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Holman M, Kambam G, Lap C, Siegel MO. Polymicrobial pericarditis caused by bacterial and fungal translocation from an oesophageal ulcer. BMJ Case Rep 2024; 17:e259584. [PMID: 39231567 DOI: 10.1136/bcr-2023-259584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
This case report discusses a rare instance of polymicrobial pericarditis in a man in his early 60s with a history of substance abuse. The patient presented with chest pain and shortness of breath, later diagnosed as pericarditis caused by Streptococcus anginosus, S. intermedius and Candida glabrata, likely originating from a large adjacent oesophageal ulcer. The condition led to critical illness, requiring pericardiocentesis, antibiotic and antifungal therapy. Despite initial improvement, the patient experienced recurrence and ultimately underwent pericardectomy. The article emphasises the rarity and severity of polymicrobial pericarditis, often associated with high mortality. It underscores the importance of prompt recognition, broad-spectrum antibiotics and source control, particularly when the gastrointestinal tract is implicated. The case highlights the challenges in managing such cases and the potential need for surgical intervention for optimal outcomes.
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Affiliation(s)
- Michael Holman
- Internal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Greeshma Kambam
- The George Washington University Hospital, Washington, District of Columbia, USA
| | - Coen Lap
- Internal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Marc O Siegel
- Infectious Diseases, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Najd Ghahremani A, Abdollahi M, Shokrpoor S, Ashrafi Tamai I. Pericarditis caused by Proteus mirabilis in sheep. Vet Med Sci 2023. [PMID: 37192480 DOI: 10.1002/vms3.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/24/2023] [Accepted: 04/18/2023] [Indexed: 05/18/2023] Open
Abstract
Pericarditis means inflammation in the pericardial sac. Pericarditis is divided into three categories based on morphology, including fibrinous, purulent, and constrictive. In the present study, a 7-month-old male Ghezel breed sheep was examined for low weighting rate for three months. Tachypnea, tachycardia, heart friction sound, absence of fever and normal appetite were recorded in the clinical examination. In the patient's history, there was a history of perforated chest trauma behind the left scapula about three months ago. After the echocardiography examination and bacteriology procedures, purulent pericarditis caused by Proteus mirabilis was diagnosed. The bacterium was analysed using genome sequencing and new strain called Abhar114 was diagnosed. This is the first report of pericarditis caused by Proteus mirabilis in sheep.
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Affiliation(s)
- Abolfazl Najd Ghahremani
- Faculty of Veterinary Medicine, Department of Internal Medicine, University of Tehran, Tehran, Iran
| | - Mostafa Abdollahi
- Faculty of Veterinary Medicine, Department of Clinical Sciences, Semnan University, Semnan, Iran
| | - Sara Shokrpoor
- Faculty of Veterinary Medicine, Department of Pathology, University of Tehran, Tehran, Iran
| | - Iraj Ashrafi Tamai
- Faculty of Veterinary Medicine, Department of Microbiology and Immunology, University of Tehran, Tehran, Iran
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Horii S, Yada H, Ito K, Osaki A, Sato A, Kimura T, Yasuda R, Toya T, Namba T, Masaki N, Adachi T. A Rare Case of Rush Progression of Purulent Pericarditis by Escherichia coli in a Patient with Malignant Lymphoma. Int Heart J 2018; 59:655-659. [PMID: 29628470 DOI: 10.1536/ihj.17-238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purulent pericarditis is a rare disease in the antibiotic era. The common pathogens of purulent pericarditis are gram-positive species such as Staphylococcus aureus. Streptococcus pneumoniae, Salmonella, Haemophilus, fungal pathogens/tuberculosis can also result in purulent pericarditis. We report an old male case of purulent pericarditis by Escherichia coli. He came to our hospital suffering from leg edema for 3 months. Echocardiography revealed the large amount of pericardial effusion, and he was admitted to test the cause of pericardial effusion without high fever, tachycardia, and shock vital signs. On the third day, he suddenly presented vital shock. We performed emergency cardiopulmonary resuscitation and pericardiocentesis. Appearance of pericardial effusion was hemorrhagic and purulent. The gram stain revealed remarkable E. coli invasion to pericardial space. Antibiotic therapy was immediately started; however, he died on sixth day with septic shock. The cytological examination of pericardial effusion suggested the invasion of malignant lymphoma to pericardium. This case showed subacute or chronic process of pericarditis without severe clinical and laboratory sings before admission. Nevertheless, bacterial purulent pericarditis usually shows acute clinical manifestation; the first process of this case was very silent. Immunosuppression of malignant lymphoma might make E. coli translocation from gastrointestinal tract to pericardial space, and bacterial pericarditis was progressed to purulent pericarditis. In the latter process, this case showed unexpected rush progression to death by sepsis from purulent pericarditis. Immediate pericardiocentesis should be performed for a prompt diagnosis of purulent pericarditis, and it might have improved the outcome of this case.
