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PubMed1998

Colchicine treatment for recurrent pericarditis. A decade of experience.

BACKGROUND: The most troublesome complication of acute pericarditis is recurrent episodes of pericardial inflammation, occurring in 15% to 32% of cases. The cause of the recurrence is usually unknown, although in some cases it may be traced to viral infection or may be a consequence of coronary artery bypass grafting. The optimal method for prevention has not been fully established; accepted modalities include nonsteroidal anti-inflammatory drugs, corticosteroids, immunosuppressive agents, and pericardiectomy. METHODS AND RESULTS: Based on the proven efficacy of colchicine therapy for familial Mediterranean fever (recurrent polyserositis), several small studies have used colchicine successfully to prevent recurrence of acute pericarditis after failure of conventional treatment. Recently, we reported the results from the largest multicenter international study on 51 patients who were treated with colchicine to prevent further relapses and who were followed up for < or = 10 years. CONCLUSIONS: In light of new trial data that have accumulated in the past decade, we review the evidence for the efficacy and safety of colchicine for the prevention of recurrent episodes of pericarditis. Clinical and personal experience shows that colchicine may be an extremely promising adjunct to conventional treatment and may ultimately serve as the initial mode of treatment, especially in idiopathic cases.

Adult↗
PubMed1992

Polymicrobial bacterial pericarditis after transbronchial needle aspiration. Case report with an investigation on the risk of bacterial contamination during fiberoptic bronchoscopy.

A 63-yr-old man developed pericardial effusion with tamponade after transbronchial needle aspiration (TBNA) of a subcarinal mass. A diagnosis of polymicrobial bacterial pericarditis was made when pericardiocentesis revealed purulent fluid that grew a mixed culture of anaerobes and aerobes, organisms that constitute part of the normal upper respiratory tract flora. To examine the possibility that contamination of the transbronchial needle (TBN) could lead to purulent pericarditis by inoculation of bacteria into the mediastinum, quantitative cultures of the TBN content were performed in seven consecutive patients. Abundant growth of multiple anaerobic and aerobic organisms was demonstrated in all seven cultures. We conclude that subcarinal TBNA is another potential cause of purulent pericarditis. This results from upper respiratory tract contamination of the open distal end of the TBN as it passes through the suction channel of the bronchoscope.

Bacteria, Aerobic↗
PubMed2005

Microbiologic and pathologic findings in an epidemic of equine pericarditis.

During the spring and summer of 2001 and in association with the mare reproductive loss syndrome, 22 terminal and 12 clinical cases of equine pericarditis were diagnosed in central Kentucky. Actinobacillus species were the principal isolates from 8 of 10 nontreated, terminally affected and 3 of 10 clinically affected horses. Enterococcus faecalis and Streptococcus zooepidemicus were cultured from the remaining 2 nontreated terminal cases. No viruses were isolated in tissue culture. Nucleic acid of equine herpesvirus-2 was detected in pericardial and tracheal wash fluids of 3 and 1 individuals, respectively. Microscopic alterations in sections of heart and parietal pericardium were consistent with chronic fibrinous bacterial pericarditis. This report confirms a significant role of Actinobacillus species in equine pericarditis and describes an epidemic of this infrequently observed syndrome in the horse.

Animals↗
PubMed2004

Five children with purulent pericarditis and review of the literature.

Purulent pericarditis in children is a life-threatening disease that requires early diagnosis and immediate intervention. This cardiac emergency is rarely seen in the western world. However, cases of purulent pericarditis are still being reported in developing countries. We describe our experience with five cases of purulent pericarditis in children seen between 1998 and 2002. Haemophilus influenzae bacteria were isolated in all except one case. With active management, all five children survived.

Child↗
PubMed2005

Clinical characteristics and treatment of constrictive pericarditis in Taiwan.

BACKGROUND: Constrictive pericarditis is an uncommon disease that prevents the normal diastolic filling of the heart and pericardiectomy is the only satisfactory treatment. METHODS AND RESULTS: The clinical characteristics and treatment of patients who underwent pericardiectomy for constrictive pericarditis (n = 23) were reviewed. Surgery was performed via left anterolateral thoracotomy plus transsternal extension in 3 patients, and median sternotomy in 20 patients. There were 2 deaths, resulting in an overall mortality rate of 8.7%. Of the 23 patients, 8 had Mycobacterium tuberculosis (Tb) infection, 2 had streptococcus infection, 1 had strongyloidiasis (Strongyloides stercoralis) and 1 developed the condition after a myocardial infarction; 2 patients underwent pericardial substitute insertion as post-heart surgery, and 3 patients had connective tissue disorders; 6 patients had idiopathic disease. CONCLUSION: These results show that bacterial infection, especially Tb, is a major etiology of constrictive pericarditis in Taiwan and that median sternotomy is an excellent approach for exposing the heart for pericardiectomy.

