associated with specific aetiologies or complications include: fever > 38 degrees C, subacute onset, large pericardial effusion, cardiac tamponade, lack of response to aspirin or a NSAID. A targeted diagnostic evaluation is warranted in acute and recurrent pericarditis, with a specific aetiological search to rule out tuberculous, purulent or neoplastic pericarditis, as well as pericarditis related to a systemic disease, in selected patients according to the epidemiological background, presentation and clinical suspicion.

OP-136 CLINICAL ANALYSIS OF 204 CASES WITH ACUTE RHEUMATIC FEVER

Objective: This retrospective study aimed to identify clinical findings, etiologies, diagnosis, treatments and prognosis of 316 patients (age range:1 month-18 years) with pericarditis. Methods: The patients with echocardiographically detected pericarditis were admitted to our center between 1996 and 2008. These patients were reviewed according to physical examinations, blood chemistry results, microbiological, radiological and cardiological studies. Results: The mean age was 7.5±4.3 years. There were 156 (49.3%) boys and 160 (50.7%) girls. Although the most common symptoms were dyspnea (58.8%), fever (51.2%), chest pain (39.8%) and cough (35.1%), the physical examination revealed tachypnea (50.9%), hepatomegaly (44.9%), fever (39.5%), murmur (38.9%), tachycardia (34.1%), peripheral edema (21.8%), distant heart sounds (16.7%), ascites (15.2%) and frotman (5.6%). The most frequent causes of the pericarditis were viral/idiopathic (22.2%), malignancy (18.3%) and cardiac diseases (15.5%). Anemia was detected in 54.1% of patients. Cardiomegaly was seen in 55.7% of the cases.Echocardiographic study showed mild pericardial effusion in 45.9% of the patients. Twenty-seven (45%) of 60 patients (19%) who underwent pericardiosentesis had purulent pericarditis. In addition to medical treatment, dialysis, pericardial tube drainage and pericardiectomy were performed in 35, 25, and 7 patients,respectively. Ten patients developed constrictive pericarditis. Conclusions: We emphasized that early diagnosis and treatment is very important in patients who have signs and symptoms of pericarditis.Also echocardiography is essential for the diagnosis. Our study demonstrated that the viral/idiopatic etiology is the most common cause of pericarditis. We considered that improvement of socioeconomic status, preventive health care services, and effective antibiotherapy can decrease the prevalence of the pericarditis.

Infected aneurysm of the aortic arch with purulent pericarditis caused by Streptococcus pneumoniae

A 76-year-old woman had a chest pain and high fever, and was admitted to the intensive care unit diagnosed as acute pericarditis. Enhanced CT-scan showed a 47-mm aneurysm in the aortic arch which seemed to be impending rupture and the part of the aorta looked like a pseudoaneurysm. Emergent total aortic arch replacement with a rifampicin-bonded Dacron graft was performed. Pericardial effusion was purulent and the aorta was infected with pus discharge in the aortic wall. There were some ulcerations on the surface of the luminal wall of the aorta. One of them was penetrating into the pericardial space causing a pseudoaneurysm. Both pericardial effusion and excised aortic wall were sent to culture study and resulted in positive for Streptococcus pneumoniae. The infection of the aorta, with erosion into the pericardial space, seemed to be the cause of purulent pericarditis. Antibiotic therapy was commenced immediately after surgery and continued for four weeks. Though she had neurological deficit after surgery, her infection was well controlled and there was no recurrence of infection 11 months after surgery.

Staphylococcus aureus pericardial abscess presenting as a localized bulge of the heart contour

Purulent pericarditis usually presents as an acute illness with diffuse involvement of the whole pericardium, but can rarely present as a localized effusion. Here, we present a patient with a pericardial abscess caused by Staphylococcus aureus. After surgical drainage of the abscess, the patient made a good recovery. To the best of our knowledge, this is the first case of a pericardial abscess presenting as a localized bulge of the heart contour on the chest X-ray.

