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3.
Turk Kardiyol Dern Ars ; 47(6): 507-511, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31483309

RESUMO

A 77-year-old man with a past medical history of myelodysplastic syndrome, coronary artery disease, hypertension, and chronic atrial fibrillation presented at the hematology outpatient clinic with progressive shortness of breath, weakness, and chest and back pain. Echocardiography was performed and the patient was diagnosed with severe pericardial effusion near the right ventricle. Pericardial drainage was performed. Erysipelothrix rhusiopathiae was isolated from the pericardial fluid. Complications of respiratory and renal failure developed during follow-up. The clinical and laboratory findings of vegetation on the tricuspid valve, pericardial effusion, and atrial fibrillation with a low heart rate suggested possible pancarditis. A multidisciplinary treatment approach with the cardiology and infectious disease departments was critical to successful management of this case.


Assuntos
Infecções por Erysipelothrix , Erysipelothrix , Pericardite , Idoso , Ecocardiografia , Infecções por Erysipelothrix/diagnóstico , Infecções por Erysipelothrix/microbiologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Líquido Pericárdico/microbiologia , Pericardite/diagnóstico , Pericardite/microbiologia , Pericárdio/diagnóstico por imagem
5.
Intern Med ; 58(21): 3103-3106, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292391

RESUMO

We herein report the first case of purulent pericarditis associated with aortic stent-graft infection in an 80-year-old Japanese man that was caused by methicillin-susceptible Staphylococcus aureus, which appropriate antibiotics failed to treat. The detailed clinical course and autopsy images revealed that purulent pericarditis associated with aortic stent-graft infection caused cardiac tamponade and eventually led to mortality. We therefore suggest that surgical procedures, including drainage, should be introduced for such cases.


Assuntos
Aorta/cirurgia , Pericardite/microbiologia , Infecções Estafilocócicas/complicações , Staphylococcus aureus , Stents/microbiologia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Aorta/microbiologia , Aorta/patologia , Tamponamento Cardíaco/etiologia , Evolução Fatal , Humanos , Masculino , Meticilina/uso terapêutico , Derrame Pericárdico/diagnóstico por imagem , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/patologia , Staphylococcus aureus/efeitos dos fármacos , Tomografia Computadorizada por Raios X , Falha de Tratamento
6.
Am J Case Rep ; 20: 975-979, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31281180

RESUMO

BACKGROUND Candida albicans is the principal human fungal opportunistic organism commonly detected in the gastrointestinal and genitourinary systems. Five species of candida (Glabrata, Tropicalis, Albicans, Parapsilosis, and Kruzei) are responsible for most cases of invasive candidiasis or candidemia, which is a growing public health concern due to the increasing complexity of patients, leading to a high fatality rate. CASE REPORT We report an extremely rare case of candida pericarditis due to esophagopericardial fistula in a young, heavy, alcoholic adult diagnosed by culture of the drained pericardial fluid, which showed a growth of Candida albicans. CONCLUSIONS We highlight the first case of candida pericarditis in immunocompetent adult successfully treated by pericardiocentesis and oral fluconazole.


Assuntos
Candida albicans/isolamento & purificação , Candidemia/microbiologia , Fístula Esofágica/complicações , Pericardite/microbiologia , Adulto , Antifúngicos/uso terapêutico , Candida albicans/efeitos dos fármacos , Candidemia/tratamento farmacológico , Candidemia/cirurgia , Dor no Peito , Fluconazol/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Masculino , Pericardiocentese , Pericardite/tratamento farmacológico , Pericardite/cirurgia
7.
Transpl Infect Dis ; 21(5): e13137, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31267603

