Search

About 90% of cases of acute pericarditis have an idiopathic or viral etiology. In some cases, it is possible to identify high-risk patients for whom hospital admission and specific etiology research are mandatory for adequate treatment. Bacterial pericarditis is uncommon and responsible for less than 1% of cases. Only 10 cases of pericarditis due to Campylobacter fetus have been documented worldwide. This case highlights the importance of good cardiac imaging, with the right clinical and microbiology-integrated approach in high-risk cases of pericardial disease. Résumé: Environ 90 % des cas de péricardite aiguë sont d’étiologie idiopathique ou virale. Dans certains cas, il est possible de déterminer les patients exposés à un risque élevé pour qui l'admission à l'hôpital et la recherche d'une étiologie précise sont indispensables pour offrir le bon traitement. La péricardite bactérienne est rare et représente moins de 1 % des cas. Seuls 10 cas de péricardite à Campylobacter fetus ont été consignés dans le monde. Ce cas illustre l'importance d'une bonne imagerie cardiaque selon une bonne approche clinique et microbiologique intégrée chez les cas exposés à un risque élevé de maladies péricardiques.

Background Cardiac tamponade is a medical emergency. This study was carried out to determine the etiologies of cardiac tamponade and review the management and outcomes. Methods We retrospectively analysed case records of patients who underwent pericardiocentesis for cardiac tamponade during the two consecutive years (1 January 2018 to 31 December 2019) at Hospital Sultanah Nora Ismail, Batu Pahat, in Johor, Malaysia. Results There were ten patients (eight males, two females; age range 20 to 70 years old, mean age 36 years old) who underwent pericardiocentesis for cardiac tamponade during the said period. Malignancy (40%), tuberculosis (30%), idiopathic (20%), and bacterial (10%) were among the common causes of the pericardial effusion in this center. The commonest symptoms were breathlessness (90%), chest pain (60%), cough (50%), and unexplained fever (20%). Pulsus paradoxus was the most specific sign (100%) for the presence of echocardiographic feature of cardiac tamponade. Two of the patients with tuberculous pericarditis had retroviral disease; one patient had bacterial pericarditis due to salmonella typhi. Conclusion This study has confirmed that there are many etiologies and presentation of cardiac tamponade; clinicians should be alert as urgent pericardiocentesis is lifesaving.

The aim of this study was to investigate the main causes of death in growing-finishing pigs in southern Brazil. During a one-year period (from 2018 to 2019), two industrial pig herds (18 and 20 thousand pigs each farm) in southern Brazil were monitored along the four seasons of the year (12 days per season on each farm), in order to perform necropsies of all pigs that died in that period. The two farms had an average monthly mortality rate ranging from 0.94 to 3.93% in the evaluated months. At necropsy, tissues were collected, fixed in 10% formalin solution and processed routinely for histopathological examination. When necessary, samples were sent for bacterial culture and PCR to identify etiologic agents. A total of 601 necropsies were performed, with 94.9% of conclusive diagnoses. Infectious diseases corresponded to 64.4% of conclusive diagnosis and non-infectious diseases to 35.6%. The most prevalent causes of death were: pneumonia (33%), gastric ulcers (15.4%), circovirosis (9.9%), systemic bacterial embolism (5.4%), polyserositis (4.4%), dilated cardiomyopathy and torsion of abdominal organs (4.3% each), and bacterial pericarditis (3.4%). Regarding pneumonias (199/601), the main agents identified in these cases were Pasteurella multocida, Influenza A virus and Mycoplasma hyopneumoniae, mainly in associations. RESUMO: O objetivo do presente trabalho foi investigar as principais causas de morte de suínos em fase de crescimento e terminação no Sul do Brasil. Durante o período de um ano (entre 2018 e 2019), duas granjas tecnificadas de suínos no Sul do Brasil foram acompanhadas nas quatro estações (12 dias por estação em cada granja), para realização de necropsias dos suínos que morreram nesse período. As duas propriedades apresentavam mortalidade mensal média entre 0,94 e 3,93% nos meses avaliados. Na necropsia, amostras de órgãos foram colhidas, fixadas em formol 10% e processadas rotineiramente para o exame histopatológico. Quando necessário, amostras foram enviadas para o cultivo bacteriano e PCR para identificação de agentes etiológicos. Foram realizadas um total de 601 necropsias, com 94,9% de diagnósticos conclusivos. As doenças infecciosas corresponderam a 64,4% dos diagnósticos conclusivos e as não infecciosas a 35,6%. As principais causas de morte foram: pneumonias (33%), úlcera gástrica (15,4%), circovirose (9,9%), embolia bacteriana sistêmica (5,4%), polisserosite (4,4%), cardiomiopatia dilatada e torção de órgãos abdominais (4,3% cada) e pericardite bacteriana (3,4%). Com relação às pneumonias (199/601), os principais agentes associadas as lesões foram Pasteurella multocida, vírus da Influenza A e Mycoplasma hyopneumoniae, principalmente associados entre si.