Pericarditis

Pericarditis

Tricuspid endocarditis in hyper-IgE syndrome

Hyper-IgE syndrome is a congenitally acquired primary immune deficiency condition. We report a case of possible hyper-IgE syndrome who presented with multiple cold skin abscesses and chest infection due to Staphylococcus aureus and hyper-IgE findings. Patient also had tricuspid valve acute bacterial endocarditis with purulent pericarditis which is very rare. This case is presented to highlight that early diagnosis and treatment in such cases decreases the mortality and morbidity in phagocytic disorders.

Purulent Pericarditis due to Streptococcus pneumoniae Diagnosed by Pneumococcal Urinary Antigen Assay and 16S rDNA Sequence of the Pericardial Fluid

A 57-year old woman was admitted to our hospital with massive pericardial fluid. Culture of the pericardial fluid was negative, however, Binax NOW Streptococcus pneumoniae urinary antigen test was positive in pericardial fluid. 16S rDNA sequencing and PCR for lyt(A) gene of the pericardial fluid sample confirmed the microbiological diagnosis of S. pneumoniae. The patient was treated with surgical drainage and continuous intravenous infusion of penicillin G and its concentration in the serum and pericardial effusion was monitored. Incorporation of molecular methods such as antigen testing and nucleic acid sequencing would benefit the management of infectious diseases especially in culture negative cases.

Cardiac tamponade from acute pericarditis associated with a cystic fibrosis (CF) lung infection

Cystic fibrosis (CF) is a genetically inherited autosomal recessive disease characterized by dehydration of the airway surface liquid and impaired mucociliary clearance leading to chronic respiratory infections, bronchiectasis and ultimately death from respiratory causes. Common pulmonary related complications resulting from bronchiectasis include pneumothorax and hemoptysis. A rare, seldom reported complication is acute pericarditis complicating cystic fibrosis. Our review of the literature identified only a single case of culture-proven purulent pericarditis attributed to Pseudomonas aeruginosa in a patient receiving systemic corticosteroids. A second reported case of acute pericarditis in a CF patient was attributed to Mycoplasma pneumoniae which is a known cause of infectious-related pericarditis independent of CF. Both cases required open pericardial drainage with 1 fatality. Here we present a case of cardiac tamponade from a fibrinous pericardial effusion in a 21-year-old female as a complication of CF related parenchymal lung disease. To our knowledge, this is the first reported case of a non-infectious parapneumonic pericardial effusion causing near fatal cardiac tamponade as a complication of CF lung disease.

Nocardia farcinica pericarditis after kidney transplantation despite prophylaxis

A deceased-donor kidney transplant recipient developed purulent pericarditis caused by Nocardia despite trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis for Pneumocystis jirovecii. She was treated empirically with ceftriaxone and amikacin and subsequently underwent sternotomy with drainage of an intrapericardial abscess. Culture and susceptibility data demonstrated Nocardia farcinica, which was susceptible to SMX and amikacin, although resistant to ceftriaxone. Nocardia asteroides, the more common human pathogen, is generally susceptible to third-generation cephalosporins and TMP-SMX. N. farcinica is rare in the United States, more virulent and resistant than N. asteroides, and is more likely to cause disseminated disease. Successful therapy of disseminated Nocardia infections is dependent upon choice of appropriate empiric antibiotics in addition to surgical drainage of purulent fluid collections. TMP-SMX prophylaxis may not be sufficient to prevent infections due to Nocardia species in all immunosuppressed transplant recipients. Here, a rare complication of this unusual pathogen is discussed.

Mycoplasma hominispericarditis in a lung transplant recipient: review of the literature about an uncommon but important cardiothoracic pathogen

Purulent pericarditis due to Mycoplasma hominis is rare, and is usually associated with mediastinitis or pleuritis following cardiothoracic surgery. We report the first case to our knowledge of isolated purulent pericarditis caused by M. hominis in a lung transplant recipient and review previously reported cases of this disease.