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Affiliation(s)
- Shunpei Horii
- Department of Cardiology, National Defense Medical College
| | - Hirotaka Yada
- Department of Cardiology, National Defense Medical College
| | - Kei Ito
- Department of Cardiology, National Defense Medical College
| | - Ayumu Osaki
- Department of Cardiology, National Defense Medical College
| | - Atsushi Sato
- Department of Cardiology, National Defense Medical College
| | | | - Risako Yasuda
- Department of Cardiology, National Defense Medical College
| | - Takumi Toya
- Department of Cardiology, National Defense Medical College
| | - Takayuki Namba
- Department of Cardiology, National Defense Medical College
| | - Nobuyuki Masaki
- Department of Intensive Care Medicine, National Defense Medical College
| | - Takeshi Adachi
- Department of Cardiology, National Defense Medical College
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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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de Jong Y, van Loenhout RB, Swank DJ, Jansen CL, Sorgdrager BJ. Polymicrobial bacterial pericarditis and cardiac tamponade caused by pericardial penetration of an adjustable gastric band. BMJ Case Rep 2018; 2018:bcr-2017-221589. [PMID: 29453210 DOI: 10.1136/bcr-2017-221589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a case of polymicrobial bacterial pericarditis with Klebsiella pneumoniae and Proteus mirabilis, caused by pericardial penetration of the tip of the catheter of a laparoscopic adjustable gastric band (LAGB). The patient developed a cardiac tamponade, and subsequently emergency pericardiocentesis was performed. Analysis of earlier CT scans showed that the tip of the catheter had migrated through the liver and through the diaphragm into the pericardium, and was in contact with the myocardium. After stabilisation he was operated to remove the LAGB. In this case report, we describe the chain of events that led to the polymicrobial pericarditis-a complication of LAGB placement that to our knowledge has thus far never been reported. We furthermore present a detailed literature review of all published cases of polymicrobial pericarditis and its causes.
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Affiliation(s)
- Ype de Jong
- Department of Internal Medicine, Haaglanden Medical Centrum, The Hague, Netherlands
| | | | - Dingeman J Swank
- Department of Bariatric Surgery, Groene Hart Hospital, Gouda, Netherlands
| | - Casper L Jansen
- Department of Medical Microbiology, Haaglanden Medical Centrum, The Hague, Netherlands
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Cillóniz C, Rangel E, Barlascini C, Piroddi IMG, Torres A, Nicolini A. Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series. J Bras Pneumol 2016; 41:389-94. [PMID: 26398760 PMCID: PMC4635960 DOI: 10.1590/s1806-37132015000000010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis.
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Affiliation(s)
- Catia Cillóniz
- Instituto de Investigación Biomédica Agustí Pi i Sunyer, Universidad de Barcelona, ES
| | - Ernesto Rangel
- Facultad de Medicina, Universidad Autónoma de Nayarit, Tepic, MX
| | | | | | - Antoni Torres
- Instituto de Investigación Biomédica Agustí Pi i Sunyer, Universidad de Barcelona, ES
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