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Tarun S, Makadia L, Demirhan S, Shah SS, Foca MD, Bacha EA, Thai L, Bansal N, Pagan CA, Barry OM. Surgical and Medical Management of Purulent Bacterial Pericarditis With Pericardial Mass in a Young Child. JACC Case Rep 2023; 15:101834. [PMID: 37283835 PMCID: PMC10240214 DOI: 10.1016/j.jaccas.2023.101834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 06/08/2023]
Abstract
Purulent bacterial pericarditis is rare and associated with significant short- and long-term morbidity. We report a case of purulent bacterial pericarditis caused by Group A Streptococcus in an immunocompetent young child presenting with a pericardial mass. She was successfully treated with a combined medical and early surgical approach. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Samiksha Tarun
- Department of Pediatrics, Division of Infectious Diseases, Columbia University Medical Center, New York, New York, USA
| | - Luv Makadia
- Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Salih Demirhan
- Department of Pediatrics, Division of Infectious Diseases, The Children’s Hospital at Montefiore, New York, New York, USA
| | - Shivang S. Shah
- Department of Pediatrics, Division of Infectious Diseases, Columbia University Medical Center, New York, New York, USA
| | - Marc D. Foca
- Department of Pediatrics, Division of Infectious Diseases, The Children’s Hospital at Montefiore, New York, New York, USA
| | - Emile A. Bacha
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Lauren Thai
- Department of Pediatrics, Division of Cardiology, The Children’s Hospital at Montefiore, New York, New York, USA
| | - Neha Bansal
- Department of Pediatrics, Division of Cardiology, The Children’s Hospital at Montefiore, New York, New York, USA
| | - Carlos A. Pagan
- Department of Pathology, Columbia University Medical Center, New York, New York, USA
| | - Oliver M. Barry
- Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York, USA
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Ochi F, Tauchi H, Miura H, Moritani T, Chisaka T, Higaki T, Eguchi M. Complicated Acute Pericarditis and Peripheral Venous Catheter-Related Bloodstream Infection Caused by Methicillin-Resistant Staphylococcus aureus after Influenza B Virus Infection: A Case Report. Case Rep Pediatr 2023; 2023:4374552. [PMID: 37180286 PMCID: PMC10169241 DOI: 10.1155/2023/4374552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/05/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
Background In this study, we report the case of a 14-month-old female patient transferred from another hospital to our hospital with a 9-day history of fever and worsening dyspnea. Case Report. The patient tested positive for influenza type B virus 7 days before being transferred to our hospital but was never treated. The physical examination performed at presentation revealed redness and swelling of the skin at the site of the peripheral venous catheter insertion performed at the previous hospital. Her electrocardiogram revealed ST segment elevations in leads II, III, aVF, and V2-V6. An emergent transthoracic echocardiogram revealed pericardial effusion. As ventricular dysfunction due to pericardial effusion was not present, pericardiocentesis was not performed. Furthermore, blood culture revealed methicillin-resistant Staphylococcus aureus (MRSA). Thus, a diagnosis of acute pericarditis complicated with sepsis and peripheral venous catheter-related bloodstream infection (PVC-BSI) due to MRSA was made. Frequent bedside ultrasound examinations were performed to evaluate the outcomes of the treatment. After administering vancomycin, aspirin, and colchicine, the patient's general condition stabilized. Conclusions In children, it is crucial to identify the causative organism and provide appropriate targeted therapy to prevent worsening of the condition and mortality due to acute pericarditis. Moreover, it is important to carefully monitor the clinical course for the progression of acute pericarditis to cardiac tamponade and evaluate the treatment outcomes.
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Affiliation(s)
- Fumihiro Ochi
- Department of Pediatrics, Ehime Prefectural Niihama Hospital, Niihama, Ehime, Japan
| | - Hisamichi Tauchi
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Hiromitsu Miura
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Tomozo Moritani
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Toshiyuki Chisaka
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Takashi Higaki
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Mariko Eguchi
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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Agrawal A, Jhamb U, Nigam A, Agrwal S, Saxena R. Purulent pericardial effusion in children: Experience from a tertiary care center in North India. Ann Pediatr Cardiol 2020; 13:289-293. [PMID: 33311916 PMCID: PMC7727893 DOI: 10.4103/apc.apc_125_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/09/2019] [Accepted: 05/21/2020] [Indexed: 11/04/2022] Open
Abstract
Background Purulent pericarditis, if not recognized and managed timely, it can lead to significant morbidity and mortality. There are no guidelines for the management of purulent pericardial effusion in pediatric patients. Aim The study describes our experience with the management of 22 patients admitted with a primary diagnosis of purulent pericardial effusion seen over a 7-year period. Materials and Methods Hospital records of 22 children admitted to the pediatric intensive care unit with purulent pericardial effusion during January 2012-December 2018 were retrospectively analyzed. Results The mean age of presentation was 4.6 years. The most common presentation was fever. History of antecedent trauma was present in 27.27% of patients. Empyema was the most common associated infection. Staphylococcus aureus was the most commonly isolated organism. Out of 22, pericardial drainage was done in 13 patients (59%). Only one of these patients required pericardiectomy later on. Six (27.2%) patients responded to antibiotics alone. Three (13.6%) patients died before any intervention could be planned. Conclusion Echocardiography-guided percutaneous pericardiocentesis and pigtail catheter placement are a safe and effective treatment for purulent pericardial effusion. When pericardial drainage is not amenable, close monitoring of the size of effusion by serial echocardiography is required. Small residual pericardial effusion may be managed conservatively.
