ro13-9904 and Pericarditis

This is a case of a 5-month-old female infant diagnosed with primary meningococcal pericarditis. Pericarditis is a well-recognized but uncommon complication of meningococcal infection. Primary meningococcal pericarditis, defined as purulent pericarditis without any clinical evidence of disseminated meningococcemia, meningitis, or other foci of meningococcal infection, is exceedingly rare, with only 21 reported cases since the first case was reported in 1939. This case report of primary meningococcal pericarditis is the youngest case and only the second case reported in an infant in the English literature to date.

Topics: Anti-Bacterial Agents; Bacteremia; Cardiac Tamponade; Ceftriaxone; Female; Fever of Unknown Origin; Humans; Infant; Leukocyte Count; Meningococcal Infections; Pericardial Effusion; Pericarditis; Tachycardia, Sinus

The authors report a case of Salmonella enteritidis pericarditis. The diagnosis was based on bacteriological analyses (blood and effusion cultures and pericardial biopsy). The microbiology of bacterial pericarditis is reviewed underlying the exceptionally rare finding of a non typhi Salmonella in this condition.

Topics: Aged; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Drainage; Humans; Male; Pefloxacin; Pericarditis; Salmonella enteritidis; Salmonella Infections; Treatment Outcome

We report a case of gonococcal pericarditis, which was unexpected due to its extremely unusual occurrence. A 42-year-old man presented with fever, chest pain, dyspnea, and tachycardia. He was initially stable but rapidly deteriorated, developing pericardial effusion with tamponade requiring a pericardial window. Incompletely decolorized gram stain of the pericardial fluid initially suggested the presence of gram-positive diplococci, which wrongly directed treatment toward possible pneumococcal infection. Because cultures were negative, identification of the causative organism was attempted by molecular and genotyping analysis. These techniques identified Neisseria gonorrhoeae-multi-antigen sequence type 14994 (por 5136/tbpB 33) as the etiology, which has been associated with disseminated gonococcal disease. Real-time polymerase chain reaction showed no evidence of mutations within the N. gonorrhoeae penA gene responsible for causing ceftriaxone resistance. This was crucial in guiding antibiotic treatment, in light of the high prevalence of multi-drug-resistant N. gonorrhoeae. This case highlights the utility of diagnostic molecular techniques in identifying N. gonorrhoeae as the etiology of an exceedingly rare case of pericarditis.

Topics: Adult; Anti-Bacterial Agents; Antigens, Bacterial; Ceftriaxone; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Pericardial Effusion; Pericarditis

BACKGROUND Salmonella infections manifest typically as self-limiting gastroenteritis after the consumption of contaminated food. Extra-intestinal manifestations of Salmonella infections such as pericarditis are rare and are usually seen in severely immunocompromised individuals. Prior case reports suggest high rates of morbidity and mortality associated with Salmonella pericarditis. Here, we present a rare case of Salmonella dublin pericarditis. CASE REPORT A 45-year-old man presented to the Emergency Department reporting chest pressure and shortness of breath. An echocardiogram showed a large pericardial effusion without tamponade physiology. Pericardial window was performed, with removal of 700 cubic centimeters of bloody fluid, with presence of fibrinous debris in the pericardial cavity. A pericardial biopsy showed chronic pericarditis, and a lymph node biopsy was negative for malignancy. Antinuclear antibody (ANA), Lyme antibodies, and human immunodeficiency virus (HIV) testing were negative. Tissue culture revealed Salmonella species. Subsequent blood cultures grew Salmonella spp. Further history-taking revealed frequent travel and recent treatment with steroids for suspected Bell's palsy. Initially, the patient was treated with ceftriaxone, which was switched to ciprofloxacin after susceptibility testing revealed ceftriaxone resistance. Final identification of the organism revealed Salmonella dublin. The patient was discharged on colchicine, ibuprofen, and a 4-week course of ciprofloxacin. Outpatient follow-up showed improvement in inflammatory markers and symptoms. CONCLUSIONS This case illustrates the rarity of Salmonella-associated pericarditis, the importance of assessing a patient's risk factors, and obtaining an extensive history when searching for an etiology of pericarditis. Investigation into why a patient was susceptible to an infection with this organism should include medication assessment and age-appropriate cancer screening. Prompt identification and treatment of the offending organism can help prevent mortality.

