Asunto(s)
Absceso/complicaciones , Taponamiento Cardíaco/microbiología , Neumopericardio/complicaciones , Tuberculosis Ganglionar/complicaciones , Absceso/tratamiento farmacológico , Absceso/microbiología , Antibacterianos , Taponamiento Cardíaco/tratamiento farmacológico , Humanos , Masculino , Pericardiocentesis , Pericardio , Piperacilina/uso terapéutico , Neumopericardio/tratamiento farmacológico , Neumopericardio/microbiología , Tazobactam/uso terapéutico , Tuberculosis Ganglionar/tratamiento farmacológico , Tuberculosis Ganglionar/microbiología , Vancomicina/uso terapéutico , Adulto JovenRESUMEN
Purulent pericarditis caused by Streptococcus anginosus is extremely rare. A 66-year-old man underwent elective coronary artery bypass surgery. This was complicated by sternal wound dehiscence with drainage. Subsequently, he developed fever, progressive dyspnoea and presyncope. Echocardiography showed a large pericardial effusion with evidence of tamponade. He underwent emergent pericardiocentesis. The pericardial fluid culture grew S. anginosus He was treated with 4 weeks of intravenous ceftriaxone with complete clinical recovery. The source of infection was most likely the sternal wound which was overlooked during debridement and rewiring surgery.
Asunto(s)
Taponamiento Cardíaco/microbiología , Puente de Arteria Coronaria , Pericarditis/microbiología , Complicaciones Posoperatorias/microbiología , Infecciones Estreptocócicas/complicaciones , Streptococcus anginosus , Anciano , Humanos , Masculino , Supuración/microbiologíaRESUMEN
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.
Asunto(s)
Bacterias Anaerobias/efectos de los fármacos , Taponamiento Cardíaco/microbiología , Taponamiento Cardíaco/terapia , Pericarditis/microbiología , Pericarditis/terapia , Adulto , Antibacterianos/uso terapéutico , Fusobacterium/efectos de los fármacos , Humanos , Masculino , Pericardiocentesis , Prevotella intermedia/efectos de los fármacos , Enfermedades RarasAsunto(s)
Taponamiento Cardíaco/microbiología , Neumonía Bacteriana/complicaciones , Neumonía por Mycoplasma/microbiología , Adolescente , Taponamiento Cardíaco/diagnóstico por imagen , Infecciones Comunitarias Adquiridas , Femenino , Humanos , Neumonía Bacteriana/diagnóstico por imagen , Neumonía por Mycoplasma/diagnóstico por imagenAsunto(s)
Taponamiento Cardíaco/microbiología , Infecciones por Haemophilus/diagnóstico , Haemophilus influenzae/aislamiento & purificación , Pericarditis/microbiología , Antibacterianos/uso terapéutico , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/terapia , Femenino , Infecciones por Haemophilus/tratamiento farmacológico , Humanos , Lactante , Pericardiectomía/métodos , Pericarditis/diagnóstico , Pericarditis/terapiaAsunto(s)
Taponamiento Cardíaco/etiología , Infecciones por Haemophilus/complicaciones , Adulto , Antibacterianos/uso terapéutico , Consumo Excesivo de Bebidas Alcohólicas/complicaciones , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/microbiología , Femenino , Infecciones por Haemophilus/diagnóstico , Infecciones por Haemophilus/tratamiento farmacológico , Haemophilus influenzae , Humanos , Pericardiocentesis , Pericarditis/tratamiento farmacológico , Pericarditis/etiología , Pericarditis/microbiologíaRESUMEN
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.
