Methicillin-resistant Staphylococcus aureus pericarditis causing cardiac tamponade

Abstract

Community acquired methicillin-resistant Staphylococcus aureus (MRSA) is an organism that can cause life threatening injuries with 6 cases of purulent pericarditis secondary to MRSA being reported so far. We report a 66 year-old -female who presented to our hospital with a two-week history of worsening shortness of breath, associated with pleuritic chest pain and chills. Patient was found to be positive for influenza type A virus two weeks prior to this presentation, but was never treated. Physical exam upon arrival showed muffled heart sounds and jugular venous distention. Electrocardiogram showed diffuse ST segment elevations along with PR segment depressions in anterolateral leads. She underwent emergent transthoracic echocardiogram that demonstrated a large pericardial effusion most noticeable around the right ventricle with impedance of right ventricle filling. Patient had a pericardial window performed and purulent fluid was drained. Pericardial fluid cultures grew MRSA. Patient was started on vancomycin along with colchicine for MRSA pericarditis and became hemodynamically stable. Pericarditis due to MRSA is extremely rare, especially in the antimicrobial era and in the absence of prior surgical interventions.

Purulent pericarditis in a patient with community-acquired methicillin-resistant Staphylococcus aureus: a case report with mini-review

“…Pericarditis due to MRSA is a rare event, only a handful of cases (12 patients) have been reported in the literature (Table 1). [6][7][8][9][10][11][12][13][14][15] Our review of literature revealed that patients across all age groups developed MRSA pericarditis (ranging from 7 months to 75 years). Direct spread from intrathoracic focus of infection (myocardial foci, thoracic surgery or contamination from penetrating trauma), hematogenous spread and extension from subdiaphragmatic suppurative focus are the various mechanisms described for the development of purulent pericarditis.…”

“…11 Cardiac tamponade was documented in a total of 7 patients. [6][7][8][9][10]12,15 Our search results revealed that vancomycin was the most common antibiotic used for the treatment of MRSA pericarditis. Duration for antibiotics therapy was variable (ranging from 2 to 6 weeks, Table 1).…”

A Rare Case of MRSA Pericarditis with Expanding, Purulent Pericardial Effusion Leading to Uremic Kidney Failure from a Right, Necrotic Toe

“…This organism colonizes the nasopharynx, perineum, and skin, and it can migrate into the circulatory system and lead to hematogenous spread if the cutaneous barrier is disrupted or damaged. The diagnosis of purulent pericarditis from MRSA is extremely rare, with only a few case reports thus far [2][3][4][5][6][7][8]. However, the mortality rate for untreated patients can approach 100% but decreases to 40% in those patients who are appropriately treated with antibiotics and source control [9].…”

The Effectivity of Thymus vulgaris Extract on IL-1 Level and Bacterial Count in The Heart of Balb-c Mice Infected with MRSA

“…Staphylococcus aureus was one of the causes of the death in several developing countries including Indonesia. 1,2 S. aureus infection is a serious problem today due to the increasing resistance of bacteria to various types of antibiotics (Multi Drug Resistance / MDR), such as MRSA (Methicillin Resistant S. aureus). There were six reported cases of purulent pericarditis due to MRSA in Jacksonville, Florida, USA in 2019.…”

“…There were six reported cases of purulent pericarditis due to MRSA in Jacksonville, Florida, USA in 2019. 1 Another unusual case report in New Delhi, India in 2016 of fatal bacterial myocarditis in a seven year old girl, who had a history of cough for a month and fever for two days. Autopsy revealed pyogenic bacterial myocarditis associated with bilateral lobar pneumonia caused by gram positive cocci named S. aureus.…”