Diagnostic value of the biochemical tests in patients with purulent pericarditis

Abstract

Objectives: Purulent pericarditis is a collection of purulent effusion in the pericardial space. It has become a rare entity with the increased availability and use of antibiotics. In contrast to pleural empyema, there are few data regarding the biochemical parameters of purulent pericardial effusion to aid diagnosis. Therefore, in this study, we have evaluated the diagnostic utility of biochemical tests in patients with purulent pericarditis. Methods: Between September 2004 and September 2012, we treated fifteen children with purulent pericarditis and tamponade. There were 8 boys and 7 girls, ranging in age from 8 months to 14 years, with a mean age of 5.3 ± 3.2 years. Echocardiographic diagnosis of cardiac tamponade was made in all patients. All patients underwent immediate surgical drainage due to cardiac tamponade. The diagnosis of purulent pericarditis was supported by biochemical tests. Anterior mini-thoracotomy or subxiphoid approach was performed for surgical drainage. Results: The most common clinical findings were tamponade, hepatomegaly, tachycardia, fever refractory antibiotic therapy, dyspnea, tachypnea, cough, and increased jugular venous pressure. Central venous pressure decreased and arterial tension increased immediately after the evacuation of purulent effusion during operation in all patients. The pericardial effusion had high lactic dehydrogenase, and low glucose concentration, confirming purulent pericarditis. Also, pH (mean± SD) was 7.01 ± 0.06. The culture of pericardial effusions and blood samples were negative. Conclusion: Biochemical tests are useful guideline when assessing the pericardial effusions. However, these tests should be interpreted with the clinical and operative findings.

Purulent bacterial pericarditis from Staphylococcus aureus

“…Aspiration of pus or positive bacterial culture of pericardial fluid is considered definitive. While infected pericardial fluid usually has a low glucose and high white blood cell count, fluid analysis is not sufficient to differentiate rheumatological from infectious causes …”

“…Treatment should be initiated promptly with broad‐spectrum antibiotics and source control. In some case series, pericardiocentesis catheters are used to instill fibrinolytics into the pericardial space, which facilitate the clearance of loculations, and DNase may be useful as well . Only a third of patients can be managed with a pericardiocentesis alone, and most will require surgical pericardial resection or pericardectomy or another surgical drainage .…”

Purulent pericarditis: a rare cause for pericardial effusions in a patient with chronic kidney disease

“…An infectious aetiology should be considered when the clinical presentation indicates sepsis or when additional predisposing factors such as immunosuppression, malignancy, alcoholism or intrathoracic procedures are present . Immediate testing for LDH, glucose and protein is helpful to differentiate between exudate and transudate at the bedside . As the diagnostic gold standard, pericardiocentesis with extensive microbiological testing is recommended, and consecutive empirical antibiotic treatment is necessary to overcome the high mortality associated with this condition …”