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Matsuo T, Matsuo CN, Matsuo N, Mori A, Murakami M, Ito H. Pericardial Effusion in Association With Periodontitis: Case Report and Review of 8 Patients in Literature. J Investig Med High Impact Case Rep 2024; 12:23247096241239559. [PMID: 38504421 PMCID: PMC10953104 DOI: 10.1177/23247096241239559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/27/2024] [Indexed: 03/21/2024] Open
Abstract
Periodontal diseases are well-known background for infective endocarditis. Here, we show that pericardial effusion or pericarditis might have origin also in periodontal diseases. An 86-year-old man with well-controlled hypertension and diabetes mellitus developed asymptomatic increase in pericardial effusion. Two weeks previously, he took oral new quinolone antibiotics for a week because he had painful periodontitis along a dental bridge in the mandibular teeth on the right side and presented cheek swelling. The sputum was positive for Streptococcus species. He was healthy and had a small volume of pericardial effusion for the previous 5 years after drug-eluting coronary stents were inserted at the left anterior descending branch 10 years previously. The differential diagnoses listed for pericardial effusion were infection including tuberculosis, autoimmune diseases, and metastatic malignancy. Thoracic to pelvic computed tomographic scan demonstrated no mass lesions, except for pericardial effusion and a small volume of pleural effusion on the left side. Fluorodeoxyglucose positron emission tomography disclosed many spotty uptakes in the pericardial effusion. The patient denied pericardiocentesis, based on his evaluation of the risk of the procedure. He was thus discharged in several days and followed at outpatient clinic. He underwent dental treatment and pericardial effusion resolved completely in a month. He was healthy in 6 years until the last follow-up at the age of 92 years. We also reviewed 8 patients with pericarditis in association with periodontal diseases in the literature to reveal that periodontal diseases would be the background for developing infective pericarditis and also mediastinitis on some occasions.
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Affiliation(s)
| | | | | | | | | | - Hiroshi Ito
- Okayama University, Japan
- Kawasaki Medical School, Okayama, Japan
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2
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Almutairi A, Cheema A, Joudeh A, Alqarni A, Albadr S, Alnaimi M. Pericardial mass: A rare form of cardiac actinomycosis case report. Ann Med Surg (Lond) 2022; 78:103854. [PMID: 35734661 PMCID: PMC9207081 DOI: 10.1016/j.amsu.2022.103854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Actinomycosis is a rare chronic infection caused by a group of anaerobic Gram-positive bacteria which inhabits commonly the oral cavity, colon, and genitourinary tract. Actinomycosis of the thorax is the third most common form. Pericardial actinomycosis is an extremely rare condition. Actinomycosis is characterized by its tendency to mimic malignancy as it can invade surrounding tissue and form a mass. Multiple manifestations should be noted by physicians as a result of the large variety of symptoms and the involvement of multiple organ systems. With proper treatment, it has a good prognosis. We describe a patient with an unusual clinical form of cardiac actinomycosis presenting as an isolated pericardial mass resembling a malignant tumor. Actinomycotic infection is rare but treatable disease. Pericardial involvement in actinomycotic infection is rare. Cardiac actinomycosis is usually secondary to contiguous spread from a pulmonary focus. Prognosis is excellent if the infection is diagnosed early and treated appropriately. This is a rare case of isolated pericardial actinomycosis mimicking malignancy treated successfully with surgery and long term penicillin therapy.
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3
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Bahlmann KN, Kennedy CR, Bandt C. Septic pericardial disease and mediastinal abscessation in a cat with an intrathoracic needle foreign body. J Vet Emerg Crit Care (San Antonio) 2022; 32:670-674. [PMID: 35442528 DOI: 10.1111/vec.13198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/08/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the successful management of a cat with an intrathoracic sewing needle foreign body and septic pericardial effusion. CASE SUMMARY A 10-year-old neutered female domestic longhair cat was referred for an intrathoracic metallic foreign body identified via thoracic radiography. Two weeks prior, the cat may have ingested a sewing needle. She was presented hemodynamically unstable; point-of-care thoracic ultrasound identified pericardial effusion with right atrial tamponade. Pericardiocentesis stabilized hemodynamic parameters. The effusion was grossly purulent, and bacterial culture grew an Actinomyces sp. The cat underwent a median sternotomy to remove the foreign body, debride associated mediastinal abscesses, and perform a partial pericardiectomy. Over the next 10 days, the cat was managed in hospital with a left unilateral thoracostomy tube and intermittent lavage of the pleural cavity. The cat was discharged, and follow-up at 7 days showed no evidence of pericardial or pleural effusion. NEW OR UNIQUE INFORMATION PROVIDED Contrary to previous reports, this case shows that extra-gastrointestinal, specifically intrathoracic, sewing needle foreign bodies can cause significant morbidity in cats. To the authors' knowledge, this report is the first to describe septic pericardial disease resulting from documented foreign body ingestion in the cat. It is also the first case report of successful surgical management of mediastinal abscessation in the cat.