Topics: Ceftriaxone; Ciprofloxacin; Humans; Male; Middle Aged; Pericardial Effusion; Pericarditis; Salmonella

, a common cause of respiratory tract infections, rarely leads to serious conditions. A 13-year-old boy with serologically confirmed

Topics: Adolescent; Ceftriaxone; Chlamydial Pneumonia; Chlamydophila pneumoniae; Clarithromycin; Humans; Immunoglobulin G; Immunoglobulin M; Male; Pericarditis; Sputum

We report an extremely rare case of purulent pericarditis caused by the normally commensal oral flora,

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Echocardiography; Female; Humans; Pericardial Effusion; Pericarditis; Pericardium; Streptococcal Infections; Streptococcus constellatus; Tomography, X-Ray Computed

We report the case of a 17-year-old adolescent girl with systemic lupus erythematosus with disseminated pneumococcal infection leading to purulent pericarditis with cardiac tamponade. Although pericarditis is not an uncommon entity in autoimmune diseases such as systemic lupus erythematosus, purulent pericarditis is a rare cause (<1%) of this presentation.

Topics: Acute Pain; Administration, Intravenous; Adolescent; Anti-Bacterial Agents; Cardiac Tamponade; Ceftriaxone; Chest Pain; Echocardiography; Electrocardiography; Female; Humans; Lupus Erythematosus, Systemic; Pericardiocentesis; Pericarditis; Pneumococcal Infections; Streptococcus pneumoniae; Tomography, X-Ray Computed; Treatment Outcome

A 28-year-old male was diagnosed with acute pericarditis after presenting with acute chest pain, fever and an abnormality in an electrocardiogram. No symptoms suggestive of myasthenia gravis were observed. Although the symptoms were alleviated by antibiotics, computed tomography (CT) showed an anterior mediastinal mass with bilateral pleural effusion. He was, therefore, diagnosed with thymoma and referred to our hospital. Surgery was performed, since the pleural effusion disappeared. The pathological examination revealed the mass to be a type B2 thymoma classified as pathological stage I (Masaoka's classification) with a multilocular thymic cyst.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Ceftriaxone; Humans; Magnetic Resonance Imaging; Male; Mediastinal Cyst; Mediastinal Neoplasms; Pericarditis; Pleural Effusion; Thymectomy; Thymoma; Tomography, X-Ray Computed; Treatment Outcome

Atrial flutter (AFL) is a common arrhythmia that is associated with postpericardiotomy and pericarditis. The relationship of AFL with tamponade has rarely been reported. A case of AFL with acute pericarditis and cardiac tamponade is thus presented here.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Atrial Flutter; Cardiac Tamponade; Ceftriaxone; Chest Pain; Female; Humans; Pericarditis; Treatment Outcome; Vancomycin

Topics: Anti-Bacterial Agents; Arthritis, Rheumatoid; Atrial Flutter; Ceftriaxone; Diagnosis, Differential; Echocardiography; Electric Countershock; Electrocardiography; Humans; Male; Middle Aged; Pericardiectomy; Pericarditis; Treatment Outcome; Whipple Disease

Purulent pericarditis is an extremely rare complication of invasive Streptococcus pneumoniae infection among children in the antibiotic era, and its mortality remains high if left untreated. This report involves a 4½-year-old girl who presented to our emergency department with productive cough, shortness of breath, and left-sided chest pain with a diagnosis of pneumococcal pneumonia. She subsequently developed life-threatening conditions including bilateral empyema with respiratory failure, purulent pericarditis, and multiple organ failure leading to death. The case highlights that purulent pericarditis is a rare yet possible disorder complicating pneumococcal disease in the antibiotic era. The increase in strains resistant to penicillin should alert emergency physicians to the potential for reemergence of pneumococcal pericarditis in children.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Empyema, Pleural; Fatal Outcome; Female; Humans; Pericarditis; Pleural Effusion; Pneumonia, Pneumococcal; Respiration, Artificial; Thoracostomy; Ultrasonography; Vancomycin

Topics: Adolescent; Adult; Anti-Bacterial Agents; Borrelia burgdorferi; Ceftriaxone; Electrocardiography; Heart Block; Humans; Lyme Disease; Male; Pericarditis

We here report the case of a previously healthy 20-y-old male with disseminated meningococcal disease and purulent pericarditis. Polymerase chain reaction was used to identify Neisseria meningitidis serogroup C as the causative agent in the pericardial fluid.

Topics: Adult; Ceftriaxone; Humans; Male; Meningococcal Infections; Neisseria meningitidis, Serogroup C; Pericardiocentesis; Pericarditis; Polymerase Chain Reaction

A previously healthy eight-month-old infant presented with shortness of breath and pyrexia. He was found to have purulent pericarditis due to Streptococcus pneumoniae, complicated by acute renal failure due to haemolytic uraemic syndrome. He received peritoneal dialysis and recovered with normalisation of renal function. This case highlights two important complications of pneumococcal infection in one individual and illustrates the need for rapid diagnosis and treatment of invasive pneumococcal disease. It is anticipated that introduction of the conjugate pneumococcal vaccination to the Australian Standard Vaccination Schedule from 2005 will reduce the incidence of pneumococcal infection and its associated morbidity and mortality.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Ceftriaxone; Follow-Up Studies; Hemolytic-Uremic Syndrome; Humans; Infant; Male; Pericarditis; Peritoneal Dialysis; Pneumococcal Infections; Streptococcus pneumoniae; Suppuration

