Pericardiectomy was carried out using one optical trocar and two operating trocars. Although it is an uncommon disease in man, aspergillosis is being recognized with increasing frequency. Purulent pericarditis can be an isolated occurrence but usually results from either direct or hematogenous spread from other primary sites of infection. A further reduction occurred with the addition of antibiotic therapy.
Pdf a case report of suppurative pericarditis researchgate. Purulent pericarditis symptoms, causes, diagnosis, and treatment information for purulent pericarditis bacterial pericarditis with alternative diagnoses, fulltext book chapters, misdiagnosis, research treatments, prevention, and prognosis. We describe an extremely rare case of primary streptococcus pneumoniae purulent pericarditis that presented with cardiac tamponade. Prior to the widespread use of antibiotics, purulent pericarditis was a. Apr 05, 2020 sagristasauleda j, barrabes ja, permanyermiralda g, solersoler j. The diagnosis was made in 18 of them during life, but only 6 survived, with an overall mortality rate of 77 per cent. Thoracoscopic pericardiectomy for purulent pericarditis. A case with an associated purulent pericarditis caused by eikenella corrodens is reported. Purulent pericarditis in aspergillosis annals of internal. We report a case of purulent bacterial pericarditis in a neonate caused by streptococcus pneumoniae serotype 7f. The 23valent pneumococcal polysaccharide vaccine ppv is available free of cost on national immunization programs in australia and the united kingdom and is effective at reducing ipd. Editor,we read with interest the report by moraes et al of a left ventricular pseudoaneurysm complicating infective pericarditis. The infection usually is caused by aspergillus fumigatus, and typically is confined to the bronchopulmonary system, where it appears as an abscess, granuloma, mycetoma, pneumonitis, lofflers syndrome 1, or a condition resembling farmers lung 2. The diagnosis was established clinically in 26 cases.
Purulent pneumococcal pericarditis is a rare but often fatal manifestation of invasive pneumococcal disease ipd. Suppurative pericarditis is defined as an infection of the pericardial space that produces pus that is found on. The term intermittent pericarditis refers to patients with symptom free. Intrapericardial streptokinase in purulent pericarditis. Occult purulent pericarditis detected by indium111. This is the method recommended in the european society of cardiology guidelines. Medline abstract for reference 1 of purulent pericarditis. This patient presented with sinus tachycardia, confusion, poor systemic perfusion, and pulmonary edema. In 1941, strieder1 observed that this rate had been reduced to 50% by the introduction of surgical. Delayed diagnosis of purulent pericarditis caused by.
We present the case of a 57yearold male, admitted with a short history of pleuritic chest pain and dyspnoea. Unfortunately, the diagnosis is made postmortem in more than half the cases. Adapted from 14 cause accountable cases infection bacterial 18% tuberculosis 4% viral 110% autoimmune rheumatoid arthritis 1150% systemic lupus erythematosus 25% after autopsy 62%. Following the introduction of antibiotics in the 1940s and more recently the pneumococcal conjugate vaccine, the incidence has drastically decreased. Pdf purulent pericarditis is a rare condition in the modern antibiotic era. An urgent pericardiocentesis was done with drainage of 550 ml of. It generally presents with acute cardiovascular decompensation and a sepsislike appearance.
Signs of tamponade see section pericardial effusion and cardiac tamponde. Bacterial pericarditis has become a clinical rarity since the onset of antimicrobial therapy, yet remains fatal in a large majority of cases. This distinction is important since purulent material in the pericardium is not synonymous with infectious pericarditis, and not all infections produce purulent effusions. Streptococcus pneumoniae purulent pericarditis in a neonate. Purulent pericarditis is a lifethreatening disease that usually manifests following bacteraemia or through spreading from an intrathoracic focus. Purulent constrictive pericarditis caused by nocardia. Only a few cases of this disease have been reported with lancefield group c streptococci as aetiological agents, and the primary focus in these infections remains unknown. Pericarditis refers to the inflammation of the pericardial layers, resulting from a variety of stimuli triggering a stereotyped immune response, and characterized by chest pain associated often. Full text full text is available as a scanned copy of the original print version. The organism usually affects the lung or brain, but almost any organ may be involved. We report the first case of purulent pericarditis with greenish pericardial effusion caused by shewanella algae in a patient with gastric and gallbladder cancer. Diagnosis and management of acute pericardial syndromes. Primary purulent bacterial pericarditis due to streptococcus.
Bacterial infections of the pericardial space are an uncommon cause of pericardial effusion. Introduction nontuberculous purulent pericarditis of bacterial origin was associated with a case fatality rate of 100% prior to the utilization of surgical drainage and antibiotic therapy. Full text get a printable copy pdf file of the complete article 762k, or click on. Purulent pneumococcal pericarditis, a vaccinepreventable. Acute primary pneumococcal purulent pericarditis with.