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Affiliation(s)
- Kaitlin N Bahlmann
- Canada West Veterinary Specialists and Critical Care Hospital, Vancouver, British Columbia, Canada
| | - Christopher R Kennedy
- Canada West Veterinary Specialists and Critical Care Hospital, Vancouver, British Columbia, Canada
| | - Carsten Bandt
- Canada West Veterinary Specialists and Critical Care Hospital, Vancouver, British Columbia, Canada
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4
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Wee LE, Tan AL, Lai SH, Ko KKK, Soo IX, Low JGH. Pericardial effusion and tamponade in a young woman. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:129-131. [PMID: 35224613 DOI: 10.47102/annals-acadmedsg.2021485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Liang En Wee
- Department of Infectious Diseases, Singapore General Hospital, Singapore
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5
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Saeed W, Adam M, Abdallah TA, Omrani AS. Percutaneous coronary intervention-associated Actinomyces oris. IDCases 2020; 22:e00929. [PMID: 32904293 PMCID: PMC7452463 DOI: 10.1016/j.idcr.2020.e00929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/22/2022] Open
Abstract
Coronary artery interventions are safe procedures yet have a risk of stent infection, bacteremia and sepsis, events that are rare but with high morbidity and mortality sequel. A few prior cases had reported post percutaneous coronary intervention (PCI) infections, abscesses and sepsis due to Staphylococcus aureus, followed by Pseudomonas aeruginosa. Cardiac Actinomyces infections are extremely rare. Here we report a case of a 50 year old patient who developed a post intervention Actinomyces oris epicardial abscess occluding right coronary artery with subsequent bacteremia eventually requiring open heart surgery. He was treated during and thereafter with IV penicillin and ceftriaxone for almost 8 weeks. We highlight during this review the available literature regarding risk factors, the possible theories of acquiring such bacterium at this unusual site as well as our patient's course and treatment outcome.
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Affiliation(s)
- Walaa Saeed
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Adam
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Tasneem A Abdallah
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | - Ali S Omrani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
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6
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Nishizawa S, Anan K, Tobino K, Okahisa M, Goto Y, Murakami K, Sueyasu T, Munechika M, Yoshimine K, Yoshino M. "Pulmonary Actinomycosis attributable to Actinomyces meyeri presenting as cardiac tamponade: a case report". Multidiscip Respir Med 2018; 13:19. [PMID: 29946465 PMCID: PMC6001145 DOI: 10.1186/s40248-018-0132-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, it is reported that Actinomyces meyeri is the most common species causing actinomycosis. However, to our knowledge, there was no report about pulmonary actinomycosis attributable to A. meyeri presenting as cardiac tamponade. CASE PRESENTATION Hereby we describe a case of pulmonary actinomycosis attributable to A. meyeri presenting as cardiac tamponade. At first, the patient was diagnosed with bacterial pericarditis with lung abscess in the left lower lung lobe and underwent pericardial drainage. Three days after the removal of the drainage tube, atrial fibrillation followed by cardiac arrest with asystole occurred and immediate cardiopulmonary resuscitation restored his circulation. Thereafter, he underwent pneumocentesis of the lung abscess and the culture grew A. meyeri. He was successfully treated with penicillin G. CONCLUSION This is the first case of pulmonary actinomycosis attributable to A. meyeri presenting as cardiac tamponade. We believe that an increased awareness of the disease is necessary to expedite diagnosis therefore minimizing morbidity and mortality.