Asunto(s)
Inmunocompetencia , Pericarditis/microbiología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/microbiología , Streptococcus intermedius/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/microbiología , Taponamiento Cardíaco/terapia , Dolor en el Pecho , Progresión de la Enfermedad , Disnea , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/microbiología , Derrame Pericárdico/terapia , Pericardiectomía , Pericardiocentesis , Pericarditis/complicaciones , Pericarditis/terapia , Infecciones Estreptocócicas/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Taponamiento Cardíaco/complicaciones , Taponamiento Cardíaco/microbiología , Pericarditis/complicaciones , Pericarditis/microbiología , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/diagnóstico , Uremia/complicaciones , Antibacterianos/uso terapéutico , Cultivo de Sangre , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/terapia , Terapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Líquido Pericárdico/microbiología , Pericardiocentesis , Pericarditis/diagnóstico , Pericarditis/terapia , Diálisis Renal , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/terapia , Staphylococcus aureus , Resultado del Tratamiento , Uremia/terapiaAsunto(s)
Dolor de Espalda/diagnóstico , Taponamiento Cardíaco/diagnóstico , Absceso Epidural/diagnóstico , Pericarditis/diagnóstico , Anciano , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Dolor de Espalda/microbiología , Dolor de Espalda/terapia , Taponamiento Cardíaco/microbiología , Taponamiento Cardíaco/terapia , Ecocardiografía Doppler , Electrocardiografía , Absceso Epidural/complicaciones , Absceso Epidural/microbiología , Absceso Epidural/terapia , Femenino , Humanos , Líquido Pericárdico/microbiología , Pericardiocentesis , Pericarditis/microbiología , Pericarditis/terapia , Pericarditis Constrictiva/diagnóstico , Pericarditis Constrictiva/microbiología , Pericarditis Constrictiva/terapia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Purulent pericarditis is uncommon among paediatric patients and cases caused by group A Streptococcus (GAS) are even rarer. We report a four-month-old female infant who was referred to the Royal Hospital, Muscat, Oman, in 2015 with pericardial effusion and cardiac tamponade. She had initially presented to a secondary hospital with a two-week history of fever, a runny nose and shortness of breath. Blood and pericardial fluid cultures confirmed GAS isolates. The infant was treated with a two-week course of antibiotics and made a complete recovery with no echocardiographical evidence of pericardial effusion at a two-month follow-up. To the best of the authors' knowledge, this case constitutes the youngest infant to present with GAS pericarditis. As invasive GAS infections can present in infancy, early recognition and treatment is required.
Asunto(s)
Taponamiento Cardíaco/microbiología , Derrame Pericárdico/microbiología , Pericarditis/microbiología , Infecciones Estreptocócicas , Streptococcus pyogenes/aislamiento & purificación , Femenino , Humanos , Lactante , OmánAsunto(s)
Aspergilosis/diagnóstico , Aspergillus flavus/aislamiento & purificación , Taponamiento Cardíaco/etiología , Disnea/etiología , Mediastinitis/microbiología , Adolescente , Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Taponamiento Cardíaco/microbiología , Diagnóstico Diferencial , Disnea/microbiología , Femenino , Humanos , Itraconazol/uso terapéutico , Mediastinitis/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
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.
Asunto(s)
Actinomicosis/diagnóstico , Taponamiento Cardíaco/microbiología , Quiste Dentígero/diagnóstico , Pericarditis/microbiología , Enfermedades Dentales/diagnóstico , Actinomicosis/complicaciones , Actinomicosis/microbiología , Enfermedad Aguda , Quiste Dentígero/complicaciones , Quiste Dentígero/microbiología , Femenino , Humanos , Persona de Mediana Edad , Tercer Molar , Enfermedades Dentales/complicaciones , Enfermedades Dentales/microbiologíaRESUMEN
Cardiac tamponade may be the first or predominant symptom of some pathologies but its etiology is not uncommonly unknown on admission to hospital. The purpose of this study was to evaluate the predominant causes of cardiac tamponade in previously healthy patients treated emergently in a single cardiac surgical center. The study involved 81 patients with the mean age of 58.1±16.0 years who underwent emergent subxyphoid pericardiotomy due to cardiac tamponade. Pericardial effusion was analyzed macro- and microscopically. Examinations done in the cardiac surgical department revealed pericarditis secondary to infection (n=17) or autoimmunologic processes (n=2) and malignancy in 18 patients (predominantly of the lungs (n=11)). Pericardial effusion obtained from patients with viral and autoimmunologic-induced pericarditis was straw-color and odorless while with bacterial infections dark yellow, iridescent and usually malodorous. Additional workup in the regional hospitals enabled to reveal malignant tumors in 29 patients, leukemia or lymphoma in 5 subjects. In all but one of the neoplastic cases, pericardial fluid was turbid and dark red or plummy. In 10 patients etiology of tamponade remained unknown. In conclusion, cardiac tamponade in previously healthy patients may be occasionally the predominant symptom of cancer, especially of the lungs. Macroscopic intraoperative appearance of pericardial fluid may be helpful in identification of causative condition of cardiac tamponade.
Asunto(s)
Taponamiento Cardíaco/etiología , Neoplasias/complicaciones , Derrame Pericárdico/microbiología , Pericardiectomía/métodos , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/microbiología , Taponamiento Cardíaco/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/cirugíaRESUMEN
A 48-year-old man was referred for an abnormal shadow in his chest x-ray. Transbronchial needle aspiration cytology was performed at the mediastinal necrotic lymph node #7, and he was diagnosed as having small cell carcinoma. Fifteen days after bronchoscopy, sudden cardiac tamponade occurred and pericardial drainage suggested a diagnosis of bacterial pericarditis. He was successfully treated by drainage and administration of antibiotics. Complication of bacterial pericarditis associated with bronchoscopy is rare. However, physicians should watch for the appearance of this condition for up to 3 weeks after bronchoscopy, especially in cases with necrotic lymph nodes.