Prior to the widespread use of antibiotics, purulent pericarditis was a frequent complication of pneumococcal pneumonia. The treatment of purulent pericarditis by free incision. The presentation is often acute, with rapid progression to tamponade unless a drainage procedure is performed. The authors present two cases of purulent pericarditis secondary to pneumococcus pneumonia, a rare entity in the antibiotic era, one of them in an apparently healthy person.
Mean sd 861 678 ml range 2402000 of thick purulent fluid was drained, and five children had complete clearance of the pus within 38 days. A markedly elevated whitecell count suggests the presence of purulent pericarditis. Occult purulent pericarditis detected by indium111 leukocyte. In eight patients, purulent pericarditis developed in the early postoperative period after thoracic surgery. Klacsmann et al 47 examined 200 cases of purulent pericarditis over an 86year period, dividing patients into 2 groups. The mortality rate ranges from 14 to 40% and pyopericardium or purulent pericarditis is rare. Thus, a high index of clinical suspicion is crucial. In modern times, most cases of purulent pericarditis are associated with nosocomial bloodstream infections such as in the setting of dialysis, thoracic surgery, or immunosuppression eg, hiv, chemotherapy. Twentysix patients with purulent pericarditis were seen at the massachusetts general hospital between 1960 and 1974.
In hd patients it is a common observation that bacteraemia gets complicated with endocarditis, epidural abscess, purulent pericarditis, septic arthritis, septic pulmonary emboli, liver abscess and endophthalmia. In patients without a symptom free interval of at least 4 to 6 weeks generally the duration of proposed medical therapy and drug tapering for pericarditis, the term incessant pericarditis has been proposed by experts rather than recurrent pericarditis because it is characterized by continuous or intermittent symptoms without remission. Purulent pericarditis accompanying pericardial abscess induced by nocardia in an immunocompromised patient. Atraumatic suppurative mediastinitis is an uncommon infection. There are five pathogenic mechanisms that can lead to invasion of the pericardial space in secondary. The first case was a 38yearold man admitted to our intensive care unit icu for management of constrictive pericarditis complicating purulent pericarditis diagnosed 17 days previously. Clinical diagnosis can be difficult in patients with pneumonia as the heart is not always enlarged. The vast majority of patients in the preantibiotic era 86% had an underlying infectious disease of which 72% was pneumonia in comparison with only 22% in the postantibiotic era.
Prior to the advent of antibiotics, purulent pericarditis. The condition was always secondary to a septic focus elsewhere, usually staphylococcal pneumonia. Atraumatic suppurative mediastinitis and purulent pericarditis due to eikenella corrodens. Get a printable copy pdf file of the complete article 592k, or click on a page image below to browse page by page. Transdiaphragmatic rupture of hepatic abscess producing purulent pericarditis and pericardial tamponade.
The ingested foreign body may rarely make perforation of the lower esophagus and cause an esophagopericardial fistula followed by purulent pericarditis. The fish bone in the esophageal wall was not shown through flexible fiberoptic esophagoscope or on chest xray films, but readily on ct scan. The incidence of the condition is probably increasing, particularly in the immunocompromised. Jan 23, 2008 bacterial pericarditis has become a clinical rarity since the onset of antimicrobial therapy, yet remains fatal in a large majority of cases.
This case expands the reported spectrum of infection caused by s. The predisposing factors for purulent pericarditis have changed over time. One child developed intrapericardial haemorrhage with a submitral pseudoaneurysm and underwent patch closure of the neck of. Submitral pseudoaneurysm in purulent pericarditis heart. Clinical and hemodynamic features of constrictive pericarditis may dissipate spontaneously, which is seen commonly 20% in idiopathic acute pericarditis with effusion, but may also be seen in tuberculous and purulent pericarditis. Purulent pericarditis is an infrequent, but important complication of infective illnesses, in particular pneumonia, which if diagnosed early has a good prognosis. Purulent pericarditis is defined as an infection in the pericardial space that produces macroscopically or microscopically purulent fluid. A free powerpoint ppt presentation displayed as a flash slide show on id. Authors of over 50 institutions that have signed a publish and read agreement with the. The pericarditis is signaled by the arrow and corresponds to a removal of the two leaflets of the pericardium that is the heart envelope. Pleural insufflation with carbon dioxide was maintained at 24 mm hg. Takashima a, yagi s, yamaguchi k, watanabe s, yamamoto n, ito h, kadota m, hara t, yamazaki h, ise t, kusunose k, tobiume t, yamada h, soeki t, wakatsuki t, sata m.
The clinical diagnosis of acute pericarditis is based on simple criteria. We report a case of purulent pericarditis with septic and. Despite advances in diagnostic and treatment modalities, purulent pericarditis remains a lifethreatening illness. Early recognition and prompt management of the lesion is keystone to improve.