Gas-forming purulent pericardial effusion

A previously healthy 45-year-old woman presented with cardiac tamponade secondary to a gas-forming purulent pericardial effusion. Eight days previously, she presented to hospital with a pericardial effusion. A subxiphoid diagnostic pericardiocentesis yielded a clear strawcoloured fluid. Cultures grew group F streptococci and alpha-hemolytic streptococci, which are associated with normal oral flora. The patient’s condition worsened with increasing respiratory distress and hemodynamic instability. She was transferred to a cardiac centre, where she was diagnosed with cardiac tamponade. A chest x-ray revealed a tension pneumopericardium (Figure 1). A large air pocket (white arrows) and a clearly defined air-fluid level (black arrows) were seen on this image. Emergent diagnostic and therapeutic pericardiocentesis revealed 560 mL of purulent fluid growing prevotella, bacteroides, Streptococcus milleri and Streptococcus viridans. Both the bacteroides and anaerobic streptococci are causes of gas-forming infections. Figure 1 Bacterial pericardial effusions are primarily a complication of an infectious focus originating elsewhere in the body, arising by direct spread or hematogenous dissemination. A total of 26% to 47% of patients have an underlying systemic disease process such as rheumatoid arthritis or autoimmune pericarditis, creating a pericardial effusion that may become secondarily infected (1). In the present case, after extensive imaging and autoimmune investigations, no source of infection or concurrent disease was found. Bacterial purulent pericarditis is a rare diagnosis with a mortality rate of up to 100% if not diagnosed and treated emergently (2). Treatment with antibiotics and surgical drainage is integral to allow for a full recovery. The present patient responded promptly after appropriate antibiotics and surgical pericardial window, with dehiscence of adhesions. It can only be speculated how these specific bacteria invaded the pericardial space and it is postulated that equipment contamination or passage of the first pericardiocentesis needle through the bowel were potential sources.

Infected aortic aneurysm, purulent pericarditis, and pulmonary trunk rupture caused by methicillin-resistant Staphylococcus aureus

A 66-year-old woman presented with cardiac tamponade. Pericardiocentesis revealed purulent pericarditis. Enhanced computed tomography showed a saccular aneurysm of the aortic arch. An irregularly shaped and partially enhanced mass was seen adjacent to the aneurysm, which suggested development of a mycotic pseudoaneurysm. Surgical drainage was performed through a subxiphoid incision, and continuous irrigation was commenced. On the following day, however, massive bleeding was recognized through the drains. The patient was immediately transferred to the operating theater, and extracorporeal circulation was established. A perforation 1 cm in diameter was found on the anterior surface of the pulmonary trunk, and a large amount of pus came out from the tear. The ascending aorta and the arch were found to be infected. Surgical repair was impossible due to extensive infection, and the patient died. Methicillin-resistant Staphylococcus aureus was isolated from the pericardial effusion, blood, and intraluminal thrombus of the aortic aneurysm.

Purulent Pericarditis in Patient with Esophageal Cancer Presenting with Cardiac Tamponade

Purulent Pericarditis in Patient with Esophageal Cancer Presenting with Cardiac Tamponade

Aetiological diagnosis in acute and recurrent pericarditis: when and how

The cause of acute and recurrent pericarditis is often a major concern for the clinicians in clinical practice. Several possible causes of pericarditis can be listed, as the pericardium may be involved in a large number of systemic disorders or may be diseased, as an isolated process. The reported diagnostic yield of extensive laboratory evaluation and pericardiocentesis is low in the absence of cardiac tamponade or suspected neoplastic, tuberculous, and purulent pericarditis. Patients with pericarditis can be safely managed on an outpatient basis without a thorough diagnostic evaluation unless a specific cause is suspected or the patient has high-risk features, or both. A targeted aetiological search should be directed to the most common cause on the basis of the clinical background, epidemiological issues or specific presentations. In developed countries the clinicians should rule out neoplastic, tuberculous, and purulent pericarditis, as well as pericarditis related to a systemic disease.

Purulent Pericarditis

Purulent pericarditis, a localized infection within the pericardial space, has become a rare entity in the modern antibiotic era. Although historically a disease of children and young adults, this is no longer the case: the median age at the time of diagnosis has increased by nearly 30 years over the past 6 decades. Despite advances in diagnostic and treatment modalities, purulent pericarditis remains a life-threatening illness. Unfortunately, the diagnosis is made postmortem in more than half the cases. Thus, a high index of clinical suspicion is crucial. We present 2 cases of purulent pericarditis, and provide an updated review of other case series published over the past 60 years.