Asunto(s)
Taponamiento Cardíaco/etiología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/efectos adversos , Pericarditis/microbiología , Antibacterianos/uso terapéutico , Taponamiento Cardíaco/tratamiento farmacológico , Taponamiento Cardíaco/microbiología , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Pericarditis/tratamiento farmacológico , Pericarditis/etiología , Carcinoma Pulmonar de Células Pequeñas/diagnóstico , Resultado del TratamientoRESUMEN
Tuberculosis is a common pulmonary disease, which is still endemic in disadvantaged communities. Pericarditis is a rare but very lethal visceral localization. The authors report the case of a 58-year-old man, without neither medical history nor social risk, who presented a cardiac tamponade as the first and atypic manifestation of a visceral tuberculosis.
Asunto(s)
Taponamiento Cardíaco/microbiología , Pericarditis/microbiología , Tuberculosis/complicaciones , Enfermedad Aguda , Humanos , Masculino , Persona de Mediana Edad , Tuberculosis/diagnóstico , VíscerasRESUMEN
Bacterial pericarditis is a rapidly progressive and highly fatal infection, and is often diagnosed postmortem in half of the cases. Even with drainage and antibiotics, the mortality rate is high. Gram-positive cocci, specifically Streptococcus penumoniae, have been the most common cause of bacterial pericarditis with a preceding primary site of infection. Following the introduction of antibiotics in the 1940s and more recently the pneumococcal conjugate vaccine, the incidence has drastically decreased.We describe an extremely rare case of primary streptococcus pneumoniae purulent pericarditis that presented with cardiac tamponade. The patient was successfully treated with broad-spectrum antibiotics and urgent pericardiocentesis.Due to the high mortality rate with purulent pericarditis, a high index of suspicion is needed when acute pericarditis is suspected for early diagnosis to instate appropriate therapy with antibiotics and drainage.
Asunto(s)
Taponamiento Cardíaco/microbiología , Pericarditis/microbiología , Infecciones Neumocócicas/complicaciones , Streptococcus pneumoniae/aislamiento & purificación , Enfermedad Aguda , Antibacterianos/uso terapéutico , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/terapia , Terapia Combinada , Diagnóstico Diferencial , Drenaje , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Huésped Inmunocomprometido , Persona de Mediana Edad , Pericarditis/diagnóstico , Pericarditis/terapia , Infecciones Neumocócicas/diagnóstico , Infecciones Neumocócicas/terapia , Radiografía TorácicaAsunto(s)
Taponamiento Cardíaco/microbiología , Absceso Hepático/complicaciones , Absceso Hepático/microbiología , Pericarditis/microbiología , Adulto , Antibacterianos/uso terapéutico , Taponamiento Cardíaco/fisiopatología , Colecistectomía , Procedimientos Quirúrgicos del Sistema Digestivo , Electrocardiografía , Resultado Fatal , Humanos , Absceso Hepático/cirugía , Masculino , Pericarditis/tratamiento farmacológico , Rotura Espontánea/complicaciones , Rotura Espontánea/microbiología , Rotura Espontánea/cirugía , SucciónAsunto(s)
Taponamiento Cardíaco/microbiología , Neumonía Estafilocócica/complicaciones , Neumopericardio/microbiología , Taponamiento Cardíaco/diagnóstico por imagen , Resultado Fatal , Femenino , Humanos , Lactante , Neumonía Estafilocócica/diagnóstico por imagen , Neumopericardio/diagnóstico por imagen , RadiografíaRESUMEN
Nontyphoidal Salmonella, especially Salmonella enterica, is a rare cause of endocarditis and pericarditis that carries a high mortality rate. Proposed predisposing conditions include immunodeficiency states, congenital heart defects, and cardiac valve diseases. We present 2 cases of cardiovascular salmonellosis. The first case is that of a 73-year-old woman with mechanical mitral and bioprosthetic aortic valves who died from sequelae of nontyphoidal Salmonella mitral valve vegetation, aortic valve abscess, and sepsis. The second case is that of a 62-year-old man with a recent systemic lupus erythematosus exacerbation treated with oral steroids, who presented with obstructive features of tamponade and sepsis secondary to a large S. enteritidis purulent pericardial cyst. He recovered after emergent pericardial drainage and antibiotic therapy. Identifying patients at risk of cardiovascular salmonellosis is important for early diagnosis and treatment to minimize sequelae and death. We reviewed the literature to identify the predisposing risk factors of nontyphoidal Salmonella cardiac infection.