Pneumococcal pericarditis presenting as an out of hospital cardiopulmonary arrest.

Wass, A R; Mann, P. G.; Wilson, James

doi:10.1136/emj.14.4.261

Cited by 9 publications

(9 citation statements)

References 15 publications

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“…As a noninvasive tool that both identifies pericardial effusions and acts as a guide for pericardiocentesis, echocardiography has greatly improved diagnosis [2]. Transthoracic echocardiography can demonstrate pericardial fluid in virtually all patients with bacterial pericarditis; however, it cannot distinguish between purulent fluid collections and sterile or inflammatory effusions.…”

Section: Discussionmentioning

confidence: 99%

“…Typical pericarditis features including pulsus paradoxus, right heart failure, chest pain, or a pericardial friction rub are frequently absent [5,7]. Diagnosis is often delayed further if a focus of infection has previously been identified due to a tendency to attribute the more reliable, but less specific symptoms, like tachycardia or pyrexia, to the underlying infection itself [2,3]. A high clinical suspicion is, therefore, paramount to timely diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The disease was also seen most often in children [1,5]. Since 1943, the widespread use of both antibiotics and the pneumococcal vaccine are responsible for a decline in the overall incidence of purulent pericarditis by a factor of three [2]. The median age at diagnosis has also increased from 21 years before penicillin use to 49 years old thereafter [3].…”

Section: Discussionmentioning

confidence: 99%

“…EKG may also be used for diagnosis. Generalized ST segment elevation without reciprocal changes are the most common changes seen in pericarditis; however, EKG may be normal in over 35% of cases [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…Its complications include empyema and endobronchial obstruction with atelectasis and lung abscess formation [1]. Purulent pericarditis, while quite rare today, is another well-demonstrated complication of untreated pneumococcal pneumonia and sepsis [2]. It may occur by direct spread of an intrathoracic, myocardial, or subdiaphragmatic focus, a perforating injury to the chest wall, or hematogenous dissemination [3,4].…”

Section: Discussionmentioning

confidence: 99%

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Purulent pericarditis

Hayden

Prahlow

2016

Forensic Sci Med Pathol

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Case ReportA 77 year old Caucasian male was found unresponsive at his residence. He had no significant medical history, except for severe anemia treated with a transfusion two months prior.At autopsy, external examination of the body revealed a well-developed, well-nourished, thin male with no remarkable features. Internal examination of body cavities revealed cloudy yellow fluid within each pleural cavity. The pleural surfaces were focally purulent, particularly inferomedially. The pericardial cavity was completely replaced with thick purulent fluid adherent to both the epicardium and pericardium (Fig. 1-4). Further cardiovascular exam revealed cardiomegaly (heart weight 520 g) with focal areas of mild to severe atherosclerosis in the coronary artery system. There was concentric left ventricular hypertrophy, measuring up to 1.7 cm, along with marked biventricular dilatation. The endocardium was unremarkable. Apart from aortic atherosclerosis and pulmonary emphysema, all other organ systems were grossly unremarkable.Microscopic examination of the heart revealed fibrinous and purulent pericarditis. The lungs showed emphysema, purulent pleuritis, and focal pneumonia. Both pericardial fluid and blood cultures grew Streptococcus pneumoniae. The urine drug screen was positive for only Caffeine and Chlorpheniramine, and a serum drug screen was positive for ethanol at 8 mg/dL.Based on the autopsy findings, the cause of death was determine to be purulent pericarditis with associated pneumonia and presumed sepsis, with underlying hypertensive and atherosclerotic cardiovascular disease and pulmonary emphysema.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Purulent pericarditis

Hayden

Prahlow

2016

Forensic Sci Med Pathol

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A case of purulent pneumococcal pericarditis

Zmora

Wiener-Well

Alpert

2019

The American Journal of Emergency Medicine

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Aspergillus Infection in Patients with Hyperimmunoglobulin E Syndrome

Meer¹,

Bont²,

Verhage³

1998

CLIN INFECT DIS

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SIR-We appreciate the interest in our article [1]. Our statement that aspergillus infection is extremely rare in patients with hyperimmunog-SIR-In their case report on pulmonary aspergillosis in a child lobulin E syndrome (HIE) was based on an extensive search of the with hyperimmunoglobulin E syndrome (HIE), Wolach et al. [1] English-language literature, which yielded only one case of an adult state that aspergillus infections in patients with this syndrome are patient with HIE and aspergillus infection [2]. We were also surprised extremely rare. They were able to find only one case of pulmonary by the paucity of reports describing the association of the aboveaspergillosis and HIE in the literature. mentioned entities. The three cases cited by van der Meer et al. in On the basis of our experience, we tend to disagree about the their correspondence were reported in Dutch [3, 4] and therefore were rarity of this occurrence. In a series of five Dutch patients with overlooked. Even with the additional three cases, aspergillosis in HIE that was reported in 1985, two patients with this complication patients with HIE is still uncommon. Its occurrence emphasizes that were included [2]. One of them, a woman, died of massive hemoppulmonary infection with opportunistic fungi can be found in patients tysis caused by multiple pulmonary aspergillomas at the age of with HIE. It is of interest that a lesion in the right lung was reported 20. A second female patient was treated surgically for a pulmonary in all four cases [1][2][3][4]. aspergilloma in the right lower lobe when she was 8 years old.We thank van der Meer et al. for bringing to our attention the Twelve years later, she had a pulmonary abscess and recurrent additional cases of aspergillosis in patients with HIE. hemoptysis refractory to embolization; a lobectomy of the right upper lobe was performed. During the postoperative period, the Giora Gottesman, Alon Eliakim, and Baruch Wolach patient died of respiratory insufficiency. we assert the fact that there is no evidence that the free-living ameba infection with Acanthamoeba causing keratitis [2]. Acanthamoeba is a proven etiologic agent of keratitis in humans, but we have demon-

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Pneumococcal pericarditis presenting as an out of hospital cardiopulmonary arrest.

Cited by 9 publications

References 15 publications

Purulent pericarditis

Purulent pericarditis

A case of purulent pneumococcal pericarditis

Aspergillus Infection in Patients with Hyperimmunoglobulin E Syndrome

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