Humans↗
PubMed1978

A clinical study on idiopathic pericarditis.

1) Thirty-eight cases of idiopathic pericarditis in our institutes were analyzed and were classified into 3; group A: clinical picture of pericarditis, group B: clinical picture of peri-myocarditis and group C: dominant clinical picture of chronic pericardial effusion. 2) All cases of group A showed a good clinical course. 3) In group B cases with complete A--V block continued to have heart block with significant myocardial changes, and the prognosis may not be good. 4) Many cases of group C belonged to elderly female and the etiology was unclear. 5) Viral pericarditis was proven in only one case.

Adolescent↗
PubMed1998

Tuberculous pericarditis: MRI features with contrast enhancement.

Tuberculous pericarditis has decreased in incidence, but early diagnosis and treatment are critical because constrictive pericarditis is a serious complication of this condition. The appearances of tuberculous pericarditis on gadolinium enhanced magnetic resonance imaging are described and the value of this modality in achieving an early diagnosis is emphasized.

Adolescent↗
PubMed1992

Candida albicans purulent pericarditis treated successfully without surgical drainage.

Cures of Candida pericarditis reported in the literature uniformly involved surgical drainage of the pericardial space. We report a patient with purulent pericarditis caused by Candida albicans who was treated successfully with antifungal chemotherapy combined with a single pericardiocentesis that did not completely evacuate the pericardial space. This case indicates that thoracotomy with surgical drainage of the pericardium is not mandatory for successful therapy of Candida pericarditis.

Amphotericin B↗
PubMed1993

Worsening tricuspid regurgitation following pericardiectomy for constrictive pericarditis.

We describe two cases of worsening tricuspid regurgitation following surgical pericardiectomy for constrictive pericarditis. Both patients demonstrated hemodynamic profiles characteristic of constrictive pericarditis on cardiac catheterization. They also had moderate tricuspid regurgitation as judged by Doppler echocardiography. The worsening tricuspid regurgitation observed was a result of postoperative right ventricular dilatation. These cases demonstrate the importance of determining tricuspid valvular function in patients with constrictive pericarditis prior to pericardiectomy; however, the hemodynamic changes that result in worsening tricuspid regurgitation may not be present for weeks.

Aged↗
PubMed1994

Staphylococcus aureus pericarditis in HIV-infected patients.

Serious infections caused by Staphylococcus aureus in HIV-infected patients have been reported. Contributing factors in the development of invasive S aureus infections include a high rate of skin and nasal colonization, frequent dermatologic disease, and the use of intravenous catheters. The authors report three cases of S aureus pericarditis in HIV-infected patients. While cases of viral, mycobacterial, and malignant pericardial effusions in HIV-infected patients have been reported, a review of the literature disclosed only three cases of bacterial pericarditis. Despite appropriate antibiotic therapy and drainage, a patient's condition may abruptly deteriorate and progress to tamponade. Early recognition of bacteremia and pericarditis and monitoring for cardiac tamponade, along with aggressive treatment, can result in a favorable outcome, but mortality remains high, particularly when S aureus is the causative agent.

Adult↗
PubMed1999

Purulent pericarditis with tamponade in a postpartum patient due to group F streptococcus.

Bacterial pericarditis with cardiac tamponade is a life-threatening disorder that has been associated with a variety of organisms. There is usually an associated underlying condition or a seeding of the pericardium from an infection elsewhere. We report the development of cardiac tamponade and a subsequent pericardial constriction due to group F streptococcus purulent pericarditis. We believe this to be the first report of a postpartum patient with purulent pericarditis.

Adult↗
PubMed1978

Echinococcosis complicated by purulent pericarditis.

Three patients are described in whom purulent pericarditis arose as a complication of hydatid disease. In one patient a myocardial cyst ruptured into the pericardial cavity and subsequently became superinfected, probably from a coexisting bronchopneumonia. This patient also had widespread intravascular dissemination of germinal membrane. Two patients had echinococcal cysts of the liver, which became infected following surgery. This led to formation of a fistula between the hepatic hydatid and the pericardium, resulting in purulent pericarditis. The cases illustrate the protean nature of echinococcosis, especially the cardiac form, and emphasize the difficulty of recognizing purulent pericarditis as a complication of other conditions.