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Affiliation(s)
- Anika Agrawal
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Urmila Jhamb
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Arima Nigam
- Department of Cardiology, G.B. Pant Hospital, New Delhi, India
| | - Shipra Agrwal
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Romit Saxena
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
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Donovan M, Smith N, Holton R, Shapiro C. Pediatric Bacterial Pericarditis. Am J Emerg Med 2019; 38:693.e1-693.e3. [PMID: 31859192 DOI: 10.1016/j.ajem.2019.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/12/2019] [Accepted: 10/13/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Megan Donovan
- Nemours/Alfred I. duPont Hospital for Children, United States.
| | - Nadine Smith
- Nemours/Alfred I. duPont Hospital for Children, United States; Sidney Kimmel Medical College of Thomas Jefferson University, United States
| | - Ryan Holton
- Nemours/Alfred I. duPont Hospital for Children, United States; Sidney Kimmel Medical College of Thomas Jefferson University, United States; Christiana Care Health System, United States
| | - Craig Shapiro
- Nemours/Alfred I. duPont Hospital for Children, United States
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Infectious and Noninfectious Acute Pericarditis in Children: An 11-Year Experience. Int J Pediatr 2018; 2018:5450697. [PMID: 30532791 PMCID: PMC6250032 DOI: 10.1155/2018/5450697] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/04/2018] [Accepted: 10/28/2018] [Indexed: 12/24/2022] Open
Abstract
Objective The study was undertaken to determine the etiology, review management, and outcome in children diagnosed with acute pericarditis during 11 years at tertiary pediatric institution. Methods Retrospective chart review of children diagnosed between 2004 and 2014. Patients with postsurgical pericardial effusions were excluded. Results Thirty-two children were identified (median age 10yr/11mo). Pericardiocentesis was performed in 24/32 (75%) patients. The most common cause of pericarditis was infection in 11/32 (34%), followed by inflammatory disorders in 9 (28%). Purulent pericarditis occurred in 5 children including 4 due to Staphylococcus aureus: 2 were methicillin resistant (MRSA). All patients with purulent pericarditis had concomitant infection including soft tissue, bone, or lung infection; all had pericardial drain placement and 2 required pericardiotomy and mediastinal exploration. Other infections were due to Histoplasma capsulatum (2), Mycoplasma pneumoniae (2), Influenza A (1), and Enterovirus (1). Pericarditis/pericardial effusion was the initial presentation in 4 children with systemic lupus erythematosus including one who presented with tamponade and in 2 children who were diagnosed with systemic onset juvenile inflammatory arthritis. Tumors were diagnosed in 2 patients. Five children had recurrent pericarditis. Systemic antibiotics were used in 21/32 (66%) and prednisone was used in 11/32 (34%) patients. Conclusion Infections remain an important cause of pericarditis in children. Purulent pericarditis is most commonly caused by Staphylococcus aureus and is associated with significant morbidity, need of surgical intervention, and prolonged antibiotic therapy. Echocardiography-guided thoracocentesis remains the preferred diagnostic and therapeutic approach. However, pericardiotomy and drainage are needed when appropriate clinical response is not achieved with percutaneous drainage.
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Bansal N, Walters HL, Kobayashi D. Purulent Pericarditis Due to Paronychia in a 16-Month-Old Child: A Nail-Biting Story. World J Pediatr Congenit Heart Surg 2018; 11:NP125-NP128. [PMID: 29506451 DOI: 10.1177/2150135117742651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purulent pericarditis is a rare infectious disease with significant mortality, even in the modern antibiotic era. The presenting signs can often be subtle and patients can deteriorate rapidly with cardiac tamponade. We report a previously healthy 16-month-old female who developed purulent pericarditis associated with paronychia and sepsis caused by methicillin-sensitive Staphylococcus aureus. In addition to antibiotic treatment, she required emergent pericardiocentesis for cardiac tamponade, followed by two surgical interventions including full median sternotomy incision and partial pericardiectomy. At 4-month follow-up, she did well with no evidence of constrictive pericarditis on echocardiogram.