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Affiliation(s)
- Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018 Japan
| | - Keisuke Anan
- Department of Respiratory Medicine, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-Ku, Kumamoto, 861-4193 Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018 Japan
| | - Masanobu Okahisa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018 Japan
| | - Yuki Goto
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018 Japan
| | - Kojin Murakami
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018 Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018 Japan
| | - Miyuki Munechika
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018 Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018 Japan
| | - Mai Yoshino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018 Japan
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Samia-Aly E, Madge S. Occult giant cell arteritis with an abnormal temporal artery finding and normal blood markers. Br J Hosp Med (Lond) 2017; 78:473. [PMID: 28783392 DOI: 10.12968/hmed.2017.78.8.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Emma Samia-Aly
- Ophthalmology Trainee, Hereford County Hospital, Wye Valley NHS Trust, Hereford HR1 2BN
| | - Simon Madge
- Consultant Ophthalmologist, Hereford County Hospital, Wye Valley NHS Trust, Hereford
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8
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Bellanti R, Chousou PA, Pugh PJ. Pericardial actinomycosis in a patient with oesophageal dysmotility and autoantibodies. Br J Hosp Med (Lond) 2017; 78:472-473. [PMID: 28783393 DOI: 10.12968/hmed.2017.78.8.472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Roberto Bellanti
- Foundation Year 2 Trainee, Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Panagiota A Chousou
- Specialty Training Registrar, Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Peter J Pugh
- Consultant Cardiologist, Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ
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9
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Broly E, Risse J, Maschino F, Wahl D. Cardiac Tamponade Due to Actinomyces odontolyticus Originating From a Dentigerous Cyst. J Oral Maxillofac Surg 2016; 74:2453-2456. [PMID: 27311847 DOI: 10.1016/j.joms.2016.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 11/18/2022]
Abstract
This report describes a rare case of pericardial effusion owing to Actinomyces odontolyticus in a 52-year-old woman that originated from a dentigerous cyst, which developed on the distal aspect of a lower left third molar. The cyst had remained asymptomatic for a long period, with no specific functional complications. This is the first case report of a patient with acute pericarditis in which the same strain of A odontolyticus was detected in an asymptomatic dentigerous cyst and in the pericardial fluid.
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Affiliation(s)
- Elyette Broly
- Resident, Department of Oral Pathology, Oral Medicine and Oral Surgery, Dental Faculty, University Hospital of Nancy, Nancy, France.
| | - Jessie Risse
- Hospital Practioner, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU de Nancy, Nancy, France
| | - François Maschino
- Hospital Practitioner, Department of Oral Pathology, Oral Medicine and Oral Surgery, Dental Faculty, University Hospital of Nancy, Nancy, France
| | - Denis Wahl
- University Professor and Hospital Practitioner, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU de Nancy, Nancy, France
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10
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Jung HY, Kim HY, Kim YK, Kim WT, Sung SY, Lee JH, Lee HS, Hwang HW, Cho MY, Park IH. A Rare Case of Pericardial Actinomycosis. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.1.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ho Yeon Jung
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Woo Taek Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Se Yong Sung
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyang Sun Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hye Won Hwang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Mee Yon Cho
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Il Hwan Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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11
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Llenas-García J, Lalueza-Blanco A, Fernández-Ruiz M, Villar-Silva J, Ochoa M, Lozano F, Lizasoain M, Aguado JM. Primary hepatic actinomycosis presenting as purulent pericarditis with cardiac tamponade. Infection 2011; 40:339-41. [PMID: 22002733 DOI: 10.1007/s15010-011-0200-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 09/14/2011] [Indexed: 12/25/2022]
Abstract
Cardiac tamponade constitutes an exceptional form of actinomycosis. We describe a case of primary hepatic actinomycosis presenting as purulent pericarditis with cardiac tamponade in a 20-year-old patient with previous esophagectomy and colonic interposition, successfully managed by computed tomography-guided percutaneous drainage and a prolonged course of antibiotic treatment. Actinomyces israelii was identified in the pericardial fluid by 16S rRNA gene sequencing. The literature on the simultaneous presentation of cardiac and hepatic actinomycosis is reviewed.
