- Massimo Imazio, MD, FESC
Massimo Imazio, MD, FESC
- Professor of Physiology
- University Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino.
- Department of Public Health and Pediatrics, University of Torino.
- Section Editors
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Martin M LeWinter, MD
Martin M LeWinter, MD
- Section Editor — Myopericardial Disease
- Professor of Medicine and Molecular Physiology and Biophysics
- University of Vermont
- Deputy Editors
- Brian C Downey, MD, FACC
Brian C Downey, MD, FACC
- Deputy Editor — Cardiology
- Assistant Professor of Medicine
- Tufts University School of Medicine
- Elinor L Baron, MD, DTMH
Elinor L Baron, MD, DTMH
- Deputy Editor — Infectious Diseases
- Assistant Clinical Professor of Medicine
- Tufts University School of Medicine
Prior to the widespread use of antibiotics, purulent pericarditis was a frequent complication of pneumococcal pneumonia. In modern times, most cases of purulent pericarditis are associated with nosocomial bloodstream infections (such as in the setting of dialysis), thoracic surgery, or immunosuppression (eg, HIV, chemotherapy).
Galen (AD 129 – 217) was one of the first clinicians to recognize and attempt to treat purulent pericarditis. While removing the "putrefied" sternum of a patient with posttraumatic pericarditis, he directly observed "mortification of the pericardium" in a patient who survived .
By the beginning of the 19th century, clinicians were aware that purulent fluid collections in the pericardium could occur in patients with pneumonia and pleurisy, and were attempting treatment with percutaneous drainage and pericardiectomy .
Issues related to purulent pericarditis will be reviewed here. Other causes of pericarditis and the management of acute pericarditis are discussed separately. (See "Etiology of pericardial disease" and "Acute pericarditis: Clinical presentation and diagnostic evaluation" and "Treatment of acute pericarditis".)
Purulent pericarditis is defined as a localized infection of the pericardial space characterized by gross pus in the pericardium or microscopic purulence (>20 leukocytes per oil immersion field). This distinction is important since purulent material in the pericardium is not synonymous with infectious pericarditis, and not all infections produce purulent effusions. As an example, pericarditis due to Mycoplasma hominis or viral infection is rarely macroscopically or microscopically purulent. By contrast, a variety of noninfectious conditions produce an inflammatory exudate that may contain >50,000 white cells/microL .
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- Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36:2921.
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- Imazio M, Cecchi E, Demichelis B, et al. Myopericarditis versus viral or idiopathic acute pericarditis. Heart 2008; 94:498.
- Nwiloh JO, Egbe PA, Tagoe AT, Weaver LW. Staphylococcus aureus pericarditis masquerading as anterior mediastinal mass: mediastinal mass from pericarditis. Chest 2000; 118:1832.
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- Nakagawa C, Kasahara K, Yonekawa S, et al. Purulent pericarditis due to Streptococcus pneumoniae diagnosed by pneumococcal urinary antigen assay and 16S rDNA sequence of the pericardial fluid. Intern Med 2010; 49:1653.
- Augustin P, Desmard M, Mordant P, et al. Clinical review: intrapericardial fibrinolysis in management of purulent pericarditis. Crit Care 2011; 15:220.
- Imazio M, Brucato A, Mayosi BM, et al. Medical therapy of pericardial diseases: part I: idiopathic and infectious pericarditis. J Cardiovasc Med (Hagerstown) 2010; 11:712.
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- Predisposing factors
- Direct spread of infection from an intrathoracic focus
- Hematogenous spread
- Extension from a myocardial focus
- Perforating injury or surgery
- Extension of infection from a subdiaphragmatic suppurative focus
- CLINICAL MANIFESTATIONS
- Laboratory findings
- Additional investigations
- Pericardial drainage
- Antimicrobial therapy
- - Empiric regimen
- - Pathogen-directed therapy
- - Duration of therapy