Purulent pericarditis

Purulent pericarditis caused by methicillin-sensitive Staphylococcus aureus bacteriuria

BACKGROUND

Purulent pericarditis (PP)- a purulent infection involving the pericardial space-requires a high index of suspicion for diagnosis as it often lacks characteristic signs of pericarditis and carries a mortality rate as high as 40% even with treatment. Common risk factors include immunosuppression, diabetes mellitus, thoracic surgery, malignancy, and uremia. Most reported cases of PP occur in individuals with predisposing risk factors, such as immunosuppression, and result from more commonly observed preceding infections, such as pneumonia, osteomyelitis, and meningitis. We report a case of PP due to asymptomatic bacteriuria in a previously immunocompetent individual on a short course of high-dose steroids.

CASE PRESENTATION

An 81-year-old male presented for severe epigastric pain that worsened with inspiration. He had been on high-dose prednisone for presumed inflammatory hip pain. History was notable for urinary retention requiring intermittent self-catheterization and asymptomatic bacteriuria and urinary tract infections due to methicillin-sensitive Staphylococcus aureus (MSSA). During the index admission he was found to have a moderate pericardial effusion. Pericardial fluid cultures grew MSSA that had an identical antibiogram to that of the urine cultures. A diagnosis of purulent pericarditis was made.

CONCLUSION

PP requires a high index of suspicion, especially in hosts with atypical risk factors. This is the second case of PP occurring as a result of asymptomatic MSSA bacteriuria. Through reporting this case we hope to highlight the importance of early recognition of PP and the clinical implications of asymptomatic MSSA bacteriuria in the setting of urinary instrumentation and steroid use.

Endogenous Purulent Pericarditis Due to Klebsiella aerogenes in a Patient With Traumatic Chest Injury: A Case Report

Purulent pericarditis is a rare but serious medical condition caused by an infection that spreads to the pericardial space surrounding the heart. Gram-positive organisms are the most common pathogens associated with purulent pericarditis. However, there has been a shift in recent years toward gram-negative bacteria. Klebsiella aerogenes is a rare pathogen that has never been linked to purulent pericarditis. In this report, we describe the case of a 40-year-old male patient with chronic bronchiectasis who, two months after suffering an injury, developed purulent pericarditis due to an uncommon organism, K. aerogenes. During his stay in the hospital, the patient developed several infections caused by K. aerogenes. These included bacteremia and ventilator-associated pneumonia (VAP). Beta-lactamase-inducible K. aerogenes was grown in pericardial fluid culture following an emergency pericardiocentesis. The organism was resistant to carbapenems in a sputum culture, even though it was sensitive to meropenem in a blood culture. The patient had hypotension, requiring inotropes, and continued persistent bacteremia due to K. aerogenes. The patient had a heart attack with no pulse or electrical activity and died despite getting the best care possible. In light of this example, it is crucial to think about K. aerogenes and other rare organisms as possible pathogens in purulent pericarditis, especially in people who do not normally have known risk factors for this condition. Multidrug resistance patterns can make treatment more complicated, and aggressive care may be necessary in critically ill patients with chronic bacteremia.

Beyond Pneumonia: A Rare Case of Pericardial Empyema Caused by Streptococcus pneumoniae

Purulent pericardial effusion is a rare but potentially deadly condition that demands immediate medical attention. When left untreated, it can have catastrophic consequences. While bacterial infection is the most common cause of this condition, it usually occurs in individuals with weakened immune systems or in those undergoing dialysis or thoracic surgery. This case report presented here is unique as it chronicles the uncommon experience of a 58-year-old male with a normally functioning immune system who suffered from purulent pericardial effusion, endocarditis, and pneumonia, all linked to septic arthritis of his knee caused by Streptococcus pneumoniae. The diagnosis and management of this condition require a swift and comprehensive approach, and any delay in treatment can have dire outcomes. This case highlights the significance of early detection and prompt treatment of purulent pericardial effusion to prevent severe complications and improve patient prognosis.