RESUMO

A 68-year-old man presented for outpatient evaluation of dyspnea and new-onset atrial fibrillation 9 months after undergoing bilateral lung transplantation. Echocardiography prior to cardioversion raised concern for tamponade. Therapeutic pericardiocentesis returned fluid containing 1875 wbc/mcl (68% pmn) and yielded Cryptococcus neoformans in culture. Cryptococcal antigen was detected in serum at a titer of 1:20. Cerebrospinal (CSF) fluid was without evidence of inflammation and without detectable cryptococcal antigen. There was no radiographic evidence of pulmonary cryptococcosis. Cultures of blood and CSF were without growth. Liposomal amphotericin B (3 mg/kg/day) was administered for 15 days. Oral fluconazole was added on day seven of amphotericin, and the patient was discharged to home 3 days later. Daily dosages of prednisone (10 mg), mycophenolate (500 mg), and tacrolimus (3 mg) at discharge were the same as at hospital admission. He was readmitted 12 days later with dyspnea and with re-accumulation and loculation of pericardial fluid. A pericardial window was created. Pericardial fluid contained 722 wbc/mcl (35% pmn); Cryptococcus was not identified on direct examinations or cultures of pericardial fluid or tissue. Cryptococcus antigen was present in serum at 1:160. Liposomal amphotericin B was resumed and continued for 2 weeks followed by resumption of fluconazole. Mycophenolate was stopped. Prednisone and tacrolimus were continued. Restrictive pericarditis was evident 3 weeks after window creation. Colchicine was initiated, prednisone increased to 15 mg daily and pericardiectomy planned. We aim to raise awareness to Cryptococcus as a potential etiology for pericarditis in solid organ transplant recipients.


Assuntos
Criptococose/diagnóstico , Transplante de Pulmão/efeitos adversos , Pericardite/microbiologia , Transplantados , Idoso , Antifúngicos/uso terapêutico , Antígenos de Fungos/líquido cefalorraquidiano , Criptococose/tratamento farmacológico , Cryptococcus neoformans/isolamento & purificação , Ecocardiografia , Humanos , Masculino , Pericardite/diagnóstico , Resultado do Tratamento
10.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 126-129, Jan.-Mar. 2019. graf
Artigo em Português | LILACS | ID: biblio-985129

RESUMO

RESUMO Objetivo: Relatar um caso raro de uma criança com meningite associada a pericardite na doença pneumocócica invasiva. Descrição do caso: Este relato descreve uma evolução clínica desfavorável de um lactente feminino de 6 meses de idade, previamente hígido, que apresentou inicialmente sintomas respiratórios e febre. A radiografia de tórax revelou um aumento da área cardíaca sem alterações radiográficas nos pulmões. Após a identificação do derrame pericárdico, o paciente apresentou convulsões e entrou em coma. Pneumonia foi descartada durante a investigação clínica. Contudo, foi identificado Streptococcus pneumoniae nas culturas de líquor e sangue. O exame neurológico inicial foi compatível com morte encefálica, posteriormente confirmada pelo protocolo. Comentários: A pericardite purulenta tornou-se uma complicação rara da doença pneumocócica invasiva desde o advento da terapia antibiótica. Pacientes com pneumonia extensa são primariamente predispostos e, mesmo com tratamento adequado e precoce, estão sujeitos a altas taxas de mortalidade. A associação de meningite pneumocócica e pericardite é incomum e, portanto, de difícil diagnóstico. Por isso, uma alta suspeição diagnóstica é necessária para instituir o tratamento precoce e aumentar a sobrevida.


ABSTRACT Objective: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. Case description: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. Comments: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.


Assuntos
Humanos , Masculino , Feminino , Streptococcus pneumoniae/isolamento & purificação , Derrame Pericárdico/diagnóstico por imagem , Pericardite/diagnóstico , Pericardite/fisiopatologia , Pericardite/microbiologia , Pericardite/terapia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/fisiopatologia , Infecções Pneumocócicas/terapia , Ecocardiografia/métodos , Radiografia Torácica/métodos , Líquido Cefalorraquidiano/microbiologia , Evolução Fatal , Hemocultura/métodos , Meningite/diagnóstico , Meningite/fisiopatologia , Meningite/microbiologia , Meningite/terapia , Antibacterianos/administração & dosagem , Antibacterianos/classificação , Exame Neurológico/métodos
11.
Rev Paul Pediatr ; 37(1): 126-129, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30183802

RESUMO

OBJECTIVE: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. CASE DESCRIPTION: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. COMMENTS: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.


