Staphylococcal Pericarditis in a Homosexual Patient with AIDS-Related Complex

Stechel, Richard; Cooper, David; Greenspan, John S.; Pizzarello, Roy A.; Tenenbaum, Marvin J.

doi:10.1016/s0022-5347(17)44542-3

Cited by 9 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are also reports of pericarditis in AIDS patients caused by herpes simplex virus (4,7,8,13,29). Bacterial pathogens causing pericarditis include Staphylococcus aureus (6,26), Streptococcus pneumoniae (14), and Klebsiella pneumoniae (24). Fungal pericarditis secondary to Cryptococcus neoformans has also been reported (2,25).…”

Section: Discussion Nocardiosis Is An Uncommon Human Infectionmentioning

confidence: 99%

Rare Case of Nocardia asteroides Pericarditis in a Human Immunodeficiency Virus-Infected Patient

et al. 2007

View full text Add to dashboard Cite

Nocardia asteroides was isolated after prolonged culture from the pericardial fluid of a human immunodeficiency virus-infected patient. The lengthy duration required for culture growth and identification of this N. asteroides isolate affected both initial therapeutic decisions and patient management. A proposed algorithm for the microbiological workup of pericardial fluid for possible Nocardia spp. is described in an effort to improve the timeliness of results. CASE REPORTThe patient was a 44-year-old Filipino male with a medical history significant for newly diagnosed human immunodeficiency virus (HIV) infection and AIDS. In March 2005, he was admitted to the hospital for persistent fever of unknown origin. He was found to have HIV on this admission, and the CD4 cell count was 42/mm 3 . The initial workup included sputum Gram stain, silver stain, and culture, which showed only normal flora. In addition, sputum acid-fast bacillus (AFB) stain and culture were negative for Mycobacterium spp. and routine urine and blood cultures were also negative. During this admission, he was noted to have a pericardial effusion, which prompted a pericardiocentesis. Direct Gram and AFB stains on the pericardial fluid were negative, and no significant growth was detected on routine bacterial cultures. After pericardiocentesis, a repeat echocardiogram showed no pericardial fluid and the patient was discharged in stable condition. However, the AFB culture of the pericardial fluid subsequently became positive at week 6. Both the AFB and modified AFB stains were positive, and the morphology at that time was interpreted as being consistent with Mycobacterium spp. The specimen was sent to a local reference laboratory for further workup. The patient was empirically treated with isoniazid, rifampin, pyrazinamide, and ethambutol for possible Mycobacterium tuberculosis, and he was discharged on this four-antimycobacterial-drug regimen, as well as trimethroprim-sulfamethoxazole (TMP-SMX) and azithromycin for empirical coverage of Pneumocystis jiroveci and Mycobacterium avium complex. Highly active antiretroviral therapy was not successfully initiated due to poor drug compliance.The patient continued to have persistent fever, fatigue, and weakness. Two weeks later, he was readmitted to the hospital with a fever of 102.6°F and severe tachycardia (heart rate of 144 beats/min). His blood pressure on admission was 128/93. A chest X-ray showed a widened mediastinum, and the echocardiogram showed a moderate pericardial effusion which appeared loculated on a subsequent computed tomography (CT) scan (Fig. 1). By this time, the additional workup performed by the local reference lab on the pericardial fluid taken during the first admission demonstrated a partially acid-fast-positive bacillus with infrequent branching. In addition, the culture of the same pericardial fluid showed tiny, dry, white colonies resembling Nocardia spp. on sheep blood agar. The specimen was then sent to a second reference lab for bacterial identification and susceptibility tes...

show abstract

Section: Discussion Nocardiosis Is An Uncommon Human Infectionmentioning

confidence: 99%

Rare Case of Nocardia asteroides Pericarditis in a Human Immunodeficiency Virus-Infected Patient

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Whatever the cause of pericardial disease, patients may develop cardiac tamponade or constriction requiring surgical intervention. 130,134 Pericardial fluid is readily confirmed by echocardiography. Thickening or nodularity of the pericardium is sometimes demonstrated by echocardiography.…”

Section: Pericardiummentioning

confidence: 97%

“…127,131 Infective pericarditis from TB, MAI, nocardia, Cryptococcus, and Staphylococcus have also been described. 60,[132][133][134][135] In some cases, no cause for pericardial disease is found (Fig. 16).…”

Section: Pericardiummentioning

confidence: 99%