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Affiliation(s)
- J Llenas-García
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Universidad Complutense, Avda. de Córdoba, S/N, 28041, Madrid, Spain
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12
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Jha A, Yiengpruksawan A, Christiano AA, Jha N, Latika P. Actinomycosis of the Pancreas: A Case Report and Review. Gastroenterology Res 2010; 3:134-138. [PMID: 27942291 PMCID: PMC5139767 DOI: 10.4021/gr2010.05.207w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2010] [Indexed: 11/04/2022] Open
Abstract
Actinomyces is a normal commensal of the upper aerodigestive tract, colon and female reproductive tract. It can give rise to invasive disease in case of any breach in mucosal integrity, as well as, in patients with immunosuppression. Rarely, actinomycosis can involve the pancreas especially after episodes of pancreatitis or in post operative patients. We observed a case of actinomycosis affecting recurrent intraductal papillary mucinous neoplasm (IPMN) of pancreatic remnant, 5 years after a Whipple's procedure. Our patient, a 66 years old male with a history of Whipple's procedure for IPMN of pancreatic uncinate process, presented with repeated episodes of acute pancreatitis. Repeated radiological investigations (CT, MRI and EUS) revealed resolving pancreatitis with recurrent IPMN of the pancreatic tail. The patient underwent laparobotic assisted resection of the remnant pancreas and spleen 3 months later. Intraoperatively, in addition to the recurrent IPMN of pancreatic tail, we found a dense peripancreatic desmoplastic reaction with areas of thick yellow pus pockets in the remnant pancreatic body. Bacteriology and histopathology revealed it as a recurrent IPMN associated with actinomycosis of pancreas with chronic xanthogranulomatous changes. We conclude that actinomycosis of the pancreas is a rare entity with only 5 cases reported in English literature to the best of our knowledge. If diagnosed preoperatively, early institution of antibiotics can improve the surgical outcome. Fortunately, after diagnosis, we were able to start antibiotics in early postoperative period with successful outcome.
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Affiliation(s)
- Amalanshu Jha
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York, USA
| | - Anusak Yiengpruksawan
- Surgical Oncology, Minimal Invasive and Robotic Surgery, The Valley Hospital, Ridgewood, New Jersey, USA
| | | | - Neeti Jha
- Department of Internal Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, USA
| | - Prajna Latika
- Department of Internal Medicine, Bronx-Lebanon Hospital Center, Bronx, New York, USA
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13
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Parikh SV, Memon N, Echols M, Shah J, McGuire DK, Keeley EC. Purulent pericarditis: report of 2 cases and review of the literature. Medicine (Baltimore) 2009; 88:52-65. [PMID: 19352300 DOI: 10.1097/md.0b013e318194432b] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
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.
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Affiliation(s)
- Shailja V Parikh
- From the Departments of Internal Medicine, Divisions of Cardiology at University of Texas Southwestern Medical Center (SVP, JS, DKM), Dallas, Texas; Washington University (NM), St. Louis, Missouri; Duke University (ME), Durham, North Carolina; and University of Virginia (ECK), Charlottesville, Virginia
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14
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Abstract
Actinomycosis is an uncommon, chronic bacterial infection that induces both suppurative and granulomatous inflammation. Localized swelling with suppuration, abscess formation, tissue fibrosis, and sinus drainage characterizes this disease. The infection spreads contiguously, often forming draining sinuses that extrude characteristic but not pathognomonic "sulfur granules." Infections of the oral and cervicofacial regions are most common; however, any site in the body can be infected and it often mimics malignancy. Other regions that are often affected are the thoracic and abdominopelvic, as well as the central nervous system. Musculoskeletal and disseminated disease can also be seen, albeit rarely. Prolonged antimicrobial therapy with penicillin has typically been recommended for patients with all clinical forms of actinomycosis to prevent disease recrudescence.
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15
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Brook I. Pericarditis caused by anaerobic bacteria. Int J Antimicrob Agents 2008; 33:297-300. [PMID: 18789852 DOI: 10.1016/j.ijantimicag.2008.06.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
Abstract
This review describes the microbiology, diagnosis and management of pericarditis due to anaerobic bacteria. The predominant anaerobes isolated from patients with pericarditis are Gram-negative bacilli (mostly Bacteroides fragilis group) as well as Peptostreptococcus, Clostridium, Fusobacterium, Bifidobacterium and Actinomyces spp. Anaerobic bacteria can be recovered from pericarditis resulting from the following mechanisms: (i) spread from a contiguous site of infection, either de novo or following surgery or trauma (pleuropulmonary, oesophageal fistula or perforation, and odontogenic); (ii) spread from a site of infection within the heart, most commonly from endocarditis; (iii) haematogenous infection; and (iv) direct inoculation resulting from a penetrating injury or cardiothoracic surgery. Anaerobic Gram-negative bacilli have increased their resistance to penicillins and other antimicrobial agents in the last two decades. Identification of pathogens and determination of their antimicrobial susceptibility and beta-lactamase production are essential for adequate selection of antibiotic therapy effective against these organisms.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics and Medicine, Georgetown University School of Medicine, Washington, DC 20016, USA.