Bacterial pericarditis is a critical diagnosis caused by a wide range of organisms including Streptococcus pneumoniae and other anaerobic organisms like Cutibacterium acnes which has been gaining more importance as a causative organism. Cutibacterium species are Gram-positive microaerophilic rods that constitute part of the normal flora of skin and mucosal membranes. The incidence of pericarditis caused by this organism is underreported as it is often dismissed as a skin flora contaminant. However, if left untreated, Cutibacterium acnes can cause pericarditis with serious complications. In this paper, we present a comprehensive review of the literature regarding pericarditis caused by Cutibacterium acnes along with a case presentation from our institution. In our institution, a 20-year-old man with history of atrial septal defect presented with chest pain radiating to the back along with symptoms of upper respiratory tract infection including headaches and myalgia. Electrocardiogram was remarkable for diffuse low-voltage waves. Echocardiography revealed a large pericardial effusion with tamponade features. Pericardiocentesis drained 1.2 L of milky fluid. Pericardial fluid analysis grew Cutibacterium acnes after being cultured for 8 days. The patient received 3 weeks of IV penicillin followed by 3 weeks of oral amoxicillin along with nonsteroidal anti-inflammatory agents and colchicine with no recurrence. Pericarditis caused by Cutibacterium acnes requires a high clinical suspicion since isolation of this organism can be dismissed as a skin flora contaminant. Literature review reveals that this infection may be underdiagnosed and underreported. Prompt diagnosis may lead to timely initiation of antibiotics which can help prevent devastating complications like constrictive pericarditis. Prospective studies are needed to evaluate the true incidence and prevalence of this disease.

The authors present a case of purulent pericarditis probably secondary to respiratory infection, a rare entity in the antibiotic era. Pericardial fluid analysis identified streptococci and oral anaerobes as the causative agents. A prolonged and complicated diagnostic and therapeutic course, which included a long stay in the intensive care unit, is described, and a review of purulent pericarditis provided. Pericardial effusion, particularly in the setting of concomitant respiratory infection and immunocompromise or other risk factors, should raise the suspicion of bacterial pericarditis and prompt its timely diagnosis and treatment. Purulent pericarditis can be lethal and has potentially severe complications, so adequate antimicrobial therapy and source control are key. LEARNING POINTS: Purulent pericarditis is a rare infection, mostly resulting from contiguous or haematogenous spread, with diagnosis often delayed because signs and symptoms are unspecific. Treatment must include drainage of the pericardial space, combined with systemic antibiotics. Prognosis is variable, depending largely on the speed of diagnosis and treatment, as death is almost certain without adequate source control.

A broom straw was ingested and penetrated the esophageal wall, the pericardial space and its tip became lodged in the coronary sinus. Bacterial pericarditis and then fungal endocarditis ensued but were temporally separated by an asymptomatic 6-month period. On transthoracic echocardiography, the straw was mistakenly identified to be a "prominent Thebesian valve." This child survived both life-threatening infections. The occurrence of infections caused by unusual organisms in the setting of immunocompetence highlights the need for a high index of suspicion for the presence of a causative foreign body.

Purulent pericarditis is a rare condition in the modern antibiotic era. The diagnosis should be suspected in patients with pericardial effusions and radiographic and laboratory investigations consistent with infection. Pericardial fluid culture is the gold standard. Early source control, in addition to antibiotics, is a cornerstone of treatment.

Abscess formation in the pericardial space has been described as a rare complication of trauma, congenital defects, penetrating foreign body, or extension of local myocardial infection in the dog. Presented here is a case of a juvenile dog with septic pericardial effusion secondary to an isolated intrapericardial abscess. Surgical pericardiectomy was successful in removing the abscess and nidus for septic effusion in this patient, and histopathology of the abscess tissue was suggestive of foreign plant material migration as the nidus for abscess formation. Recheck echocardiogram at the six-month postoperative period showed no recurrence of pericardial effusion or abscessation. Although abscess formation and septic pericarditis secondary to foreign body migration is an uncommon cause for large volume pericardial effusion, this should be considered as a differential particularly in a young and previously healthy dog.