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Affiliation(s)
- Neha Bansal
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Henry L Walters
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Daisuke Kobayashi
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
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Shari CR, Sawe HR, Davey K, Murray BL. Emergency centre diagnosis and treatment of purulent pericarditis: A case report from Tanzania. Afr J Emerg Med 2018; 8:37-39. [PMID: 30456144 PMCID: PMC6223587 DOI: 10.1016/j.afjem.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/18/2017] [Accepted: 12/13/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Purulent pericarditis poses diagnostic and therapeutic challenges, especially in resource-limited settings due to the unavailability of diagnostic tools, equipment, and expertise. CASE REPORT A three-year-old female presented to the emergency centre at Muhimbili National Hospital in Dar es Salaam, Tanzania with altered mental status, lethargy, intermittent fevers, worsening difficulty in breathing, and progressive lower extremity swelling over two months. The child was in shock upon arrival. Point-of-care ultrasound demonstrated cardiac tamponade secondary to purulent pericarditis. An ultrasound guided pericardiocentesis and lavage was successfully done in the emergency centre and antibiotics were started. Though definitive management (pericardiectomy) was delayed, the child survived to hospital discharge. CONCLUSION Pericardiocentesis, pericardial lavage, and the initiation of broad spectrum antibiotics are the mainstay of early treatment of purulent pericarditis. This treatment can be done safely in an emergency centre with little specialised equipment aside from point-of-care ultrasound.
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Affiliation(s)
- Catherine R. Shari
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Hendry R. Sawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Kevin Davey
- Department of Emergency Medicine, University of California, San Francisco, CA, USA
| | - Brittany L. Murray
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Hindi Z. Rare Purulent Cardiac Tamponade Caused by Streptococcus Constellatus in a Young Immunocompetent Patient: Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:855-859. [PMID: 27847383 PMCID: PMC5113858 DOI: 10.12659/ajcr.900904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patient: Male, 19 Final Diagnosis: Cardiac tamponade Symptoms: Chest pain • shortness of breath Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- Zakaria Hindi
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Kramer PA, Chacko BK, Ravi S, Johnson MS, Mitchell T, Barnes S, Arabshahi A, Dell’Italia LJ, George DJ, Steele C, George JF, Darley-Usmar VM, Melby SJ. Hemoglobin-associated oxidative stress in the pericardial compartment of postoperative cardiac surgery patients. J Transl Med 2015; 95:132-41. [PMID: 25437645 PMCID: PMC4422823 DOI: 10.1038/labinvest.2014.144] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/09/2014] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis and valvular heart disease often require treatment with corrective surgery to prevent future myocardial infarction, ischemic heart disease, and heart failure. Mechanisms underlying the development of the associated complications of surgery are multifactorial and have been linked to inflammation and oxidative stress, classically as measured in the blood or plasma of patients. Postoperative pericardial fluid (PO-PCF) has not been investigated in depth with respect to the potential to induce oxidative stress. This is important because cardiac surgery disrupts the integrity of the pericardial membrane surrounding the heart and causes significant alterations in the composition of the pericardial fluid (PCF). This includes contamination with hemolyzed blood and high concentrations of oxidized hemoglobin, which suggests that cardiac surgery results in oxidative stress within the pericardial space. Accordingly, we tested the hypothesis that PO-PCF is highly pro-oxidant and that the potential interaction between inflammatory cell-derived hydrogen peroxide with hemoglobin is associated with oxidative stress. Blood and PCF were collected from 31 patients at the time of surgery and postoperatively from 4 to 48 h after coronary artery bypass grafting, valve replacement, or valve repair (mitral or aortic). PO-PCF contained high concentrations of neutrophils and monocytes, which are capable of generating elevated amounts of superoxide and hydrogen peroxide through the oxidative burst. In addition, PO-PCF primed naive neutrophils resulting in an enhanced oxidative burst upon stimulation. The PO-PCF also contained increased concentrations of cell-free oxidized hemoglobin that was associated with elevated levels of F2α isoprostanes and prostaglandins, consistent with both oxidative stress and activation of cyclooxygenase. Lastly, protein analysis of the PO-PCF revealed evidence of protein thiol oxidation and protein carbonylation. We conclude that PO-PCF is highly pro-oxidant and speculate that it may contribute to the risk of postoperative complications.
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Affiliation(s)
- Philip A. Kramer
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Balu K. Chacko
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Saranya Ravi
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Michelle S. Johnson
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Tanecia Mitchell
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Stephen Barnes
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Targeted Metabolomics and Proteomics Laboratory, Department of Pharmacology and Toxicology, University of Alabama at Birmingham, AL 35294
| | - Alireza Arabshahi
- Targeted Metabolomics and Proteomics Laboratory, Department of Pharmacology and Toxicology, University of Alabama at Birmingham, AL 35294
| | - Louis J. Dell’Italia
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Heart Failure Research, Division of Cardiovascular Sciences, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294,Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - David J. George
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Chad Steele
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - James F. George
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Victor M. Darley-Usmar
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Spencer J. Melby
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294,Corresponding author.
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Armstrong SK, Raidal SL, Hughes KJ. Fibrinous pericarditis and pericardial effusion in three neonatal foals. Aust Vet J 2014; 92:392-9. [DOI: 10.1111/avj.12238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- SK Armstrong
- School of Animal and Veterinary Sciences; Charles Sturt University; Locked Bag 588 Wagga Wagga New South Wales 2678 Australia
| | - SL Raidal
- School of Animal and Veterinary Sciences; Charles Sturt University; Locked Bag 588 Wagga Wagga New South Wales 2678 Australia
| | - KJ Hughes
- School of Animal and Veterinary Sciences; Charles Sturt University; Locked Bag 588 Wagga Wagga New South Wales 2678 Australia
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