Acute purulent pericarditis treated conservatively with intrapericardial fibrinolysis and intrapericardial and systemic antibiotics.
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ABSTRACT:
SUBMITTER: Abdelnabi M
PROVIDER: S-EPMC8224196 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Meningococcal pericarditis is a rare but severe form of acute purulent pericarditis. It is a classic complication of Neisseria meningitidis of serotype W135, usually occurring in pilgrims to Mecca and their household contacts. This severe form of meningococcaemia is difficult to diagnose and evolves frequently and gradually towards a tamponade, requiring emergency drainage. We report a case of meningococcal pericarditis caused by N. meningitidis W135 in an immunocompetent patient, without any other organ involvement especially meningeal, requiring pericardium drainage in emergency and then intrapericardial fibrinolysis.
| S-EPMC6202986 | biostudies-literature
Project description:BackgroundPericardial constriction is one of the complications of purulent pericarditis (PP). Most difficult to treat, which may develop both in early and in the late period of the disease, resulting in a very poor prognosis.Case presentationWe present case series of 4 patients with purulent pericarditis, in whom direct intrapericardial administration of recombinant tissue plasminogen activator (r-tPA) was used. Management of PP requires a combined surgical and medical approach. The most important is complete drainage of the effusion by subxiphoid pericardiotomy connected with complementary use of broad-spectrum antibiotics. Despite the use of broad- spectrum antibiotics, in some patients a large volume of daily drainage is still present. Constrictive pericarditis as a complication of PP is observed in majority of patients. Intrapericardial administration of fibrinolytic agents, although not strongly recommended, can improve efficacy of antibiotic treatment especially in patients with loculation fluid and can prevent the development of constrictive pericarditis. r-tPA was applied at a dose of 20 mg dissolved in 100 ml of normal saline in a 100 ml syringe, administered by a large pericardial drain (Pezzer drain) installed into the pericardial cavity during pericardioscopy. The tube was closed and re-opened after 24 h. No serious complications, such as bleeding, allergy or hypotension, were noted.ConclusionWe present case series of 4 patients with purulent pericarditis, in whom direct intrapericardial administration of recombinant tissue plasminogen activator (r-tPA), prevented the development of constrictive pericarditis, and increased efficacy of antibiotic treatment without any significant complications.
| S-EPMC7451238 | biostudies-literature
Project description: Not available
| S-EPMC6710824 | biostudies-literature
Project description:We describe a man with cardiac tamponade after anterior myocardial infarction (MI) with a mass on echocardiography, complicated by a S. Milleri purulent pericarditis. This case is an example of how 2 cardiac conditions can interfere with the diagnosis and management of each individual disorder, resulting in an extremely complex disease course. (Level of Difficulty: Beginner.).
| S-EPMC9730162 | biostudies-literature
Project description:A 78-year-old man was admitted to the hospital for evaluation and treatment of anasarca secondary to staphylococcal purulent pericarditis. One month earlier he had undergone a lumbar laminectomy that was complicated postoperatively by a lumbar abscess that was not clinically apparent. The infection subsequently spread to the pericardium. Despite aggressive therapy that included therapeutic pericardiocentesis, drainage of pericardial fluid, and prolonged intravenous antibiotic therapy, the patient returned 2 weeks after discharge from the hospital with complicating constrictive pericarditis. Pericardiectomy was performed, resulting in complete relief of the patient's symptoms.
| S-EPMC101181 | biostudies-literature
Project description:We report the first case of purulent pericarditis with greenish pericardial effusion caused by Shewanella algae in a patient with gastric and gallbladder cancer. This case expands the reported spectrum of infection caused by S. algae and raises the possibility that S. algae is a causative pathogen for purulent pericarditis.
| S-EPMC2519482 | biostudies-literature
Project description:BackgroundUltrasound is an accurate tool for diagnosing acute appendicitis. Conservative treatment for uncomplicated acute appendicitis is feasible and safe in children. However, no sonographic follow-up results from children with nonoperatively managed acute appendicitis have been reported.ObjectiveTo describe the sonographic appearance of the appendix at follow-up ultrasound and to attempt to identify signs predictive of recurrent acute appendicitis.Materials and methodsChildren diagnosed with uncomplicated acute appendicitis and treated conservatively in our hospital from 2014 to 2019, and who presented for follow-up ultrasound at 3, 6 and 9 months, were included in our study. Clinical, laboratory and ultrasound data were recorded.ResultsBy the end of follow-up, 29 (14.2%) of 204 children in the cohort had developed recurrent acute appendicitis and 175 had recovered uneventfully. On follow-up ultrasound, appendiceal diameter measured > 6 mm in 56/204 (27.5%) cases at 3 months and in 9/26 (34.5%) at 6 months. After 3 months, 102/204 (50%) children had normal appendiceal diameter on ultrasound. Appendiceal diameter > 6 mm was associated with intraluminal fluid or sludge in the appendiceal lumen at 3- and 6-month follow-up (P < 0.001, P = 0.002, respectively). Comparing cases with and without recurrence, at 3-month follow-up, appendiceal diameter > 6 mm was found in 17/29 (58.6%) cases vs. 39/175 (22.3%), respectively (P < 0.001). Appendiceal diameter returned to normal in 12/19 (63.2%) cases in the nonrecurrent acute appendicitis group compared with 2/7 (28.6%) in the recurrent acute appendicitis group (P = 0.05) at the 6-month follow-up. Intraluminal fluid or sludge was detected more frequently in the recurrent acute appendicitis versus the nonrecurrent acute appendicitis group at 3- (P < 0.001) and 6-month (P = 0.001) follow-up.ConclusionProgressive normalization of appendiceal diameter was noted on follow-up ultrasound. The prevalence of both appendiceal diameter > 6 mm and intraluminal fluid or sludge were found to be increased in children who later developed recurrent acute appendicitis. Ultrasound appears to be a useful tool for follow-up in children with conservatively treated uncomplicated acute appendicitis and possibly might help predict recurrence.