Key Clinical Message Although conventional microbiology cultures may be negative, polymerase chain reaction (PCR) can effectively identify both typical and atypical microorganisms. With careful interpretation, PCR could become the gold‐standard diagnostic test for culture‐negative bacterial pericarditis.

Background Bacterial pericarditis is a rare, rapidly progressive, and highly fatal infection, even with drainage and antibiotics. Gram-positive cocci, specifically Streptococcus pneumoniae, have been the most common cause of bacterial pericarditis from either haematogenous dissemination, or spread from another adjacent site of infection. Following the introduction of antibiotics in the 1940s and more recently the pneumococcal conjugate vaccine, the incidence has drastically decreased. Case summary A previously healthy young male was diagnosed with acute pericarditis with no signs of haemodynamic compromise on initial presentation. Several hours later, he became unstable suffering from cardiac tamponade and septic shock. Despite urgent pericardiocentesis and drainage of purulent fluid, culture positive for streptococcus pneumoniae, multi-organ failure was eventually fatal. Discussion We describe a rare case of primary S. pneumoniae purulent pericarditis leading to tamponade, septic shock, and death. Due to the high mortality rate of purulent pericarditis, a high index of suspicion is needed in order to initiate appropriate therapy with antibiotics and drainage.

Infectious pericarditis does not always present with all the classic findings. Some of the traditional signs of fever, pleuritic chest pain, and frictional rub may be missing. This presents a diagnostic challenge, thus clinical suspicion is important. The most common cause of infectious pericarditis is viral. However, bacterial pericarditis may occur with severe complications such as constrictive pericarditis, pericardial effusion, cardiac tamponade, left ventricular pseudoaneurysm, and aortic mycotic aneurysm. The purpose of this presentation is to increase awareness of Cutibacterium acnes (C. acnes) as a cause of bacterial pericarditis. This case report highlights C. acnes as a prevalent cause of both pleural and pericardial infections. The diagnosis can be challenging, considering that this bacterium is difficult to isolate, slow growing, and causes indolent illness. Prolonged incubation time may be required. In addition to the more traditional causes of bacterial pericarditis, namely Staphylococcus and Streptococcus species, C acnes appears to play an important role. It should not be considered a contaminant as it may require further investigation.

Introduction Acute purulent pericarditis is an exceedingly rare entity most often caused by direct intrathoracic contamination or hematogenous spread of a bacterial infection. Mortality nears 100% when left untreated. We present here a rare case of idiopathic bacterial pericarditis caused by methicillin-sensitive Staphylococcus aureus (MSSA). Case A 69-year-old male presented with chest pain and abdominal pain. He was found to have a pericardial effusion and tamponade and underwent emergent pericardiocentesis. Pericardial fluid culture grew methicillin-sensitive Staphylococcus aureus. The patient required multiple pericardial washouts and was then treated with four weeks of intravenous antibiotics. Conclusion While uncommon, clinical suspicion for purulent pericarditis should remain high due to the associated high mortality.

BACKGROUND Acute bacterial pericarditis is rare, and the incidence numbers have been declining in the modern antibiotic era. Purulent bacterial pericarditis is a fatal disease in which mortality rates can reach 100% if left untreated. CASE REPORT We present a case of primary purulent bacterial pericarditis with polymicrobial growth including Micromonas micro, Prevotella intermedia and Fusobacterium species, all of which are anaerobic flora of the oral cavity. Constant re-accumulation of the purulent pericardial effusion led the patient to have recurrent echocardiographic and clinical cardiac tamponade requiring recurrent pericardiocentesis' and eventually a pericardial window. CONCLUSIONS Although rare, bacterial pericarditis has been noted to lead to clinical and echocardiographic tamponade. Early diagnosis and treatment are necessary for improving clinical outcomes. It is important to have a suspicion for purulent pericarditis, due to its high level of mortality, in patients who present with non-specific symptoms and pleuritic chest pain.

Cancers can directly affect the pericardium (pericardial tumors, cardiac tumors, direct invasion of nearby cancer, or pericardial metastasis of distant tumors) or indirectly (as side effects of radiotherapy, chemotherapy and secondary immunodepression of opportunistic infections such as viral or bacterial pericarditis). In contrast to pericardial effusions of other aetiologies, malignant pericardial effusions present an increased risk of rapid fluid accumulation in pericardial sac with the onset of cardiac tamponade. Currently, in the case of malignant pericardial effusions, available therapeutic methods are pericardiocentesis, subxiphoidal pericardiotomy, pleural- pericardial window, peritoneal-pericardial window, and pericardiectomy. We present here a short uptodate of surgical approaches for malignant pericardial effusions.