Assuntos
Antibacterianos , Meningite , Pericardite , Infecções Pneumocócicas , Streptococcus pneumoniae/isolamento & purificação , Antibacterianos/administração & dosagem , Antibacterianos/classificação , Hemocultura/métodos , Líquido Cefalorraquidiano/microbiologia , Ecocardiografia/métodos , Evolução Fatal , Feminino , Humanos , Lactente , Meningite/diagnóstico , Meningite/microbiologia , Meningite/fisiopatologia , Meningite/terapia , Exame Neurológico/métodos , Derrame Pericárdico/diagnóstico por imagem , Pericardite/diagnóstico , Pericardite/microbiologia , Pericardite/fisiopatologia , Pericardite/terapia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/fisiopatologia , Infecções Pneumocócicas/terapia , Radiografia Torácica/métodos
12.
Ann Thorac Surg ; 107(1): e27-e29, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29932888

RESUMO

A 58-year-old man presented with tamponade and underwent an emergency pericardiocentesis. We made the diagnosis of methicillin-resistant Staphylococcus aureus pericarditis based on culture results and treated the patient with pericardial drainage and antibiotics as the first-line therapy. After temporary relief, reaccumulation of effusion developed. We successfully created a pericardial window using thoracotomy, and the patient's postoperative course was uneventful. Methicillin-resistant Staphylococcus aureus pericarditis is an extremely rare and life-threatening illness. No consensus exists concerning the ideal surgical intervention. Creating a pericardial window using thoracotomy can be an effective definitive therapy for methicillin-resistant Staphylococcus aureus pericarditis, especially for patients with significant pericardial adhesions.


Assuntos
Tamponamento Cardíaco/etiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Técnicas de Janela Pericárdica , Pericardite/cirurgia , Infecções Estafilocócicas/cirurgia , Antibacterianos/uso terapêutico , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/cirurgia , Terapia Combinada , Quimioterapia Combinada , Ecocardiografia , Emergências , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Líquido Pericárdico/microbiologia , Pericardiocentese , Pericardite/complicações , Pericardite/tratamento farmacológico , Pericardite/microbiologia , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Tomografia Computadorizada por Raios X , Dispositivos de Acesso Vascular/efeitos adversos
13.
Kyobu Geka ; 71(12): 1023-1026, 2018 11.
Artigo em Japonês | MEDLINE | ID: mdl-30449871

RESUMO

A 69-year-old man was hospitalized urgently to the department of cardiology, with the progressive general malaise. On admission, his blood pressure was 80/42 mmHg, his white cell count 13,700/µl, and C-reactive protein 25.55 mg/dl suggesting existence of aggressive infection with impaired circulation. Massive pericardial effusion was detected in echocardiography. Pericardial drainage was undergone promptly. There was drainage of 700 ml and the property was purulent. Pneumococcus was detected by the culture test of the pericardial fluid. Antibiotic administration was started by a diagnosis of the purulent pericarditis. His general condition was improved. However, a rapidly expanding saccular aneurysm was found in a descending thoracic aorta by computed tomography( CT). As an infected thoracic aortic aneurysm secondary to the purulent pericarditis, we performed thoracic endovascular aneurysm repair (TEVAR). The intravenous administration of antibiotics was continued for 2 weeks after TEVAR, which was followed by oral antibiotic administration for 1 year. The aneurysm completely disappeared by CT, 10 months after TEVAR. In case with an infected thoracic aortic aneurysm, TEVAR can be a 1st choice of treatment, depending on a causative organism and the morphology of the aneurysm.


