meropenem and Pericarditis

Acute pericarditis is inflammation of the pericardium with or without pericardial effusion. In the pediatric population, most patients with acute pericarditis are diagnosed with idiopathic pericarditis. Herein, we present two children with idiopathic pericarditis who underwent immunological assessment of pericardial effusion for the first time. Both patients showed equally high levels of interleukin-6 in the pericardial effusion. However, they had different treatment responses, in accordance with the pericardial effusion and serum interleukin-10 concentrations. Our present cases suggest that interleukin-10 may be associated with the response to anti-inflammatory therapy in idiopathic acute pericarditis.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Cardiotonic Agents; Cefotaxime; Child, Preschool; Cytokines; Dobutamine; Dopamine; Humans; Infant; Interleukin-10; Interleukin-6; Male; Meropenem; Pericardial Effusion; Pericardial Fluid; Pericarditis; Prednisolone; Treatment Outcome

The patient presented with increasing fatigue and dyspnoea. The patient had medical history of rheumatoid arthritis for which she had been taking methotrexate for the past 15 years and etanercept for the past 6 years. Initial diagnosis was cardiac failure but further investigation by echocardiogram revealed a large pericardial effusion. Empirical piperacillin-tazobactam was started due to moderately raised inflammatory markers. Four hundred millilitre of frank pus was aspirated from the pericardial sac and antimicrobial treatment was changed to meropenem. Gram positive cocci were seen in the initial Gram stain, but conventional cultures remained negative. However, 16S ribosomal RNA gene sequencing of the pus sample detected the presence of Parvimonas micra genome. Reaccumulation of the effusion required further drainage where again P micra was detected by 16S ribosomal RNA gene sequencing. Two weeks of meropenem was completed followed by treatment with benzylpenicillin and metronidazole.

Topics: Aged; Anti-Bacterial Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Drug Therapy, Combination; Etanercept; Female; Gram-Positive Bacteria; Humans; Immunoglobulin G; Meropenem; Metronidazole; Opportunistic Infections; Penicillin G; Pericarditis; Receptors, Tumor Necrosis Factor; Risk Factors; Thienamycins

A 23-year-old woman with prolonged fever, rash, and pericarditis associated with high titers of antinuclear, anti-Sm, and anti-RNP antibodies was suspected of having systemic lupus erythematosus (SLE). However, we also considered infectious diseases, particularly Q fever, as the C-reactive protein level was elevated and the patient reported contact with zoo animals around two weeks before the onset. The condition responded rapidly to administration of minocycline; symptoms resolved without using steroids. Thereafter, no recurrence of the illness was observed. Titer of Coxiella burnetii antibody was high and the illness was accordingly diagnosed as acute Q fever rather than SLE.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; C-Reactive Protein; Cardiomegaly; Coxiella burnetii; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Lupus Erythematosus, Systemic; Meropenem; Minocycline; Pericarditis; Q Fever; Radiography; Thienamycins

Chryseobacterium meningosepticum is a lactose-nonfermenting gram-negative bacilli ubiquitously found in the natural and hospital environment. Clinical infection caused by C. meningosepticum is very rare among healthy adults. We present the case of a patient with end-stage renal disease who developed purulent pericarditis with C. meningosepticum infection, which rapidly evolved into cardiac tamponade and death. To our knowledge, this is the first case in which C. meningosepticum caused fatal purulent pericarditis in a hemodialysis patient.

Topics: Aged; Anti-Bacterial Agents; Cardiac Tamponade; Chryseobacterium; Ciprofloxacin; Fatal Outcome; Flavobacteriaceae Infections; Humans; Kidney Failure, Chronic; Male; Meropenem; Pericarditis; Renal Dialysis; Thienamycins; Vancomycin