Purulent pericarditis is a rare disease in the antibiotic era. The common pathogens of purulent pericarditis are gram-positive species such as Staphylococcus aureus. Streptococcus pneumoniae, Salmonella, Haemophilus, fungal pathogens/tuberculosis can also result in purulent pericarditis. We report an old male case of purulent pericarditis by Escherichia coli. He came to our hospital suffering from leg edema for 3 months. Echocardiography revealed the large amount of pericardial effusion, and he was admitted to test the cause of pericardial effusion without high fever, tachycardia, and shock vital signs. On the third day, he suddenly presented vital shock. We performed emergency cardiopulmonary resuscitation and pericardiocentesis. Appearance of pericardial effusion was hemorrhagic and purulent. The gram stain revealed remarkable E. coli invasion to pericardial space. Antibiotic therapy was immediately started; however, he died on sixth day with septic shock. The cytological examination of pericardial effusion suggested the invasion of malignant lymphoma to pericardium. This case showed subacute or chronic process of pericarditis without severe clinical and laboratory sings before admission. Nevertheless, bacterial purulent pericarditis usually shows acute clinical manifestation; the first process of this case was very silent. Immunosuppression of malignant lymphoma might make E. coli translocation from gastrointestinal tract to pericardial space, and bacterial pericarditis was progressed to purulent pericarditis. In the latter process, this case showed unexpected rush progression to death by sepsis from purulent pericarditis. Immediate pericardiocentesis should be performed for a prompt diagnosis of purulent pericarditis, and it might have improved the outcome of this case.

Introducción. La pericarditis purulenta es un proceso inflamatorio del pericardio producto de una infección bacteriana. De no lograrse un diagnóstico oportuno, se convierte en una patología con alta mortalidad en la infancia.Presentación del caso. Lactante de 10 meses de edad que ingresó a un hospital pediátrico de alta complejidad en Bogotá D.C., Colombia, por un cuadro clínico dado por tos, dificultad respiratoria y fiebre. Se tomó una radiografía de tórax donde se observó cardiomegalia y compromiso neumónico multilobar. El ecocardiograma mostró un derrame pericárdico global que requirió pericardiotomía, en la cual se obtuvo 50 mL de líquido turbio con membranas blanquecinas. En la prueba citoquímica se encontraron 2 600mm3 leucocitos, polimorfonucleares del 90% y elevación de proteínas. Con los hallazgos de imagenología y laboratorio se hizo el diagnóstico de pericarditis purulenta, por lo que se inició tratamiento con ceftriaxona y clindamicina por 4 semanas, obteniendo una resolución clínica y ecocardiográfica efectiva.Discusión. La presentación clínica y los hallazgos imagenológicos, paraclínicos y electrocardiográficos sugirieron como primera posibilidad pericarditis purulenta, lo cual se confirmó por las características de líquido pericárdico, que era compatible con un exudado. La resolución clínica, apoyada por el manejo antibiótico y a pesar de no obtener aislamiento microbiológico en los cultivos, corroboró el diagnóstico.Conclusiones. La pericarditis purulenta es una enfermedad poco frecuente en pediatría pero con alta mortalidad. Realizar un diagnóstico oportuno sumado a un tratamiento tempano se relaciona con un mejor pronóstico de esta patología.

Patient: Male, 34-year-old Final Diagnosis: Pericarditis Symptoms: Chest pain • cough • fever • shortness of breath Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Mistake in diagnosis Background: Bacterial pericarditis can present a diagnostic challenge due to the difficulty of obtaining tissue for bacterial identification. This report is of a 34-year-old man who presented with fever and cough. Diagnosis was initially delayed without a tissue sample, but the patient was later found to have polymicrobial bacterial pericarditis. Case Report: A 34-year-old man from the Democratic Republic of Congo presented to the emergency room with cough, fever, and night sweats. He was admitted and found to have pericardial thickening and fluid collection with calcifications. A tissue sample was not obtained for diagnosis, and he was discharged on RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) and steroids for presumed tuberculosis pericarditis. He worsened clinically and was readmitted to the hospital with evolving pericardial effusion with air present, in addition to new pleural effusion and parenchymal consolidation. He subsequently underwent thoracotomy and pericardial biopsy. Tissue cultures and sequence-based bacterial analysis eventually revealed the presence of Prevotella oris and Fusobacterium nucleatum. He improved dramatically with appropriate antibiotic therapy. Conclusions: This report demonstrates the importance of undergoing further diagnostic work-up for bacterial pericarditis, especially in resource-rich settings. Although tuberculosis pericarditis should remain high on the differential, it is imperative not to anchor on that diagnosis. Instead, when feasible and safe, tissue biopsy should be obtained and sent for organism identification. AFB smears and cultures, Xpert MTB/RIF, and sequence-based bacterial analysis have all been used for identification. Delay in diagnosis can lead to progression of disease and unnecessary incorrect therapies.