Adult↗
PubMed1980

Elevation of plasma MB creatine kinase and the development of new Q waves in association with pericarditis.

A 64-year-old woman with an acute exacerbation of chronic relapsing pericarditis had initial clinical and ECG features that were consistent with an acute anterior myocardial infarction. Transient Q waves were observed in the precordial leads, and she also exhibited elevated plasma MB creatine kinase (MB CK) activity. However, the overall clinical and laboratory data, including angiographic and radionuclide studies, suggest that the myocardial damage was secondary to pericarditis per se, rather than ischemic myocardial infarction. This case emphasizes that Q waves and elevated MB CK activity can be seen in association with pericarditis, and this must be differentiated from myocardial infarction secondary to coronary artery disease.

Creatine Kinase↗
PubMed1983

Repolarization variant vs acute pericarditis. A prospective electrocardiographic and echocardiographic evaluation.

Patients with ECG nonischemic ST segment elevation were prospectively studied to determine the accuracy of the initial ECG diagnoses. Evaluations were made of 131 consecutive patients by serial clinical, ECG, and echocardiography to establish a diagnosis. Eighty-six (66 percent) had an initial ECG interpretation of repolarization variant. Only three of the 86 (3 percent) subsequently met clinical criteria for acute pericarditis. Analysis of the mean frontal ST segment vector and PR segment depression revealed no significant differences between the 119 patients with final clinical diagnosis of repolarization variant and the 12 with clinical acute pericarditis. The diagnostic reliability of the initial ECG alone as a means of confirming acute pericarditis is low (9/45, 20 percent) but in the detection of repolarization variant is extremely high (83/86, 97 percent).

Acute Disease↗
PubMed1984

Occult purulent pericarditis detected by indium-111 leukocyte imaging.

Leukocyte imaging with indium-111 is a relatively new technique which, to this point in time, has been discussed almost exclusively in the radiologic literature. Although this procedure has been used mainly to detect intra-abdominal infection, the thorax is routinely imaged along with the abdomen, and therefore detection of cardiac disease may be feasible. This case report is of a young woman after liver transplantation who developed occult purulent pericarditis initially detected by a leukocyte scan with indium-111. This case demonstrates that striking pericardial uptake on a whole-body indium-111 leukocyte scan can occur with purulent pericarditis, and it reemphasizes how insidiously purulent pericarditis may present in an immunosuppressed patient.

Adult↗
PubMed1988

Chronic constrictive pericarditis associated with asbestosis.

Observation of chronic constrictive pericarditis associated with pulmonary asbestosis is reported here. Heart catheterization revealed typical patterns of cardiac constriction. The diagnosis of asbestosis was based on pathologic features associated with a long history of asbestos dust exposure without evidence for tuberculosis. The etiology of this constrictive pericarditis was related to an asbestosis pericarditis involvement.

Aged↗
PubMed2004

Chylous ascites and pleural effusion secondary to constrictive pericarditis presenting with signs of lymphatic obstruction.

Chylous ascites is a clinical entity characterized by accumulation of milky fluid containing high amounts of triglycerides in the peritoneal cavity. The cause is usually lymphatic obstruction secondary to neoplastic processes. Constrictive pericarditis rarely causes cylous ascites through elevated venous pressure and lymphatic stasis. To the best of our knowledge, there is no report of constrictive pericarditis leading to chylous ascites in a patient presenting with objective lymphangiographic findings of lymphatic obstruction rather than stasis. We present a case of chylous ascites and pleural effusion secondary to constrictive pericarditis presenting with signs of lymphatic obstruction in lymphangio-graphy, in whom complete clinical and laboratory improvement was achieved after pericardiectomy.

Chylous Ascites↗
PubMed1993

Tuberculous pericarditis: importance of adenosine deaminase activity in pericardial fluid.

We present a case of tuberculous pericarditis that was diagnosed early by a high titer of adenosine deaminase activity in the pericardial fluid and by a strongly positive tuberculin test. Within 2 weeks of initiation of treatment, pericardial effusion gradually decreased while clinical symptoms improved markedly. Culture from sputum, gastric juice, urine, and pericardial fluid were negative for tubercle bacillus. Measurement of adenosine deaminase activity in the pericardial fluid is a supplementary diagnostic test which is as important as for tuberculous pericarditis as it is for tuberculous pleuritis, because negative Ziehl Neelsen staining and culture for tubercle bacillus are common in tuberculous pericarditis.

Adenosine Deaminase↗