Cardiac tamponade secondary to haemophilus pericarditis: a case report.

Pyogenic pericarditis is encountered uncommonly in clinical practice. The majority of cases of clinically apparent pericarditis are viral in origin. When bacterial infection of the pericardial space does occur the causative organism is usually Staphylococcus or Streptococcus species. Isolation of an haemophilus organism from the pericardial space in this condition is distinctly unusual. There are only 10 previously reported cases in the literature of pericarditis secondary to Haemophilus influenzae. This report describes the case of a 36-year-old woman who presented with haemophilus empyema and purulent pericarditis progressing to cardiac tamponade. There are isolated reports of successful treatment of pyogenic pericarditis with closed drainage and antibiotics. In the absence of clear evidence demonstrating the efficacy of this approach the authors favour open exploration of the pericardial space.     

Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production

Haemophili are pathogenic or opportunistic bacteria often colonizing the upper respiratory tract mucosa. The prevalence of Haemophilus influenzae (with serotypes distribution), and H. parainfluenzae in the nasopharynx and/or the adenoid core in children with recurrent pharyngotonsillitis undergoing adenoidectomy was assessed. Haemophili isolates were investigated for their ability to biofilm production.Nasopharyngeal swabs and the adenoid core were collected from 164 children who underwent adenoidectomy (2–5 years old). Bacteria were identified by the standard methods. Serotyping of H. influenzae was performed using polyclonal and monoclonal antisera. Biofilm formation was detected spectrophotometrically using 96-well microplates and 0.1% crystal violet.Ninety seven percent (159/164) children who underwent adenoidectomy were colonized by Haemophilus spp. The adenoid core was colonized in 99.4% (158/159) children, whereas the nasopharynx in 47.2% (75/159) children (P < 0.0001). In 32% (51/159) children only encapsulated (typeable) isolates of H. influenzae were identified, in 22.6% (36/159) children only (nonencapsulated) H. influenzae NTHi (nonencapsulated) isolates were present, whereas 7.5% (12/159) children were colonized by both types. 14.5% (23/159) children were colonized by untypeable (rough) H. influenzae. In 22% (35/159) children H. influenzae serotype d was isolated. Totally, 192 isolates of H. influenzae, 96 isolates of H. parainfluenzae and 14 isolates of other Haemophilus spp. were selected. In 20.1% (32/159) children 2 or 3 phenotypically different isolates of the same species (H. influenzae or H. parainfluenzae) or serotypes (H. influenzae) were identified in 1 child. 67.2% (129/192) isolates of H. influenzae, 56.3% (54/96) isolates of H. parainfluenzae and 85.7% (12/14) isolates of other Haemophilus spp. were positive for biofilm production. Statistically significant differences (P = 0.0029) among H. parainfluenzae biofilmproducers and nonproducers in the adenoid core and the nasopharynx were detected.H. influenzae and H. parainfluenzae carriage rate was comparatively higher in the adenoid core than that in the nasopharynx in children undergoing adenoidectomy, suggesting that their involvement in chronic adenoiditis. The growth in the biofilm seems to be an important feature of haemophili colonizing the upper respiratory tract responsible for their persistence.     

Purulent Pericarditis in Sickle Cell Disease Due to Streptococcus agalactiae; a Unique Case Report and Literature Review

Purulent pericarditis is a localized infection with a thick, fibrinous hypercellular exudate and is historically associated with a high mortality. We describe a case of purulent pericarditis due to Streptococcus agalactiae (S. agalactiae) in a 30-year-old woman with sickle cell disease who presented with fever, dyspnea, and S. agalactiae septicemia. Despite timely initiation of antibiotics, she developed a large purulent pericardial effusion requiring surgical pericardiocentesis followed by a pericardial window. At 14?months follow-up, she has remained asymptomatic without sequelae. A review of the literature contained only four patients with purulent pericarditis in sickle cell patients. We discuss the unique aspects of this case in the context of purulent pericarditis in the age of modern antibiotics and hypothesize on the pathogenesis of delayed pericardial effusion after pericarditis.     