| S-EPMC9483395 | biostudies-literature
Project description:The present report describes a case of spontaneous purulent granulomatous pericarditis in a 16-month-old beagle. A gross necropsy revealed pericardial effusion and multiple nodules on the surface of the heart and around the aorta adjacent to the heart. The cut surface of these nodules was solid and white in color, containing partially yellowish white regions. Microscopically, granulomatous inflammation characterized by central necrotic cellular debris surrounded by neutrophils, macrophages, lymphocytes, plasma cells, fibroblasts and collagen fibers was observed in the epicardium. In addition, degeneration or necrosis of the arterial wall with inflammation was observed in the nodules. No gross and histological findings were observed in any organs other than the heart. Bacteria and fungi were not detected by Periodic acid-Schiff staining, Gram-Hucker staining and Ziehl-Neelsen staining. Based on these findings, the dog was diagnosed as having purulent granulomatous pericarditis. Purulent pericarditis is usually caused by pyogenic bacterial or fungus infections; however, no changes indicating a possible infection were observed in this case. In cases with spontaneous vascular changes, such as idiopathic canine polyarteritis or beagle pain syndrome, epicarditis could be secondarily caused by vascular lesions. Since this case showed different pathological features from those of spontaneous vascular changes, the pathogenesis may be different and remains unclear. To the best of our knowledge, this is the first report describing purulent pericarditis in beagles. Our case report is expected to be useful information that can be used as cardiac background findings for evaluating heart lesions in preclinical toxicology studies performed in beagles.
| S-EPMC5545679 | biostudies-other
Project description:IntroductionPurulent pericarditis poses diagnostic and therapeutic challenges, especially in resource-limited settings due to the unavailability of diagnostic tools, equipment, and expertise.Case reportA three-year-old female presented to the emergency centre at Muhimbili National Hospital in Dar es Salaam, Tanzania with altered mental status, lethargy, intermittent fevers, worsening difficulty in breathing, and progressive lower extremity swelling over two months. The child was in shock upon arrival. Point-of-care ultrasound demonstrated cardiac tamponade secondary to purulent pericarditis. An ultrasound guided pericardiocentesis and lavage was successfully done in the emergency centre and antibiotics were started. Though definitive management (pericardiectomy) was delayed, the child survived to hospital discharge.ConclusionPericardiocentesis, pericardial lavage, and the initiation of broad spectrum antibiotics are the mainstay of early treatment of purulent pericarditis. This treatment can be done safely in an emergency centre with little specialised equipment aside from point-of-care ultrasound.
| S-EPMC6223587 | biostudies-literature
Project description:BackgroundQuality improvement in conservative pain management (QUIKS), a module for nonoperative patients in the QUIPS project was tested on a cohort of tumor patients regarding its applicability.Material and methodsConservatively treated inpatients at the University Hospital of Würzburg (UKW) were prospectively surveyed on the quality of pain management using the QUIKS outcome questionnaire (AZ 129/17, Ethics Committee at UKW). Information on therapy and demographics was taken from the hospital's internal documentation system.ResultsDuring the data collection period 100 conservatively treated inhouse tumor patients from different hospitals were included. Of the patients 74% required assistance in answering the questionnaire. Functional limitations or pain treatment-related side effects were present in 77% of the patients; the average pain level was 6 on the numerical rating scale. The most commonly reported type of pain was back pain and headache. Of the patients 18% received pain therapy with opioids and 26% with nonopioids, adjustment was made in 5% with opioids and in 44% with nonopioids and pain medicine specialists were consulted in 9% of cases.ConclusionThe application of the questionnaire was well accepted by the patients but required a high level of assistance in completing it. A high level of pain was observed during the hospital stay and the adjustment of pain therapy or the involvement of pain medicine specialists was rare. The interpretation of statements regarding the quality of tumor pain may be limited as other (pre-existing) pain entities, such as nontumor-associated pain or chronic tumor pain could not be clearly delineated.
| S-EPMC9512755 | biostudies-literature