Detection of Anaplasma phagocytophilum in an inflammatory pericardial effusion of a dog.

An 11-year-old female spayed German Wirehaired Pointer with a 1-week history of lethargy, hyporexia, diarrhea, and coughing presented with pericardial effusion causing cardiac tamponade. An echocardiogram revealed no structural cause for pericardial effusion. The pericardial effusion was an exudate with mixed macrophagic and neutrophilic inflammation. Morulae occasionally were found within neutrophils. The pericardial fluid and blood were qPCR and cPCR positive for Anaplasma phagocytophilum (NC State University, Vector-borne Disease Diagnostic Laboratory, Raleigh, NC). The dog's blood was negative by ELISA (Vetscan Flex4 Rapid Test, Zoetis, Parsippany, NJ) for A. phagocytophilum antibodies at initial presentation and subsequently positive (SNAP4DxPlus, IDEXX, Westbrook, ME) 7 days later. After pericardiocentesis and administration of doxycycline (5 mg/kg PO q12h for 14 days), a repeat echocardiogram performed 1 month later showed no recurrence of pericardial effusion.

A Rare Case of Effusive-Constrictive Pericarditis Caused by Streptococcus agalactiae: Emergency Surgical Treatment.

A 70-year-old male patient was admitted to the emergency room in cardiac arrest. The patient was resuscitated and then referred to our cardiac surgery department, where he was diagnosed with suspected effusive constrictive pericarditis. A failed trial of TEE-guided pericardiocentesis led to the decision of surgical intervention. Sternotomy was performed and revealed pericardial thickening and very dense adhesions involving the pericardium and both pleurae, suggesting a neoplastic disease. An extensive pericardiectomy and bilateral pleural decortication were performed. After surgery, the patient improved significantly and was discharged from the intensive care unit 24 h later. Pericardial thickening, dense adhesions, the amount and color of pericardial fluid and the aspect of epicardial tissue increased our suspicion of neoplastic disease. Histological samples were sent to be analyzed immediately; a few days later, they were unexpectedly negative for any neoplastic disease but showed a group-B-hemolytic Streptococcus agalactiae infection, which causes pericarditis in extremely rare cases. Postoperatively, the patient, under intravenous antibiotic and anti-inflammatory therapy, remained asymptomatic and was discharged ten days after the surgery. At the three-month follow-up, transthoracic echocardiography showed a normal right and left ventricular function with no pericardial effusion.

Gastropericardial fistula induced acute purulent pericarditis.

Gastropericardial fistula is a rare but lethal condition. Several etiologies have been reported, including previous gastric or esophageal surgery, malignancy, trauma, infection, and ulcer perforation. Typical symptoms included chest pain, epigastric pain, fever and dyspnea. Gastropericardial fistula can lead to serious complications, including cardiac tamponade, sepsis, hemodynamic compromise and death. Therefore, early diagnosis and timely management are important for physicians to prevent from catastrophic complications. Here, we present a case of a man who presented with acute purulent pericarditis secondary to a gastropericardial fistula to highlight the pathogenesis and suggest therapeutic strategies.

Actinomyces in Forensic Practice.

ABSTRACT: A 19-year-old woman in septic shock with recent computed tomography findings of a loculated hepatic abscess was transferred to an intensive care unit where she went into asystolic cardiac arrest. After resuscitation, surgical exploration revealed a purulent pericardial effusion with tamponade and a liver abscess. Microbiological analyses from both sites were negative. Shortly after surgical exploration, she developed multiorgan failure and died. At autopsy, pus was observed both within the pericardial cavity and around the left lobe of the liver. Green "sulfur granules" suggestive of infection with Actinomyces spp. were able to be extruded from the liver during the postmortem examination and cultures returned positive for Actinomyces israelii. This case is a rare example of primary hepatic actinomycosis infection that resulted in the death of a young woman. Nonspecific clinical manifestations may delay diagnosis; however, the finding of "sulfur granules" in areas of abscess formation at autopsy should be taken as an indication of possible underlying Actinomyces infection.

Disseminated Salmonella infection.

A 47-year-old Malay man who presented with fever, poor oral intake and loss of weight for 1 month duration. Further work-up revealed evidence of disseminated Salmonella infection that was further complicated with pericardial and pleural empyema. Cultures from pericardial and pleural fluids grew Salmonella species with negative serial blood cultures. Contrast enhanced CT thorax showed pleural effusion with large pericardial effusion. The patient was treated with antibiotics and drainage of pericardial and pleural empyema was done and he was discharged well.