Assuntos
Aneurisma Infectado/etiologia , Aneurisma da Aorta Torácica/etiologia , Derrame Pericárdico/terapia , Pericardite/complicações , Idoso , Aneurisma Infectado/microbiologia , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Aorta Torácica , Aneurisma da Aorta Torácica/microbiologia , Aneurisma da Aorta Torácica/terapia , Proteína C-Reativa/análise , Drenagem/métodos , Humanos , Contagem de Leucócitos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/microbiologia , Pericardite/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Supuração/microbiologia , Supuração/terapia , Resultado do Tratamento
15.
Cardiol Young ; 28(12): 1481-1483, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30221617

RESUMO

Purulent pericarditis occurs rarely in the current antibiotic era. We describe clinical and echocardiographic features of purulent pericarditis in a previously healthy child with influenza and community-acquired methicillin-resistant Staphylococcus aureus co-infection. The child was already on appropriate antibiotics and had a very subtle clinical presentation, with prominent abdominal symptoms. Timely surgical drainage led to complete recovery.


Assuntos
Influenza Humana/complicações , Pericardite/microbiologia , Infecções Estafilocócicas/complicações , Antibacterianos/uso terapêutico , Pré-Escolar , Infecções Comunitárias Adquiridas , Humanos , Vírus da Influenza B , Masculino , Staphylococcus aureus Resistente à Meticilina , Pericardite/diagnóstico por imagem , Pericardite/tratamento farmacológico , Rifampina/uso terapêutico , Staphylococcus aureus , Vancomicina/uso terapêutico
17.
BMC Vet Res ; 14(1): 244, 2018 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-30134904

RESUMO

BACKGROUND: Pasteurella multocida type A (PmA) is considered a secondary agent of pneumonia in pigs. The role of PmA as a primary pathogen was investigated by challenging pigs with eight field strains isolated from pneumonia and serositis in six Brazilian states. Eight groups of eight pigs each were intranasally inoculated with different strains of PmA (1.5 mL/nostril of 10e7 CFU/mL). The control group (n = 12) received sterile PBS. The pigs were euthanized by electrocution and necropsied by 5 dpi. Macroscopic lesions were recorded, and swabs and fragments of thoracic and abdominal organs were analyzed by bacteriological and pathological assays. The PmA strains were analyzed for four virulence genes (toxA: toxin; pfhA: adhesion; tbpA and hgbB: iron acquisition) by PCR and sequencing and submitted to multilocus sequence typing (MLST). RESULTS: The eight PmA strains were classified as follows: five as highly pathogenic (HP) for causing necrotic bronchopneumonia and diffuse fibrinous pleuritis and pericarditis; one as low pathogenic for causing only focal bronchopneumonia; and two as nonpathogenic because they did not cause injury to any pig. PCR for the gene pfhA was positive for all five HP isolates. Sequencing demonstrated that the pfhA region of the HP strains comprised four genes: tpsB1, pfhA1, tpsB2 and pfhA2. The low and nonpathogenic strains did not contain the genes tpsB2 and pfhA2. A deletion of four bases was observed in the pfhA gene in the low pathogenic strain, and an insertion of 37 kb of phage DNA was observed in the nonpathogenic strains. MLST clustered the HP isolates in one group and the low and nonpathogenic isolates in another. Only the nonpathogenic isolates matched sequence type 10; the other isolates did not match any type available in the MLST database. CONCLUSIONS: The hypothesis that some PmA strains are primary pathogens and cause disease in pigs without any co-factor was confirmed. The pfhA region, comprising the genes tpsB1, tpsB2, pfhA1 and pfhA2, is related to the pathogenicity of PmA. The HP strains can cause necrotic bronchopneumonia, fibrinous pleuritis and pericarditis in pigs and can be identified by PCR amplification of the gene pfhA2.


