Purulent pericarditis: Rediscovery of an old remedy

Mann-Segal, Daniel D.M.; Shanahan, E. Anne; Jones, Bruce R; Ramasamy, Day

doi:10.1016/s0022-5223(96)70462-2

Cited by 23 publications

(15 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…8 The incidence of purulent pericarditis has declined since the introduction of broad-spectrum antibiotics, 9 but it remains an important differential diagnosis because if left untreated, the combination of tamponade and sepsis results in a mortality rate approaching 100%. 10 With each decade, the most common causative organisms of infectious pericarditis seem to change, but the frequency and importance of the disease do not diminish. 7 Majid and Omar 11 reported that 6 of 12 cases of purulent pericarditis occurred secondary to a S. aureus infection, but only 1 of those arose from a remote septic focus.…”

Section: Discussionmentioning

confidence: 99%

“…Streptokinase acts by activating the fibrinolytic system, dissolving blood clots and the fibrinous components of exudate. 10 After forming a complex with plasminogen, streptokinase combines with fibrin and activates thrombolysis. 6 Fibrinolytic therapy can have adverse effects, including allergic reactions, although there are no reports of any systemic side effects being caused by absorbtion of the substance by the pleural and pericardial tissues.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intrapericardial Streptokinase for Purulent Pericarditis

Ekim

Demirbağ

2004

Surg Today

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intrapericardial Streptokinase for Purulent Pericarditis

Ekim

Demirbağ

2004

Surg Today

View full text Add to dashboard Cite

show abstract

“…The ongoing discussions and numerous investigations into a wide array of agents as possible ‘magic bullets’ in the prevention of pericardial constriction (post-TB infection) illustrates both the interest in the field, and also the lack of a satisfying solution to this problem. The following strategies have previously been evaluated: Mycobacterium indicus pranii immunotherapy,5 corticosteroids,5 pericardiocentesis,6 open surgical drainage (pericardial window),7 thalidomide,8 instilling intrapericardial fibrinolytic therapies,9-11 and a wide array of non-steroidal anti-inflammatory medication. Not one of these therapies has, to date, been internationally recognised as an acceptable standard of therapy, and the choice of adjuvant treatment varies significantly among experts in the field.…”

Section: Introductionmentioning

confidence: 99%

A prospective investigation into the effect of colchicine on tuberculous pericarditis

Liebenberg¹,

Dold²,

Olivier³

2016

CVJA

View full text Add to dashboard Cite

SummaryIntroductionTuberculous (TB) pericarditis carries significant mortality and morbidity rates, not only during the primary infection, but also as part of the granulomatous scar-forming fibrocalcific constrictive pericarditis so commonly associated with this disease. Numerous therapies have previously been investigated as adjuvant strategies in the prevention of pericardial constriction. Colchicine is well described in the treatment of various aetiologies of pericarditis. The aim of this research was to investigate the merit for the use of colchicine in the management of tuberculous pericarditis, specifically to prevent constrictive pericarditis.MethodsThis pilot study was designed as a prospective, double-blinded, randomised, control cohort study and was conducted at a secondary level hospital in the Northern Cape of South Africa between August 2013 and December 2015. Patients with a probable or definite diagnosis of TB pericarditis were included (n = 33). Study participants with pericardial effusions amenable to pericardiocentesis underwent aspiration until dryness. All patients were treated with standard TB treatment and corticosteroids in accordance with the South African Tuberculosis Treatment Guidelines. Patients were randomised to an intervention and control group using a webbased computer system that ensured assignment concealment. The intervention group received colchicine 1.0 mg per day for six weeks and the control group received a placebo for the same period. Patients were followed up with serial echocardiography for 16 weeks. The primary outcome assessed was the development of pericardial constriction. Upon completion of the research period, the blinding was unveiled and data were presented for statistical analysis.ResultsTB pericarditis was found exclusively in HIV-positive individuals. The incidence of pericardial constriction in our cohort was 23.8%. No demonstrable benefit with the use of colchicine was found in terms of prevention of pericardial constriction (p = 0.88, relative risk 1.07, 95% CI: 0.46–2.46). Interestingly, pericardiocentesis appeared to decrease the incidence of pericardial constriction.ConclusionBased on this research, the use of colchicine in TB pericarditis cannot be advised. Adjuvant therapy in the prevention of pericardial constriction is still being investigated and routine pericardiocentesis may prove to be beneficial in this regard.

show abstract

“…However, many authors have now described the use of fibrinolytic agents for the treatment of extravascular conditions such as empyema, purulent pericarditis, and peritoneal catheter-related peritonitis [9][10][11][12][13]. Although most of this experience has been in adults, multiple studies have now documented their use in children [14][15][16][17][18].…”

mentioning

confidence: 99%