A 65-year-old previously healthy man was referred because of high fever, progressive dyspnea and retrosternal pain for 2 days. On admission, the patient was already in a reduced general condition, blood pressure was 120/70 mmHg, heart rate irregular at 75/min and temperature at 39.7 degrees C. Auscultation of the heart revealed distant heart sounds, murmurs were not present, but mild rales were heard over both lung bases. Jugular veins were congested.. ECG showed a generalized ST-segment elevation with preserved R-waves, slightly depressed PR-segment and atrial bigemini. Chest X-ray revealed an enlarged cardiac silhouette with signs of a pneumopericardium. Transthoracic echocardiography showed a circular pericardial effusion and haemodynamic impairment. Percutaneous pericardiocentesis revealed a purulent effusion with microbiological proof of pneumococci. The primary infectious focus was a maxillary sinusitis caused by pneumococci.. Bacterial pericarditis due to by haematogenous spread of pneumococci.. Antibiotic therapy consisted of intravenous ceftriaxon and gentamicin. To rinse the pericardial space and drain the thick, purulent effusion subxiphoidal, pericardiocentesis and insertion of a drainage tube were done. Physiological saline was put into the pericardial space several times a day, drained and analysed microbiologically. In the meantime rinsing of the infected maxillary sinus was performed. Transthoracic echocardiography was done repeatedly to rule out complications of bacterial pericarditis, especially constrictive pericarditis. The pericardial tube was removed after proof of a sterile drainage 9 days after insertion. The patient was discharged after 4 weeks of hospitalization without clinical or echocardiographic signs of diastolic dysfunction.. Suspected bacterial pericarditis must be treated as an emergency and confirmed or ruled out by percutaneous pericardiocentesis.

Topics: Aged; Ceftriaxone; Diagnosis, Differential; Diagnostic Imaging; Dyspnea; Fever of Unknown Origin; Follow-Up Studies; Gentamicins; Humans; Male; Maxillary Sinusitis; Microbial Sensitivity Tests; Pericarditis; Pneumococcal Infections; Suction; Therapeutic Irrigation

A 34-year-old female with end-stage renal disease was admitted for severe metabolic acidosis, uremic encephalopathy, pericarditis and severe anemia following a bout of acute gastroenteritis. She improved on aggressive medical management including intensive hemodialysis and was initiated onto maintenance heparin-free hemodialysis (twelve hours per week) and discharged. After a week, she presented with fever with chills and rigors for three days, was toxic, severely orthopenic and had a pulsus paradoxus of 36 mmHg. Echocardiography suggested cardiac tamponade. Aspiration revealed frank pus with polymorphonuclear predominance and Staphylococcus aureus on culture. CT of the thorax revealed pericardial effusion. In the absence of any obvious septic foci, concomitant pleuro-pulmonary sepsis, mediastinal or intra-abdominal pathology; a diagnosis of "acute primary purulent pericarditis" was made. Patient was put on parenteral antibiotics-ceftriaxone and metrogyl. Vancomycin was added after sensitivity results. Pericardial drainage was required initially. After toxemia improved, paradox decreased and fever subsided, the pericardial catheter was removed and antibiotics continued for a period of four weeks. Maintenance hemodialysis was continued during hospital stay and after discharge.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Echocardiography; Female; Humans; Kidney Failure, Chronic; Metronidazole; Pericarditis; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus; Tomography, X-Ray Computed; Vancomycin

Topics: Aged; Aged, 80 and over; Amoxicillin; Ceftriaxone; Cephalosporins; Follow-Up Studies; Humans; Male; Penicillin G; Penicillins; Pericardial Effusion; Pericardiocentesis; Pericarditis; Pneumococcal Infections; Time Factors

This case report describes Nocardia pericarditis in a newly diagnosed human immunodeficiency virus (HIV) patient as an initial manifestation. Previously, two cases of Nocardia pericarditis were reported in patients with established HIV infection. To our knowledge this is the first case of Nocardia pericarditis as an initial manifestation of HIV infection. This case substantiates and emphasizes the importance of identifying Nocardia as an infectious cause of pericarditis in patients with acquired immunodeficiency. Long-term survival may be achieved with a combined medical and surgical approach.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Chest Pain; Combined Modality Therapy; Cough; Drug Therapy, Combination; Dyspnea; Humans; Male; Minocycline; Nocardia asteroides; Nocardia Infections; Pericardial Effusion; Pericardial Window Techniques; Pericarditis

Topics: Aged; Cardiac Tamponade; Cefotaxime; Ceftriaxone; Cephalosporins; Drug Resistance, Microbial; Female; Humans; Penicillin Resistance; Pericarditis; Streptococcus pneumoniae

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Clarithromycin; Humans; Lyme Disease; Male; Pericarditis