Acute primary pneumococcal purulent pericarditis with cardia. If suspected purulent, tuberculous, or neoplastic peri. The authors present two cases of purulent pericarditis secondary to. Pdf purulent bacterial pericarditis from staphylococcus aureus. Eleven children under 16 years of age with purulent pericarditis were seen in one hospital in one year. Purulent bacterial pericarditis from staphylococcus aureus ncbi. Although cases of bacterial pericarditis caused by streptococcus pneumoniae as. Tuberculous pericarditis and purulent pericarditis are very uncommon in spain. Purulent pericarditis and pneumonia caused by streptococcus. Transdiaphragmatic rupture of hepatic abscess producing. Investigations led to diagnosis of pyopericardium, most likely secondary to fistulating thoracic malignancy. Sagristasauleda j, barrabes ja, permanyermiralda g, solersoler j. The term intermittent pericarditis refers to patients with symptomfree.
Although several infectious agents account for the majority of infections, the differential diagnosis is broad. Tuberculosis pericarditis is a lethal condition and can be life threatening if prompt treatment is delayed. Necrotizing pneumonia and acute purulent pericarditis caused by streptococcus pneumoniae serotype 19a in a healthy 4yearold girl after one catchup dose of valent pneumococcal conjugate vaccine. Thus, in our opinion, the guidelines for clinical practice of the european society of. Hence, a primarily conservative approach may alleviate the need for epicardiectomy. In conclusion, we have demonstrated that striking pericardial uptake on a wholebody indium111 leukocyte scan can occur with purulent pericarditis and relates to the presence of leukocytes in the pericardial fluid. Guidelines on the diagnosis and management of pericardial diseases. Pericarditis and cancer american college of cardiology. Purulent pericarditis, also called bacterial pericarditis, has a high mortality rate if not recognized early. Purulent pericarditis caused by group a streptococcus. Since indium111 leukocyte imaging may become the procedure of choice for occult infection, 8 x 8 coleman, re. Streptococcus pneumoniae purulent pericarditis in a.
Chronic forms with a 3month evolution may also take all these forms. Six consecutive children with proven purulent pericarditis were treated with pericardial irrigation with streptokinase. One child developed intrapericardial haemorrhage with a submitral pseudoaneurysm and. The incidence of the condition is probably increasing, particularly in the immunocompromised group of patients. He was found to have large pericardial effusion with cardiac tamponade. Purulent pericarditis with greenish pericardial effusion. Purulent pericarditis jama pediatrics jama network. Surgery was performed in 7 including excision of intrapericardial xanthogranuloma, pericardial tissue biopsy in a child with restrictive cardiomyopathy, and 5 patients with purulent pericarditis who underwent drainage procedures including pericardiotomy and mediastinal exploration for mediastinal fluid drainage and removal of adhesions in 2 patients table 2.
The clinical manifestation of tuberculous pericarditis can be nonspecific and varies with symptoms of fever, weight loss, night sweats and fatigue. Purulent pericarditis represents a subset of pericardial disease usually due to a nonviral infectious agent. It may be primary extremely rare or secondary to another infectious process. A purulent pericarditis caused by salmonella typhimurium. In patients who survive the acute episode, complications such as persistent pericarditis and constrictive pericarditis occur with relatively high frequency 3. Ppt pericarditis powerpoint presentation free to view. Drained pericardial fluid should be analyzed with gram staining and culture. This case demonstrates that striking pericardial uptake on a wholebody indiumifi leukocyte scan can occur with purulent pericarditis, and it reemphasizes how insidiously purulent pericarditis may present in an immunosuppressed patient. Most of the fistula is an acute illness associated with characteristic clinical finding and extremely high mortality 1,2.
Purulent pericarditis is defined as a localized infection of the pericardial space characterized by gross pus in the pericardium or microscopic purulence 20 leukocytes per oil immersion field. The presence of pericardial effusion with persistent fever with or without. Purulent pericarditis definition of purulent pericarditis. A diagnosis of purulent pericarditis and pericardial tamponade secondary to transdiaphragmatic rupture of hepatic abscesses was madethe etiology of abscess formation was thought to be. We present our experience in performing thoracoscopic pericardiectomy for purulent pericarditis in 21 children materials and methods. Purulent definition of purulent by medical dictionary. Authors of over 50 institutions that have signed a publish and read agreement with the society are now eligible for fee free open access. In 1941, strieder 1 observed that this rate had been reduced to 50% by the introduction of surgical drainage. Primary purulent pericarditis and secondary endocarditis. Frequency of the disorder under different causes of pericarditis. Anterior pericardiectomy was performed from the left phrenic nerve. The following case is reported because we believe it to be the first instance in the literature in which nocardial infection gave rise to purulent constrictive pericarditis and to emphasize the difficulty that may attend the diagnosis. Purulent bacterial pericarditis is an uncommon infection that manifests during childhood, and in the postantibiotic era streptococcus pneumoniae is an unusual cause. A case of chronic purulent pericarditis caused by the esophagopericardial fistula was managed by removal of a fish bone and pericardiectomy through median sternotomy without closing the fistula.
519 1444 1060 421 103 1088 742 1137 1027 1548 1288 1392 1437 253 1230 671 1204 778 863 164 1509 694 75 417 142 687 583 247 158 1325 1121 343 728 654 1190 174 1335 27 465 603 1307 1167 337 781