Pyo-pericardium secondary to bacteremia in intra-venous drug user

Pyo-pericardium is a collection of purulent fluid in the pericardial sac. It is a rare finding seen in less than 1% of patients who develop acute pericarditis. The condition, though uncommon, has a mortality risk of 100% in untreated patients and 40% in treated patients. Most of the reported cases in the literature describe the occurrence of pyo-pericardium in IV drug users that's secondary to needle fragment embolization to the pericardium diagnosed through an echocardiogram and CT scan with no evidence of bacteremia. Unlike reported cases, we present a case of pyo-pericardium in a 37-year-old woman with bacteremia from a wound infection on her leg secondary to IV drug use. Needle embolization was ruled out in our case as no foreign object was identified on echocardiography or CT scan. Prompt identification followed by aggressive treatment with pericardial window and systemic antibiotics is crucial for decreasing mortality in such high-risk patients.

A Disastrous Omen - Candidal Pyo pneumopericardium

Pyo-pneumopericardium or purulent pericarditis is a rare medical entity associated with high mortality. We hereby report a rare case of a 25-years old lady with pyo-pneumopericardium, aspirated pus culture from the pericardial cavity of which grew yeast (Candida species) like organism. This patient underwent a pericardiocentesis and was initiated on generic antibiotic treatment. However, despite the best possible medical management, she succumbed to her illness. This is a rare case report from India and an addition to the already available literature.

Idiopathic Purulent Pericarditis Caused by Methicillin-Sensitive Staphylococcus Aureus in an Immunocompetent Adult

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 Staphylococcusaureus (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 Staphylococcusaureus. 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.

A successfully treated case of primary purulent pericarditis complicated by cardiac tamponade and pneumopericardium

Acute pericarditis is caused by various factors, but purulent pericarditis is rare. Primary purulent pericarditis in immunocompetent hosts is very rare in the modern antibiotics era. We report a successfully treated case of primary purulent pericarditis complicated with cardiac tamponade and pneumopericardium in an immunocompetent host. A 69-year-old female was referred from another hospital because of pleuritic chest pain with a large amount of pericardial effusion. She was diagnosed with acute pericarditis accompanied by cardiac tamponade. We performed emergency pericardiocentesis, with drainage of 360 ml of bloody pericardial fluid. The culture grew Streptococcus anginosus, confirming the diagnosis of acute purulent pericarditis. We performed pericardiostomy because cardiomegaly and pneumopericardium were aggravated after removal of the pericardial drainage catheter. The patient received antibiotics for a total of 23 days intravenously and was discharged with oral antibiotic therapy. Purulent pericarditis is one of the rare forms of pericarditis and is life-threatening. A multimodality approach is required for proper diagnosis and treatment of this disease.

Rare purulent pericarditis caused by carbapenem-resistant Acinetobacter baumannii: A case report

BACKGROUND

Pericardial infection caused by Acinetobacter baumannii is rare, particularly that of carbapenem-resistant A baumannii (CRAB).

CASE PRESENTATION

We describe a rare case of purulent pericarditis due to CRAB in a 76-year-old man with acute myocardial infarction and acute kidney injury. The man was admitted to the intensive care unit for a catheter-related bloodstream infection. Pericardial effusion was detected via the bedside X-ray and ultrasound, and pericardiocentesis was performed. Cultures of the pericardial fluid, catheter tip, and blood independently revealed the presence of CRAB. These findings confirmed a diagnosis of purulent pericarditis.

CONCLUSIONS

Clinicians should be reminded that CRAB infection can lead to purulent pericarditis, particularly in patients with congestive heart failure or renal insufficiency.

