Purulent pericarditis

Purulent Pericarditis
Echocardiogram showing pericardial effusion with signs of cardiac tamponade
Echocardiogram showing pericardial effusion with signs of cardiac tamponade
SpecialtyCardiology
Symptomssubsternal chest pain (exacerbated supine and with breathing deeply), dyspnea, fever, rigors/chills, and cardiorespiratory signs (i.e., tachycardia, friction rub, pulsus paradoxus, pericardial effusion, cardiac tamponade, pleural effusion)
Usual onsetacute
Causesrecent surgery, adjacent infection, trauma, primary infection
Diagnostic methodelectrocardiogram (ECG), echocardiogram/cardiac ultrasound ("echo"), chest radiograph, clinical symptoms, laboratory tests
Treatmentantibiotics, pericardiocentesis, pericardiectomy, pericardial window, video-assisted thoracic surgery

Purulent pericarditis refers to localized inflammation in the setting of infection of the pericardial sac surrounding the heart.[1] In contrast to other causes of pericarditis which may have a viral etiology, purulent pericarditis refers specifically to bacterial or fungal infection of the pericardial sac.[2] Clinical etiologies of purulent pericarditis may include recent surgery, adjacent infection, trauma, or even primary infection.[3] The onset of purulent pericarditis is usually acute, with most individuals presenting to a medical facility approximately 3 days following the onset of symptoms.[4]

As a subtype of pericarditis, purulent pericarditis often presents with substernal chest pain that is exacerbated by deep breathing and lying in the supine position.[5] Other presenting features that may be more specific for purulent pericarditis include fever, rigors/chills, and cardiorespiratory signs (i.e., tachycardia, friction rub, pulsus paradoxus, pericardial effusion, cardiac tamponade, pleural effusion).[4] The incidence of cardiac tamponade varies from 42-77% and is associated with rapid-onset mortality, especially without prompt intervention.[4]

Chest radiography may reveal cardiomegaly, pneumonia, pleural effusion, and/or mediastinal widening.[4] Electrocardiogram (ECG) is a component of the diagnostic work-up which may suggest pericarditis as the underlying cause of symptoms. The ECG findings for purulent pericarditis are similar to those for other etiologies of pericarditis. ECG findings may include diffuse S-T segment elevation, diffuse T wave inversion, low QRS voltage, and/or electrical alternans.[4][6] Echocardiogram may be used to evaluate for fluid collection in the pericardial sac, and may be important in guiding therapy in patients with signs of cardiac compromise (i.e., cardiac tamponade).[3][7]

Treatment modalities for purulent pericarditis include antibiotic therapy, with potential adjuncts such as pericardiocentesis or pericardial window when cardiac compromise is evident.[3]

  1. ^ Costa, Laura; Carvalho, Diana; Coelho, Elisabete; Leal, Dina; Lencastre, Luís (2021-07-14). "Purulent Pericarditis: Is It Really a Disease of the Past?". European Journal of Case Reports in Internal Medicine. 8 (7): 002658. doi:10.12890/2021_002658. ISSN 2284-2594. PMC 8336749. PMID 34377691.
  2. ^ Tingle, Leslie E.; Molina, Daniel; Calvert, Charles W. (2007-11-15). "Acute pericarditis". American Family Physician. 76 (10): 1509–1514. ISSN 0002-838X. PMID 18052017.
  3. ^ a b c Adler, Yehuda; Charron, Philippe; Imazio, Massimo; Badano, Luigi; Barón-Esquivias, Gonzalo; Bogaert, Jan; Brucato, Antonio; Gueret, Pascal; Klingel, Karin; Lionis, Christos; Maisch, Bernhard; Mayosi, Bongani; Pavie, Alain; Ristić, Arsen D; Sabaté Tenas, Manel (2015-11-07). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases". European Heart Journal. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. ISSN 0195-668X. PMC 7539677. PMID 26320112.
  4. ^ a b c d e Rubin, Robert H.; Moellering, Robert C. (July 1975). "Clinical, microbiologic and therapeutic aspects of purulent pericarditis". The American Journal of Medicine. 59 (1): 68–78. doi:10.1016/0002-9343(75)90323-X. PMID 1138554.
  5. ^ Chiabrando, Juan Guido; Bonaventura, Aldo; Vecchié, Alessandra; Wohlford, George F.; Mauro, Adolfo G.; Jordan, Jennifer H.; Grizzard, John D.; Montecucco, Fabrizio; Berrocal, Daniel Horacio; Brucato, Antonio; Imazio, Massimo; Abbate, Antonio (January 2020). "Management of Acute and Recurrent Pericarditis". Journal of the American College of Cardiology. 75 (1): 76–92. doi:10.1016/j.jacc.2019.11.021. PMID 31918837. S2CID 210132213.
  6. ^ Imazio, Massimo; Demichelis, Brunella; Parrini, Iris; Giuggia, Marco; Cecchi, Enrico; Gaschino, Gianni; Demarie, Daniela; Ghisio, Aldo; Trinchero, Rita (2004-03-17). "Day-hospital treatment of acute pericarditis: a management program for outpatient therapy". Journal of the American College of Cardiology. 43 (6): 1042–1046. doi:10.1016/j.jacc.2003.09.055. ISSN 0735-1097. PMID 15028364.
  7. ^ Salem, K.; Mulji, A.; Lonn, E. (November 1999). "Echocardiographically guided pericardiocentesis - the gold standard for the management of pericardial effusion and cardiac tamponade". The Canadian Journal of Cardiology. 15 (11): 1251–1255. ISSN 0828-282X. PMID 10579740.