Viral pericarditis is the most common cause of acute pericarditis and it is typically responsive to aspirin or nonsteroidal anti-inflammatory drugs. Tuberculous pericarditis is common in immunocompromised patients or in immunocompetent patients in endemic areas. The diagnosis of tuberculous pericarditis usually requires a multidisciplinary approach, and presumptive treatment should be started for people with suspected infections living in endemic areas. Antituberculous treatment along with corticosteroid therapy can reduce complications from constrictive pericarditis. Purulent pericarditis is fatal if untreated. Bacterial and fungal cultures from pericardial fluid and blood are essential to determine the best treatment.

Background: Liquid pericarditis is a frequent cause of hospitalization in developing countries. Objective: of this study was to describe the etiological and evolutionary aspects of fluid pericarditis in pediatric cardiology at ICA. Methods: This was a retrospective study of 42 cases of fluid pericarditis diagnosed among 202 children hospitalized over a five-year period (1st January 2009 to 31st December 2014). All patients with pericardial effusion were included in the study. Results: Prevalence was estimated at 20.8% of hospitalizations, sex ratio was 1.1 with a female predominance (52%) and the mean age at 9.2 years (11 days to 15 years). The etiologic varieties identified were: tuberculosis 22 cases, 52%, rheumatic pericarditis 6 cases or 14.3%, chronic parietal endocarditis 5 cases (11.9%), bacterial pericarditis with trivial germ 3 cases (7.1% 3 cases (7.1%), post-surgery syndrome 2 cases (4.8%), umbilical post-catheterization 1 case (2.4%). HIV serology was positive in 11.9% of cases. The progression was favorable in 55% of the cases with 10% of deaths. Conclusion: Fluid pericarditis in children is a severe condition that is clearly on the rise today, especially in immunocompromised patients. Optimal management of fluid pericarditis in children is the best guarantee to avoid short-term tamponade and in the medium term constriction.

Cardiac tamponade is an important and potentially lethal complication of acute pericarditis. However, recurrence of cardiac tamponade is rare when it is treated appropriately. We present a 49-year-old man with bacterial pericarditis and recurrent cardiac tamponade, which was caused by the rupture of an upper part of the left atrium (LA). According to the autopsy findings, bacteremia from Staphylococcus aureus developed on a substrate of poorly controlled diabetes mellitus and spread to the pericardium via the blood. Subsequently, tissue necrosis developed from the pulmonary trunk and aorta to the LA, leading to recurrence of cardiac rupture and cardiac tamponade.

Acute bacterial pericarditis is rarely encountered in the modern antibiotic era. Purulent pericarditis is a serious form of bacterial pericarditis with high mortality. It can rapidly progress to cardiac tamponade, leading to hemodynamic instability, septic shock, and death if left untreated. Here we present a case of massive purulent pericarditis with cardiac tamponade that was successfully managed with intravenous antibiotics and drainage in a young immunocompetent man.

Se presenta el caso de un paciente de sexo masculino, de 35 años de edad, en hemodiálisis, que desarrolló un cuadro progresivo de insuficiencia cardíaca de predominio derecho. Una ecocardiografía reveló derrame pericárdico con patrón constrictivo en el llenado de cavidades derechas, tabicación, ausencia de daño valvular y buena función sistólica y diastólica del ventrículo izquierdo. Se realizó un drenaje pericárdico con pericardiectomía amplia, aislándose en el cultivo de líquido y tejido pericárdico un microorganismo del grupo HACEK, Cardiobacterium hominis, con hemocultivos reiteradamente negativos. Es un caso infrecuente de pericarditis bacteriana por una bacteria atípica, sin endocarditis. Se postulan los mecanismos de infección y se discute la escasa literatura científica disponible.