Streptococcus pyogenes Pericarditis with Resultant Pulmonary Trunk Compression Secondary to Mycotic Pseudoaneurysm

Purulent pericarditis is a rare disease in the era of antibiotics, with Streptococcus pyogenes being a possible, though uncommon etiology. Even more uncommon are mycotic aneurysms secondary to group A strep purulent pericarditis and bacteremia. We report a case of an 18-year-old female with a history of strep pharyngitis develop Streptococcus pyogenes purulent pericarditis with subsequent ventricular fibrillation (VF). Following initial stabilization, she ultimately developed a 4.8 cm mycotic aneurysm of the ascending aorta, with resultant compression of the pulmonary trunk and right pulmonary arteries.

Pyopericardium progressing to tamponade in a patient with immune thrombocytopenia

Pericardial effusion can develop during any stage of pericarditis, and small effusions that appear rapidly can cause cardiac tamponade. Pyopericardium is a rare aetiology for tamponade. This is a case of an elderly diabetic lady, on steroid therapy for immune thrombocytopenia, who presented with fever and acute dyspnoea. She developed cardiac tamponade due to pyopericardium with Staphylococcus as the causative organism. Staphylococcus pyopericardium, in the absence of a primary focus of infection, progressing to tamponade is an uncommon scenario.

Primary purulent bacterial pericarditis due to Streptococcus intermedius in an immunocompetent adult: a case report

Background

Acute purulent bacterial pericarditis is of rare occurrence in this modern antibiotic era. Primary involvement of the pericardium without evidence of underlying infection elsewhere is even rarer. It is a rapidly progressive infection with high mortality. We present an extremely rare case of acute purulent bacterial pericarditis in an immunocompetent adult patient with no underlying chronic medical conditions.

Case presentation

A 33-year-old previously healthy white man presented with the complaints of chest pain and dyspnea. He was diagnosed as having acute pericarditis and was discharged home on indomethacin. Over a period of 2 weeks, his symptoms worsened gradually and he was readmitted to our hospital. He was found to have large pericardial effusion with cardiac tamponade. An urgent pericardiocentesis was done with drainage of 550 ml of purulent material. Cultures grew Streptococcus intermedius confirming the diagnosis of acute purulent bacterial pericarditis. No other focus of infection was identified on imaging workup suggesting primary infection of the pericardium. His clinical course was complicated by development of constrictive pericarditis for which he underwent surgical pericardiectomy. He received a total of 7 weeks of intravenously administered antibiotics with complete clinical recovery.

Conclusions

Acute purulent bacterial pericarditis, although rare, should always be kept in mind as a possible cause of pericarditis. Early recognition and prompt intervention are important for a successful outcome.

Streptococcus intermedius: An Unusual Case of Purulent Pericarditis

Purulent pericarditis is a rare diagnosis with life-threatening implications due to the rapid accumulation of pericardial material, swiftly progressing to tamponade physiology. The nature of its quickly evolving and severe implications demands a low threshold for diagnostic consideration where appropriate. We present an unusual case of purulent pericarditis secondary to Streptococcus intermedius in a previously healthy male adolescent without traditional risk factors, which raises the question of whether emergent S. intermedius species may have acquired novel molecular mechanisms.

The unmasking of a pyopericardium

Pyopericardium is a rare condition with a high mortality rate in which infection propagates in the pericardial space, leading to a pus filled pericardial effusion and cardiac tamponade, which can cause cardiogenic shock and death. We present a case of a previously healthy woman of 52, who was admitted with a severe lower respiratory tract infection that eventually led to a pyopericardium. The diagnosis of pyopericardium was delayed due to masking of symptoms by her underlying infection, sepsis and an upper gastrointestinal bleed that the patient suffered during the admission, requiring an emergency gastroscopy. The pyopericardium was considered when ST elevation was seen on an ECG and an ECHO discovered a large pericardial effusion causing tamponade. An emergency pericardiocentesis drained frank pus. Treatment with intravenous antibiotics, frequent pericardial drainage and a pericardectomy led to an excellent outcome, and a full recovery.

