II. Epidemiology
- Represent <1% of Pericarditis cases in Western Europe and U.S.
- Represents <5% of cases worldwide (except for Tuberculous Pericarditis)
- Non-Tuberculous Bacterial Causes are Uncommon
- Most Pericarditis cases are instead viral induced and inflammatory (see Pericarditis Causes)
III. Causes
- Seeding of Pericardium
- Direct spread from thoracic infection (e.g. empyema)
- Endocarditis with paravalvular abscess
- Hematogenous spread (Trauma, procedures)
- Organisms
- Coxiella Burnetii (most common of the nontuberculous purulent causes)
- Borelia Burgdorferi (most common of the nontuberculous purulent causes)
- Staphylococcus Aureus (high mortality)
- Empyema with direct spread or hematogenous spread in children
- Streptococcus Pneumoniae
- More common prior to current Immunizations in U.S.
- HaemophilusInfluenzae
- More common prior to current Immunizations in U.S.
- Mycobacterium tuberculosis (mortality approaches 85% for untreated cases)
- See Tuberculous Pericarditis
- Most common cause in developing countries
- Salmonella
- Meningococcus
- Syphilis
- Whipple Disease
- Rickettsia
IV. Findings
- See Pericarditis
- Ill or septic appearing, febrile patients
V. Differential Diagnosis
VI. Diagnosis
- Pericardiocentesis for Gram Stain and culture
VII. Management
- See Pericarditis
- Purulent Bacterial Pericarditis
- Typically empiric Antibiotics, then guided by Pericardiocentesis fluid culture and sensitivity
- First-line Antibiotics
- Vancomycin 15-20 mg/kg IV every 8-12 hours AND
- Ceftriaxone 2 g IV every 24 hours OR Cefepime 2 g IV every 12 hours
- Alternative regimen
- Vancomycin 15-20 mg/kg IV every 8-12 hours AND
- Ciprofloxacin 750 mg orally twice daily OR 400 mg IV twice daily
-
Tuberculous Pericarditis
- Most common cause of Pericarditis in developing world (esp. with HIV Infection)
- See Tuberculous Pericarditis
- See Active Tuberculosis Treatment
- Interventions
- During Pericardiocentesis, irrigation and Fibrinolytic agent instillation within Pericardium may be considered
- Pericardial window may be needed in some cases
VIII. Prognosis
- Associated with worse prognosis than typical idiopathic or Viral Pericarditis
IX. References
- (2016) Sanford Guide, accessed 4/8/2016
- Klasek and Alblaihed (2023) Crit Dec Emerg Med 37(6): 4-11
- Pankuweit (2005) Am J Cardiovasc Drugs 5(2): 103-12 [PubMed]
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Related Studies
Concepts | Disease or Syndrome (T047) |
ICD10 | I30.1 |
SnomedCT | 266236008, 194919000, 2554006 |
English | Acute purulent pericard.unsp., Acute purulent pericarditis unspecified, PERICARDITIS ACUTE SUPPURATIVE, purulent pericarditis, purulent pericarditis (diagnosis), Suppurative pericarditis, Pericardial empyema, Purulent pericarditis, Acute purulent pericarditis unspecified (disorder), pericarditis acute purulent, Acute purulent pericarditis (diagnosis), Acute purulent pericarditis, Acute suppurative pericarditis, Acute purulent pericarditis (disorder), pericarditis; purulent, pericarditis; suppurative, purulent; pericarditis, suppurative; pericarditis, Pericarditis, purulent, Acute pericarditis, purulent, Acute pericarditis, suppurative, Pericarditis, suppurative |
Italian | Pericardite purulenta, Empiema pericardico |
Dutch | pericardiaal empyeem, pericarditis; etterig, pericarditis; purulent, pericarditis; suppuratief, purulent; pericarditis, suppuratief; pericarditis, etterende pericarditis |
French | Empyème péricardique, Péricardite purulente |
German | Perikardempyem, Eitrige Perikarditis |
Portuguese | Empiema pericárdico, Pericardite purulenta |
Spanish | Empiema pericárdico, pericarditis purulenta aguda no especificada, pericarditis purulenta aguda no especificada (trastorno), pericarditis purulenta aguda, pericarditis supurativa aguda (trastorno), pericarditis supurativa aguda, Pericarditis purulenta |
Japanese | 化膿性心膜炎, 心嚢蓄膿, シンノウチクノウ, カノウセイシンマクエン |
Czech | Empyém perikardu, Hnisavá perikarditida |
Hungarian | Pericardialis empyema, purulens pericarditis |
Ontology: Bacterial pericarditis (C0340445)
Concepts | Disease or Syndrome (T047) |
SnomedCT | 233883000 |
Italian | Pericardite batterica |
Japanese | 細菌性心膜炎, サイキンセイシンマクエン |
English | bacterial pericarditis (diagnosis), bacterial pericarditis, Bacterial pericarditis, Bacterial pericarditis (disorder), bacterial; pericarditis, pericarditis; bacterial |
Czech | Bakteriální perikarditida |
Hungarian | bacterialis pericarditis |
Dutch | bacterieel; pericarditis, pericarditis; bacterieel, bacteriële pericarditis |
Spanish | pericarditis bacteriana (trastorno), pericarditis bacteriana, Pericarditis bacteriana |
Portuguese | Pericardite bacteriana |
French | Péricardite bactérienne |
German | bakterielle Perikarditis |