Assuntos
Infecções por Pasteurella/veterinária , Pasteurella multocida/genética , Pasteurella multocida/patogenicidade , Doenças dos Suínos/microbiologia , Animais , Brasil , Broncopneumonia/microbiologia , Broncopneumonia/veterinária , Genes Bacterianos , Tipagem de Sequências Multilocus/veterinária , Infecções por Pasteurella/genética , Pasteurella multocida/isolamento & purificação , Pericardite/microbiologia , Pericardite/veterinária , Pleurisia/microbiologia , Pleurisia/veterinária , Reação em Cadeia da Polimerase/veterinária , Suínos , Virulência/genética
18.
Medicine (Baltimore) ; 97(28): e11286, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29995762

RESUMO

RATIONALE: Candida pericarditis is a rare condition with high mortality. Risk factors include thoracic surgery and immunosuppression. We report a case of candida pericarditis which developed forty-years after esophageal reconstruction surgery. PATIENT CONCERNS: A 42-year-old female presented with nausea, abdominal discomfort, and chest pain, and was found to have a cardiac tamponade secondary to candida pericarditis. Her notable risk factor was colonic interposition done during her infancy for esophageal atresia. DIAGNOSES: The patient underwent emergent pericardial window where 500cc of purulent fluid was drained. The pericardial fluid culture grew Candida albicans. INTERVENTIONS: Esophagram did not show any visible leak and the patient improved with surgical drainage and antifungal treatment with Caspofungin. Caspofungin was continued intravenously for a total of four weeks and was switched to fluconazole. OUTCOMES: An Echocardiogram performed one month after pericardial window revealed trivial pericardial effusion. Serum beta-D-glucan at the time was negative. LESSONS: This report highlights that candida pericarditis infection could occur as a late complication of colonic interposition. We also demonstrate the utility of using an echinocandin in treating this entity.


Assuntos
Candida albicans/isolamento & purificação , Drenagem/métodos , Equinocandinas/administração & dosagem , Atresia Esofágica/cirurgia , Fluconazol/administração & dosagem , Lipopeptídeos/administração & dosagem , Micoses , Pericardite , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adulto , Antifúngicos/administração & dosagem , Caspofungina , Colo/transplante , Feminino , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/etiologia , Efeitos Adversos de Longa Duração/microbiologia , Micoses/diagnóstico , Micoses/etiologia , Micoses/terapia , Pericardite/diagnóstico , Pericardite/etiologia , Pericardite/microbiologia , Pericardite/terapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Supuração/microbiologia , Resultado do Tratamento
19.
Avian Dis ; 62(2): 233-236, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29944397

RESUMO

To evaluate the virulence of avian pathogenic Escherichia coli (APEC) isolates obtained from colibacillosis cases associated with pericarditis, perihepatitis, and salpingitis, the embryo lethality assay and experimental infection model in chicks were used in this study. According to the established criteria based on mortality in the embryo lethality assay for evaluating the virulence of E. coli isolates, 23 of the 26 APEC isolates associated with pericarditis and perihepatitis and 8 of the 20 isolates associated with salpingitis were found to be virulent. Isolate D137, which had been obtained from a case with pericarditis and perihepatitis and had an embryo mortality of 92%, and isolate D445, which had been obtained from a case with pericarditis and perihepatitis and had an embryo mortality of 17%, were used for the experimental infection. Four of the five 11-day-old chickens inoculated through the air sac with isolate D137 died 1 day postinoculation, and the challenge strain was recovered from the air sac, pericardial sac, or liver; however, colibacillosis lesions were found in only one of the five birds postmortem. All five chicks inoculated with isolate D445 survived for 7 days postinoculation and exhibited airsacculitis or pericarditis lesions at 7 days postinoculation; the challenge strain was not recovered from the lesions postmortem. The results obtained in this study suggest that the different APEC isolates tested cause illness in chickens through distinct pathogenesis.


Assuntos
Infecções por Chlamydia/veterinária , Infecções por Escherichia coli/veterinária , Escherichia coli/isolamento & purificação , Escherichia coli/patogenicidade , Doença Inflamatória Pélvica/veterinária , Pericardite/veterinária , Peritonite/veterinária , Doenças das Aves Domésticas/microbiologia , Salpingite/veterinária , Animais , Embrião de Galinha , Galinhas , Infecções por Chlamydia/microbiologia , Infecções por Escherichia coli/microbiologia , Feminino , Hepatite/microbiologia , Doença Inflamatória Pélvica/microbiologia , Pericardite/microbiologia , Peritonite/microbiologia , Salpingite/microbiologia , Virulência
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