Beware the normal angiogram

Purulent pericarditis is now rare due to the widespread use of antibiotics. However, it is associated with significant morbidity and mortality, and non-specific symptoms and signs can make diagnosis difficult. We report a patient who presented with left-sided chest pain, mild fever and ST segment elevation on electrocardiography, who required prolonged organ support in the intensive care unit. This lesson highlights the diagnostic difficulties and management challenges that this condition can present.

Purulent pericarditis caused by Haemophilus parainfluenzae

Bacterial pericarditis is a rare disease in the era of antibiotics. Purulent pericarditis is most often caused by Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae. The number of H. parainfluenzae infections has been increasing; in rare cases, it has caused endocarditis. We report a case of purulent pericarditis caused by H. parainfluenzae in a 62-year-old woman who reported a recent upper respiratory tract infection. The patient presented with signs and symptoms of pericardial tamponade. Urgent pericardiocentesis restored her hemodynamic stability. However, within 24 hours, fluid reaccumulation led to recurrent pericardial tamponade and necessitated the creation of a pericardial window. Cultures of the first pericardial fluid grew H. parainfluenzae. Levofloxacin therapy was started, and the patient recovered. Haemophilus parainfluenzae should be considered in a patient who has signs and symptoms of purulent pericarditis. Prompt diagnosis, treatment, and antibiotic therapy are necessary for the patient's survival. To our knowledge, this is the first report of purulent pericarditis caused by H. parainfluenzae.

Invasive group A streptococcus infection presenting as purulent pericarditis with multiple splenic abscesses: case report and literature review

Purulent pericarditis is a localized infection of the pericardium producing an effusion that is both microscopically and macroscopically purulent. Purulent pericarditis is most frequently caused by Staphylococcus, although rarely Streptococcus and other organisms are implicated. This article describes a case of invasive group A streptococcal disease presenting as purulent pericarditis with multiple splenic abscesses in a 4-year-old boy.

Pneumococcal Pyopericardium Masquerading as Acute Coronary Syndrome

A 54-year-old man was admitted with a one-week history of chest pain, increasing in severity and worsening dyspnoea. An ECG revealed changes consistent with an acute coronary syndrome (ACS) and a chest X-ray showed an enlarged cardiac shadow. Following admission to the coronary care unit for treatment of presumed ACS his condition deteriorated. A diagnosis of sepsis was made. A CT scan revealed a large pericardial and bilateral pleural effusions. Heart sounds were muffled and neck veins distended, suggesting pericardial tamponade. Echocardiography showed a global pericardial effusion ranging from 2–4 cm with haemodynamic compromise. Sub-xiphisternal pericardiocentesis revealed frank pus from the pericardial cavity and a total of 1,000 mL drained over 48 hours. Rapid haemodynamic improvement ensued. Streptococcus pneumoniae was isolated and the patient was successfully treated with intravenous antibiotics with no requirement for pericardial surgery. In the developed world acute purulent pericarditis is a rare entity with a high mortality rate. Only 10–20% of cases are diagnosed ante-mortem. The condition requires prompt recognition and immediate intervention. The diagnostic picture in this case was initially clouded by the suspicion of ischaemic coronary disease as well as the presence of sepsis. The presentation, management and risk factors associated with this unusual condition are discussed.

Diagnosis of pneumococcal pericarditis using antigen testing and polymerase chain reaction

Following the advent of antibiotics, pneumococcal pericarditis has become a rare clinical diagnosis. We discuss 2 cases of pneumococcal pericarditis that were preceded by community-acquired pneumonia. Cultures were negative in both patients and the diagnosis was made by antigen testing and polymerase chain reaction (PCR) of the pericardial fluid. PCR or antigen testing of pericardial fluid for pneumococci should be considered in patients with a typical history, particularly when culture-negative and with a history of prior antibiotics.

Purulent pericarditis: report of 2 cases and review of the literature

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.