Intrapericardial Encephalitozoon pogonae-associated arteritis with fatal hemopericardium in two juvenile central bearded dragons.

Two male juvenile central bearded dragons ( Pogona vitticeps) were submitted for postmortem examination after dying at their respective homes. Dragon 1 had marked hemopericardium with restrictive epicarditis. The inner aspect of the distended pericardial sac was lined by a fibrinoheterophilic membrane. In addition, granulomas abutted the testes. Dragon 2 had acute hemopericardium and granulomatous arteritis of the great vessels exiting the heart. Histologically, both animals had granulomatous arteritis of the large arteries with intrahistiocytic gram-positive, slightly elongated, up to 2 µm long microorganisms that contained a vacuole. These microorganisms were also present in the paratesticular granulomas. On transmission electron microscopy, the microorganisms were identified as microsporidians given the presence of exospore, endospore, vacuole, nucleus, and a filament with 4-6 coils. The microsporidia were identified as Encephalitozoon pogonae based on sequencing of the internal transcribed spacer 1 of the ribosomal RNA genes. Microsporidia are agents of disease in bearded dragons. Intrapericardial arteritis of large arteries with hemopericardium or restrictive epicarditis is a fatal manifestation of this infection.

[Infected Thoracic Aortic Aneurysm Secondary to the Purulent Pericarditis;Report of a Case].

A 69-year-old man was hospitalized urgently to the department of cardiology, with the progressive general malaise. On admission, his blood pressure was 80/42 mmHg, his white cell count 13,700/µl, and C-reactive protein 25.55 mg/dl suggesting existence of aggressive infection with impaired circulation. Massive pericardial effusion was detected in echocardiography. Pericardial drainage was undergone promptly. There was drainage of 700 ml and the property was purulent. Pneumococcus was detected by the culture test of the pericardial fluid. Antibiotic administration was started by a diagnosis of the purulent pericarditis. His general condition was improved. However, a rapidly expanding saccular aneurysm was found in a descending thoracic aorta by computed tomography( CT). As an infected thoracic aortic aneurysm secondary to the purulent pericarditis, we performed thoracic endovascular aneurysm repair (TEVAR). The intravenous administration of antibiotics was continued for 2 weeks after TEVAR, which was followed by oral antibiotic administration for 1 year. The aneurysm completely disappeared by CT, 10 months after TEVAR. In case with an infected thoracic aortic aneurysm, TEVAR can be a 1st choice of treatment, depending on a causative organism and the morphology of the aneurysm.

A case of tuberculosis pericarditis with an interesting echocardiographic image.

Tuberculosis-associated pericardial disorders are an excessively rare manifestation of extrapulmonary tuberculosis. The patients may present with constrictive pericarditis or pericardial fluid accumulation leading to cardiac tamponade. This paper reports a case of tuberculosis-associated pericardial effusion with dense fibrinous material not causing tamponade in a foreigner presenting with nonspecific symptoms. It also provides a discussion about the diagnostic and therapeutic methods as well as interesting echocardiographic images of the patient.

A Rare Case of Rush Progression of Purulent Pericarditis by Escherichia coli in a Patient with Malignant Lymphoma.

Purulent pericarditis is a rare disease in the antibiotic era. The common pathogens of purulent pericarditis are gram-positive species such as Staphylococcus aureus. Streptococcus pneumoniae, Salmonella, Haemophilus, fungal pathogens/tuberculosis can also result in purulent pericarditis. We report an old male case of purulent pericarditis by Escherichia coli. He came to our hospital suffering from leg edema for 3 months. Echocardiography revealed the large amount of pericardial effusion, and he was admitted to test the cause of pericardial effusion without high fever, tachycardia, and shock vital signs. On the third day, he suddenly presented vital shock. We performed emergency cardiopulmonary resuscitation and pericardiocentesis. Appearance of pericardial effusion was hemorrhagic and purulent. The gram stain revealed remarkable E. coli invasion to pericardial space. Antibiotic therapy was immediately started; however, he died on sixth day with septic shock. The cytological examination of pericardial effusion suggested the invasion of malignant lymphoma to pericardium. This case showed subacute or chronic process of pericarditis without severe clinical and laboratory sings before admission. Nevertheless, bacterial purulent pericarditis usually shows acute clinical manifestation; the first process of this case was very silent. Immunosuppression of malignant lymphoma might make E. coli translocation from gastrointestinal tract to pericardial space, and bacterial pericarditis was progressed to purulent pericarditis. In the latter process, this case showed unexpected rush progression to death by sepsis from purulent pericarditis. Immediate pericardiocentesis should be performed for a prompt diagnosis of purulent pericarditis, and it might have improved the outcome of this case.