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16
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Acevedo F, Baudrand R, Letelier LM, Gaete P. Actinomycosis: a great pretender. Case reports of unusual presentations and a review of the literature. Int J Infect Dis 2008; 12:358-62. [PMID: 18164641 DOI: 10.1016/j.ijid.2007.10.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022] Open
Abstract
Actinomycosis is a rare, chronic disease caused by a group of anaerobic Gram-positive bacteria that normally colonize the mouth, colon, and urogenital tract. Infection involving the cervicofacial area is the most common clinical presentation, followed by pelvic region and thoracic involvement. Due to its propensity to mimic many other diseases and its wide variety of symptoms, clinicians should be aware of its multiple presentations and its ability to be a 'great pretender'. We describe herein three cases of unusual presentation: an inferior caval vein syndrome, an acute cholecystitis, and an acute cardiac tamponade. We review the literature on its epidemiology, clinical presentation, diagnosis, treatment, and prognosis.
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Affiliation(s)
- Francisco Acevedo
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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17
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Peters GL, Davies RA, Veinot JP, Burwash IG. Cardiac Actinomycosis: An Unusual Cause of an Intracardiac Mass. J Am Soc Echocardiogr 2006; 19:1530.e7-11. [PMID: 17138045 DOI: 10.1016/j.echo.2006.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Indexed: 11/20/2022]
Abstract
Actinomycosis is a chronic disease characterized by abscess formation, tissue fibrosis, and draining sinuses that may involve the cervicofacial area, thorax, abdominopelvic region, or central nervous system. We describe a patient with cardiac actinomycosis presenting with pericardial disease and an intracardiac mass. The diagnosis failed to be obtained by pericardiocentesis, but was obtained after echocardiographically guided biopsy of the intracardiac mass. The patient recovered with long-term penicillin therapy. A review of the literature highlights the frequent pericardial presentation of cardiac actinomycosis, the potential difficulty in making the diagnosis, and the remarkable clinical response and good prognosis that can result when the correct diagnosis is made and appropriate antibiotic therapy administered.
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Affiliation(s)
- Grant L Peters
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
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18
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Makaryus AN, Latzman J, Yang R, Rosman D. A rare case of Actinomyces israelii presenting as pericarditis in a 75-year-old man. Cardiol Rev 2005; 13:125-7. [PMID: 15831144 DOI: 10.1097/01.crd.0000148846.97618.aa] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Actinomyces israelii is a gram-positive bacillus that is rarely associated with infections in the general population. A. israelii belongs to the normal flora of the body and it rarely becomes pathogenic. Cardiac involvement is rare and in most cases involves the pericardium. Fewer than 20 cases of pericardial actinomycosis have been reported in the literature since 1950. We report the case of a 75-year-old man with a history of coronary artery disease with recent myocardial infarction and stent placement, atrial fibrillation, and recent colonic perforation with subsequent colectomy/colostomy who presented to our hospital with a 2-week history of left-sided chest pain. Workup revealed the presence of a pericardial effusion and pericarditis. Pericardial fluid analysis demonstrated A. israelii. An examination and discussion of the literature is performed regarding this rare manifestation of human actinomycosis.
