Staphylococcal Pericarditis Causing Pericardial Tamponade and Concurrent Empyema

Abstract

Bacterial pericarditis is a rare presentation and is usually due to secondary infection from a hematogenous cause or can occur secondary to trauma, intrathoracic surgery, or due to spread of infection from a contiguous focus via ligaments that anchor the pericardium to its surrounding structures. Its course is fulminant characterized by a high mortality rate from sepsis, tamponade, and constriction. We describe a rare case of Staphylococcus aureus pericarditis with concurrent unilateral empyema. The patient rapidly developed tamponade and was successfully treated with antibiotics and urgent percutaneous pericardial drainage with placement of a temporary catheter. Treatment for bacterial pericarditis typically is 4–6 weeks long. Thoracic surgery should be consulted as soon as possible to determine need for surgical intervention, as fibrin deposition may occur, making percutaneous drainage incomplete and leading to complications of persistent purulent pericarditis or constrictive pericarditis.

Great Toe Infection Leading to Methicillin-Sensitive Staphylococcus aureus Pericarditis and Tamponade

“…This comes from the latest 2015 European Society of Cardiology (ESC) guidelines on the management of pericardial diseases that label pericardiocentesis for moderate to large effusions a Class I recommendation [ 13 ]. Ultimately, the removal of purulent pericardial fluid is a life-saving procedure, especially in cases of hemodynamic instability [ 7 ]. While there are many surgical approaches to removing the purulent effusion, pericardiocentesis is usually the first-line therapy to drain the excess fluid [ 13 ].…”

“…This disease process occurs via many mechanisms including hematogenous dissemination, contiguous spread from an intrathoracic, myocardial, or subdiaphragmatic focus, or direct infection during trauma, thoracic surgery, or catheter drainage [ 6 ]. It is associated with a high mortality rate given its ability to rapidly progress to tamponade and death [ 7 ]. Here, we present a case of bacterial pericarditis, days after great toe amputation, resulting in cardiac tamponade which was successfully managed with pericardial drainage and IV antibiotics.…”

Purulent Pericarditis Secondary to Methicillin-Resistant Staphylococcus Aureus in a Previously Healthy Infant: A Case Report

“…[2][3] The occurrence of low QRS voltages and electrical alternans are observed in the presence of significant effusion. 1 Echocardiography remains to be the most sensitive technique for identifying and locating pericardial effusions while detecting evidence for tamponade, and relatedly, a 2D-echo guided pericardiocentesis is the preferred diagnostic and therapeutic option. 2,10 However, the surgical intervention performed by the team of thoraco-vascular surgery in our patient in draining the effusion is pericardiostomy instead of a pericardiocentesis due to the sizeable circumferential nature of the pericardial effusion with certainty that posteriorly located effusion cannot be approached by the latter.…”

“…Purulent pericarditis is defined as an infection of the pericardium characterized by frank pus in the pericardial space. 1 It is a fatal infection requiring immediate detection and treatment. In the advent of antibiotics, this has become rare with limited epidemiologic data and accounts for only <1% of all reported cases of infectious pericarditis.…”

“…While a number of pediatric literature reports of purulent pericarditis, there is limited data on community-acquired methicillinresistant Staphylococcus aureus (MRSA) as the etiology in children. [1][2][3][4][5][6][7][8] There have been studies demonstrating an increase in the incidence of various community-acquired MRSA infections affecting the pediatric population such as soft tissue infections, sepsis, and pneumonia. We report a case of a previously well immunocompetent 10-monthold male infant with purulent pericarditis secondary to a community-acquired methicillin-resistant Staphylococcus aureus with characteristics of cardiac tamponade.…”