A rare case of pyogenic pericarditis secondary to Streptococcus constellatus.

We report an extremely rare case of purulent pericarditis caused by the normally commensal oral flora, Streptococcus constellatus, a viridans Streptococcal species and member of the S. anginosus group (previously also known by the eponymous 'S. milleri', for American Willoughby Dayton Miller). This case is a previously healthy 71-year-old immunocompetent woman from Arizona who presented with a 5-day history of progressive shortness of breath and chest tightness, and subjective fever and chills, but without history of nausea, vomiting, night sweats, recent travel, autoimmune disease or sick contacts. Early recognition and intervention of purulent pericarditis allow patients like the one outlined in this case to achieve full recovery.

Implantation of multiple polytetrafluoroethylene covered stent inside drug eluting stent to rescue purulent coronary artery ectasia with giant saccular aneurysm.

A 79-year-old male with diabetes mellitus and old cerebral infarction was admitted to hospital due to fever and palpitation. Diagnosis of purulent pericarditis was established by pericardial effusion examination. The patient's general condition improved temporarily after drainage of the pericardial effusion. However, computed tomography demonstrated a saccular aneurysm arising from RCA have rapidly grown even larger, up to 63 × 51 mm on 7th hospital day. This indicated that the risk of rupture of the aneurysm was high. Percutaneous coronary intervention was applied to prevent rupture of the aneurysm. Several polytetrafluoroethylene (PTFE)-covered stents were required to cover the extended aneurysm lesion. A long drug-eluting stent (DES), which was initially implanted through the aneurysm, was itself implanted with 3 PTFE-covered stents located inside the DES. This procedure provided protection against endoleak of the aneurysm. To our knowledge, the present case shows for the first time that PTFE-covered stents located within DES are useful in treatment of a giant coronary aneurysm.

Primary purulent bacterial pericarditis due to Streptococcus intermedius in an immunocompetent adult: a case report.

BACKGROUND: Acute purulent bacterial pericarditis is of rare occurrence in this modern antibiotic era. Primary involvement of the pericardium without evidence of underlying infection elsewhere is even rarer. It is a rapidly progressive infection with high mortality. We present an extremely rare case of acute purulent bacterial pericarditis in an immunocompetent adult patient with no underlying chronic medical conditions. CASE PRESENTATION: A 33-year-old previously healthy white man presented with the complaints of chest pain and dyspnea. He was diagnosed as having acute pericarditis and was discharged home on indomethacin. Over a period of 2 weeks, his symptoms worsened gradually and he was readmitted to our hospital. He was found to have large pericardial effusion with cardiac tamponade. An urgent pericardiocentesis was done with drainage of 550 ml of purulent material. Cultures grew Streptococcus intermedius confirming the diagnosis of acute purulent bacterial pericarditis. No other focus of infection was identified on imaging workup suggesting primary infection of the pericardium. His clinical course was complicated by development of constrictive pericarditis for which he underwent surgical pericardiectomy. He received a total of 7 weeks of intravenously administered antibiotics with complete clinical recovery. CONCLUSIONS: Acute purulent bacterial pericarditis, although rare, should always be kept in mind as a possible cause of pericarditis. Early recognition and prompt intervention are important for a successful outcome.

[Purulent pericarditis, an unusual complication of pneumococcal pneumonia: a case report]. / Péricardite purulente Complication inhabituelle de pneumonie à pneumocoque : à propos d'un cas chez une femme enceinte.

Purulent pericarditis has become rare since the advent of antibiotics. Among the involved germs, S. pneumoniae remains the most implicated pathogen to evoke in principle, especially that prescription of systematic antibiotics for any febrile condition can considerably mask the clinical picture. A 36-year-old pregnant woman was visiting the emergency department for dyspnea and flu-like syndrom that had been going on for a week. The chest X-ray showed a white lung on the left and the transthoracic ultrasound revealed a pericardial effusion, resulting in pericardial drainage and pleural puncture that allows the evacuation of a purulent fluid. S. pneumoniae was identified on the pericardial fluid. Antibiotic therapy and resuscitation measures have allowed a good evolution. Even if it has become exceptional, pneumococcal pericarditis must not be overlooked since the evolution is often favorable in triple conditions: early recognition, prompt institution of appropriate antibiotic therapy, and early surgical drainage.