Purulent pericarditis caused by the Streptococcus milleri group: a case report and review of the literature

A 69-year-old woman with a history of diabetes mellitus presented at our emergency room with chest pain and dyspnea. A chest computed tomography revealed a pericardial effusion. Pericardiocentesis was performed; strains of the Streptococcus milleri group were detected on culture of the fluid thus obtained. Therefore, purulent pericarditis was diagnosed. Despite treatment with panipenem/betamipron, the pericarditis worsened leading to the development of cardiac tamponade. Emergency pericardial drainage was performed, after which the condition resolved without any complications. We report an extremely rare case of purulent pericarditis caused by a strain of the Streptococcus milleri group. In addition, we review 5 previously reported cases of purulent pericarditis caused by strains.

Staphylococcal pericarditis in a chronic renal failure patient

A 34-year-old female with end-stage renal disease was admitted for severe metabolic acidosis, uremic encephalopathy, pericarditis and severe anemia following a bout of acute gastroenteritis. She improved on aggressive medical management including intensive hemodialysis and was initiated onto maintenance heparin-free hemodialysis (twelve hours per week) and discharged. After a week, she presented with fever with chills and rigors for three days, was toxic, severely orthopenic and had a pulsus paradoxus of 36 mmHg. Echocardiography suggested cardiac tamponade. Aspiration revealed frank pus with polymorphonuclear predominance and Staphylococcus aureus on culture. CT of the thorax revealed pericardial effusion. In the absence of any obvious septic foci, concomitant pleuro-pulmonary sepsis, mediastinal or intra-abdominal pathology; a diagnosis of "acute primary purulent pericarditis" was made. Patient was put on parenteral antibiotics-ceftriaxone and metrogyl. Vancomycin was added after sensitivity results. Pericardial drainage was required initially. After toxemia improved, paradox decreased and fever subsided, the pericardial catheter was removed and antibiotics continued for a period of four weeks. Maintenance hemodialysis was continued during hospital stay and after discharge.

Isolated pericardial empyema secondary to Staphylococcus aureus

Pericardial empyema, or purulent pericarditis, is a condition uncommonly encountered in routine medical practice but one which is rapidly fatal if left untreated. Early diagnosis is paramount if the patient is to survive. This case report highlights the covert nature of presentation which may occur, hindering early diagnosis, and reviews the current literature.

Purulent and constrictive pericarditis arising from a staphylococcal lumbar infection

A 78-year-old man was admitted to the hospital for evaluation and treatment of anasarca secondary to staphylococcal purulent pericarditis. One month earlier he had undergone a lumbar laminectomy that was complicated postoperatively by a lumbar abscess that was not clinically apparent. The infection subsequently spread to the pericardium. Despite aggressive therapy that included therapeutic pericardiocentesis, drainage of pericardial fluid, and prolonged intravenous antibiotic therapy, the patient returned 2 weeks after discharge from the hospital with complicating constrictive pericarditis. Pericardiectomy was performed, resulting in complete relief of the patient's symptoms.

Purulent pericarditis due to group B streptococcus and mycotic aneurysm of the ascending aorta: case report

A 61-year-old female, with a history of uterine and cervical cancer treated with radical hysterectomy and 2 years of postoperative chemotherapy, presented to the emergency department with dyspnea on exertion. Computed tomography of the chest revealed a large pericardial effusion and a sacciform aneurysm of the ascending aorta. The patient subsequently underwent emergency pericardiocentesis with drainage of approximately 330 ml of a bloody and turbid effusion. Cultures from the effusion yielded group B streptococcus. Multiple organ failure and disseminated intravascular coagulation syndrome occurred in the acute phase, but gradually improved with continuous antibiotic therapy. On the 194th hospital day, in situ reconstruction of the ascending aorta was successfully performed using a synthetic graft. Although rarely reported, both purulent bacterial pericarditis and mycotic aneurysm can be life-threatening.