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Affiliation(s)
- Amgad N Makaryus
- Division of Cardiology, North Shore University Hospital, Manhasset, New York 11030, USA
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20
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Jánoskuti L, Lengyel M, Fenyvesi T. Cardiac actinomycosis in a patient presenting with acute cardiac tamponade and a mass mimicking pericardial tumour. BRITISH HEART JOURNAL 2004; 90:e27. [PMID: 15084575 PMCID: PMC1768208 DOI: 10.1136/hrt.2003.031633] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A case of pericardial actinomycosis mimicking a pericardial tumour is reported. After the appearance of non-specific subpleural pulmonary nodules, a 48 year old woman presented with fever and clinical signs of pericardial tamponade. Subxiphoid pericardiotomy yielded a culture negative fluid and inflammatory reactive histopathology in the pericardial biopsy specimen. Because of suspected infection cefamandole was administered for 10 days and the patient became afebrile. The pericardial effusion recurred with no clinical signs two weeks later. Steroid medication resulted in rapid regression of the pericardial effusion. Subsequent echocardiography controls showed a tumour-like pericardial mass, confirmed by cardiac magnetic imaging. Surgical exploration led to the final histological diagnosis of actinomycosis. After high dose and long term penicillin G treatment the patient recovered fully with no recurrence during two years' follow up.
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Affiliation(s)
- L Jánoskuti
- III Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
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21
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Calvo D, González S, Fernández B, Fernández JA. Actinomicosis osteoarticular y retroperitoneal. A propósito de un caso. RADIOLOGIA 2004. [DOI: 10.1016/s0033-8338(04)77945-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Avisbal Portillo N, Rueda Ríos C, Benítez Domenech A. [Actinomycosis as the cause of pleural effusion]. Arch Bronconeumol 2002; 38:153-4. [PMID: 11900696 DOI: 10.1016/s0300-2896(02)75176-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Chaumentin G, Pariset C, Stouls T, Boibieux A, Reverdy ME, Baulieux J, Spitalier P, Biron F, Peyramond D. [Actinomyces meyeri disseminated actinomycosis disclosing pulmonary carcinoma]. Rev Med Interne 1997; 18:563-5. [PMID: 9255374 DOI: 10.1016/s0248-8663(97)80808-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The diagnosis of severe actinomycosis parallel to that of neoplasia leads to speculation of a possible fortuitous association. Because underlying conditions such as immuno-suppression are suspected in such disease, and to strengthen this hypothesis, we report one more case of disseminated actinomycosis associated with a malignant disease, namely an epidermoid pulmonary carcinoma. The diagnosis was made by thoracotomy a few months after the infectious episode. Two years later the patient recovered. The analysis of the literature data is in favor of a fortuitous association between both diagnoses.
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Affiliation(s)
- G Chaumentin
- Service de pathologie infectíeuse et tropicale, hôpital de la Croix-Rousse, Lyon, France
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Pastorín J, Gacía Gil D, León A. [Recurrent hemoptysis as a presentation form of thoracic actinomycosis]. Arch Bronconeumol 1996; 32:157. [PMID: 8634800 DOI: 10.1016/s0300-2896(15)30808-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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25
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Abstract
Pleural effusion represents an unusual but significant manifestation of actinomycosis, as illustrated in this case presentation. The diagnosis was made after bronchoscopy and examination of bronchoalveolar fluid and culture. No parenchymal abnormality was noted on the chest film.
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Affiliation(s)
- E L Coodley
- General Medicine Section, University of California, Irvine
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26
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Sato TT, Geary RL, Ashbaugh DG, Jurkovich GJ. Diagnosis and management of pericardial abscess in trauma patients. Am J Surg 1993; 165:637-41. [PMID: 8488952 DOI: 10.1016/s0002-9610(05)80451-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pericardial infection is an uncommon clinical entity after traumatic injury. Although invasive intervention is rarely necessary for mild pericardial inflammation, pericardial abscess can be life-threatening. The charts of 27 patients with pericarditis requiring management in the intensive care unit and/or invasive intervention at Harborview Medical Center during a 10-year period were reviewed. Six cases of trauma-related pericarditis were identified, including three cases of pericardial abscess following torso trauma without initial cardiac or pericardial injury. Pericardial abscess following trauma was associated with the sepsis syndrome and multiple system organ failure (MSOF) in all patients. Computed tomography and pericardiocentesis were useful diagnostic adjuncts. All patients required thoracotomy for pericardial drainage and pericardiectomy. Successful surgical management of pericardial abscess contributed to the resolution of sepsis, multiple end-organ dysfunction and, ultimately, patient survival in all cases. We conclude that pericardial abscess, although rare, should be considered a potential occult site of sepsis capable of driving MSOF in trauma patients. Expedient diagnosis and surgical drainage are essential for successful patient outcome.
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Affiliation(s)
- T T Sato
- Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle 98104
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