PCR evaluation of selected vector-borne pathogens in dogs with pericardial effusion.

OBJECTIVES: To investigate evidence for selected vector-borne pathogen infections in dogs with pericardial effusion living in a Mediterranean area in which several canine vector-borne diseases are endemic. MATERIALS AND METHODS: Archived EDTA blood (n=68) and pericardial fluid samples (n=58) from dogs with pericardial effusion (n=68) were included. Dogs without pericardial effusion examined for other reasons were included as controls (n=60). Pericardial effusion was classified as neoplastic in 40 dogs, idiopathic in 23 dogs and of unknown aetiology in 5 dogs. Real-time PCR was performed for Leishmania infantum, Ehrlichia/Anaplasma species, Hepatozoon canis, Babesia species, Rickettsia species and Bartonella species, and sequencing of PCR products from positive samples was used to confirm species specificity. RESULTS: Vector-borne pathogens were found in 18 dogs: 16 of 68 dogs with pericardial effusion (23·5%) and two of 60 control dogs (3·3%). Positive dogs demonstrated DNA of Leishmania infantum (n=7), Anaplasma platys (n=2, one dog coinfected with Leishmania infantum), Babesia canis (n=5), Babesia gibsoni (n=3) and Hepatozoon canis (n=2). Vector-borne pathogens were more commonly detected among dogs with pericardial effusion than controls (P=0·001). There was no relationship between aetiology of the pericardial effusion and evidence of vector-borne pathogens (P=0·932). CLINICAL SIGNIFICANCE: Vector-borne pathogens are often detected in dogs with pericardial effusion and require further investigation, especially in dogs with idiopathic pericardial effusion. PCR can provide additional information about the potential role of vector-borne pathogens in dogs with pericardial effusion living in endemic areas.

A case of pulmonary cryptococcosis with large pericardial effusion diagnosed using cervical lymph node biopsy.

Pulmonary cryptococcosis (PC) is a relatively rare infectious disease. It mainly involves the lungs; however, in some patients, the infection could spread to other parts of the body. PC mostly occurs in patients with immune deficiencies. However, PC infections have been reported in non-immunocompromised patients. The diagnosis of PC is challenging in patients without immune deficiencies. Here, the case of a 27-year-old immunocompetent woman who was diagnosed with PC was report. She had unexplained fever and a history of close contact with poultry feathers. Lesions were observed in the lungs, pleural cavity, pericardium, and cervical lymph nodes. Biopsy of the cervical lymph nodes helped in the pathological diagnosis of PC. She was treated with fluconazole, and the lesions disappeared. They present this case to encourage detailed inquiry of medical history in such patients, improve the diagnostic awareness of clinicians, and help reduce the likelihood of misdiagnosis.

Tuberculous Pericardial Effusions in Children.

Current data on tuberculous pericardial effusion in children are limited. In this study, the cases of 30 children with tuberculous pericardial effusion were reviewed retrospectively. The prevalence of human immunodeficiency virus and of culture-confirmed tuberculosis was high. Chest radiography provided lower diagnostic sensitivity than sonography but detected all large and complicated effusions. Outcomes were generally good, and residual complications were mainly due to comorbidity.

Perivalvular Mitral Abscess Fistulised to the Pericardial Cavity Revealing Staphylococcal Endocarditis.

BACKGROUND: Fistula to the pericardial cavity is a very rare complication of perivalvular abscess during infective endocarditis, with Staphylococcus aureus being the most commonly associated microorganism. METHODS: We report a fatal septic shock due to a mitral endocarditis revealed by a myocardial abscess fistulised toward the pericardial cavity. RESULTS: A 66-year-old female without previous valvular disease was admitted to intensive care for severe sepsis. A few hours after admission, an unexpected cardiac arrest occurred. Chest computed tomographic-scan and transoesophageal echocardiography revealed a pericardial effusion due to a perivalvular mitral abscess fistulised toward the pericardial cavity. Despite prompt management including surgical debridement and appropriate antibiotics, death occurred 36hours after intensive care admission. All blood cultures as well as native mitral valve and pericardial fluid grew methicillin-sensitive Staphylococcus aureus. CONCLUSIONS: Intensivists should consider this rare complication in patients with staphylococcal infective endocarditis and perivalvular abscess.