Spontaneous Echo Contrast in Purulent Pericardial Effusion due to Non-Gas-Forming Organisms

We present the case of a 55-year-old man who developed massive pericardial effusion with tamponade within a 5-day period. During transthoracic two-dimensional echocardiographic examination, spontaneous echo contrast was visualized in pericardial effusion. A diagnosis of polymicrobial pyopericarditis was made when urgent pericardiocentesis revealed a significantly foul odor and purulent fluid that grew a culture of aerobes. After surgical drainage and appropriate antimicrobial therapy, this patient's pyopericarditis resolved. It was suggested that spontaneous echo contrast in pericardial effusion could be induced by non-gas-forming pyogenic cells.

Polymicrobial bacterial pericarditis with mediastinitis after endotracheal intubation

Polymicrobial bacterial pericarditis with mediastinitis after traumatic endotracheal intubation is an unusual condition. We report a 54-year-old man, a victim of nasopharyngeal carcinoma, who developed pericardial effusion with tamponade after traumatic endotracheal intubation. The diagnosis of polymicrobial bacterial pericarditis was made when pericardiocentesis revealed purulent fluid that grew a mixed culture of anaerobic and aerobic bacteria, reflecting the normal upper airway flora. By bronchoscopic study, a laceration over the lower trachea was detected. The patient received prolonged aggressive antibiotic therapy and pericardial drainage. The infection improved, but the patient later died from another episode of nosocomial infection.

Purulent pericarditis: review of a 20-year experience in a general hospital

OBJECTIVES

The purpose of this study was to review the features of purulent pericarditis in patients from a general hospital during a recent 20-year period.

BACKGROUND

Although studies published from 1974 to 1977 suggested a changing spectrum for purulent pericarditis, this view has not been proved.

METHODS

We retrospectively evaluated the records of 33 patients from one general hospital who had a diagnosis of purulent pericarditis during the period 1972 to 1991. All autopsy protocols from the same period were also reviewed. In 19 patients (group I), the condition was diagnosed during life; in 14 (group II), it was identified at autopsy.

RESULTS

In group I, the possible sources of pericardial infection were identified in 17 patients; pneumonia (6 patients) was the most common source. Empyema was present in 10 patients; 15 had cardiac tamponade. The most common microorganisms were streptococci, pneumococci and staphylococci. Six patients developed constrictive pericarditis and required pericardiectomy. Three patients died, 1 patient was lost to follow up and 15 patients had a favorable outcome at a mean follow-up interval of 35 months. In group II, the clinical diagnoses included pneumonia (five patients) among other infections, with empyema in six patients. Purulent pericarditis was probably the direct cause of death in two patients.

CONCLUSIONS

In our experience, the spectrum of purulent pericarditis has not changed in recent years. Many patients do not have the classical findings of pericarditis, and diagnosis is made only at autopsy or after tamponade has developed. Empyema remains a common predisposing condition. Purulent pericarditis is still a severe disease, but its prognosis is excellent in patients who can be discharged from the hospital.

Diagnosis and management of pericardial abscess in trauma patients

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.

Purulent pericarditis: recognition from the chest radiograph

A patient is described in whom the diagnosis of purulent pericarditis was made by chest radiograph because of the presence of air with a fluid level within the pericardial cavity and was confirmed subsequently at surgery.

The oxygen affinity of haemoglobin Tak, a variant with an elongated beta chain

The oxygen affinity was investigated of purified Hb Tak, a human haemoglobin variant with elongated beta-chains. A very low P50 value was found which was not influenced by the addition of 2,3 diphosphoglycerate. The n value was 1, indicating non-cooperativity. The oxygen equilibrium curve of the whole blood haemolysate containing Hbs A and Tak was close to that of Hb A at the top of the curve, while the bottom of the curve greatly deviated from the latter, indicative of small if any interaction between Hb A and Tak during oxygenation.