Purulent pericarditis caused by Haemophilus influenzae type B

Purulent pericarditis, once a common entity associated with intrathoracic infections, such as pneumonia and empyema, has become an infrequent illness in the post-antibiotic era. Prompt recognition and therapy are vital in improving disease-related mortality. Herein, we describe a rare case of Haemophilus influenzae type B purulent pericarditis and associated cardiac tamponade. Antibiotic therapy, pericardial drainage, and subsequent pericardiectomy were performed with resolution of illness.     

Purulent pericarditis caused by group a streptococcus

Purulent pericarditis is a rare disease that is most often caused by organisms such as Staphylococcus aureus, Streptococcus pneumoniae, viridans streptococci, Haemophilus influenzae, and anaerobic bacteria. We present an unusual case of purulent pericarditis caused by Streptococcus pyogenes, Lancefield group A streptococcus (GAS), and we provide a review of the literature.     

Invasive infections caused by haemophilus species other than haemophilus influenzae

Summary In a retrospective study covering a 13-year period and a population of 817,900 inhabitants, 13 cases of invasive infection caused byHaemophilus species other thanHaemophilus influenzae were found. Ten of the infectious episodes were caused byHaemophilus parainfluenzae and three byHaemophilus aphrophilus. The clinical manifestations comprised endocarditis, meningitis, pleuropneumonia, epiglottitis and septicaemia from an unknown focus. These 13 infectious episodes caused by uncommonHaemophilus species constituted less than 3% of the total number (473) of invasiveHaemophilus infections registered during the same period of time. InvasiveH. influenzae infections were more common in all age groups than infections caused by otherHaemophilus species. In contrast toH. influenzae infections, which predominate in childhood, invasive infections due to uncommonHaemophilus species had no predilection for any age group.

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Invasive Infektionen durch Haemophilus species außer Haemophilus influenzae

Zusammenfassung In einer retrospektiven Studie, die einen Zeitraum von 13 Jahren und eine Bevölkerung von 817 900 Einwohnern erfaßte, wurden 13 Fälle einer invasiven Infektion durchHaemophilus species außerHaemophilus influenzae festgestellt. Zehn der Infektionen wurden durchHaemophilus parainfluenzae und drei durchHaemophilus aphrophilus verursacht. Die klinischen Manifestationsformen umfaßten Endokarditis, Meningitis, Pleuropneumonie, Epiglottitis und Septikämie unbekannter Herkunft. Diese 13 Infektionen durch ungewöhnlicheHaemophilus species machten weniger als 3% der Gesamtzahl an invasivenHaemophilus-Infektionen (473) aus, die während derselben Zeit registriert wurden. In allen Altersgruppen waren invasive Infektionen durchH. influenzae häufiger als Infektionen durch andereHaemophilus species. Im Gegensatz zuH. influenzae-Infektionen, die vorwiegend in der Kindheit auftreten, hatten invasive Infektionen durch ungewöhnlicheHaemophilus species keine Prädilektion für irgendeine Altersgruppe.

     

Prevalence of Haemophilus influenzae type b infection in Chinese children: a systematic review and meta-analysis

Background

Haemophilus influenzae type b is an important cause of invasive bacterial disease in children worldwide. The establishment of epidemiological estimates is an essential first step towards the introduction of H influenzae type b vaccine into the Chinese national immunisation programme. We therefore undertook a systematic review and meta-analysis to estimate the prevalence of H influenzae type b in Chinese children.

Non-surgical treatment of purulent pericarditis, due to non-encapsulated Haemophilus influenzae, in an immunocompromised patient.

A 59-year-old woman suffering from rheumatoid arthritis was admitted with pleural empyema and pericarditis due to non-encapsulated H. influenzae, and developed signs of cardiac tamponade. Purulent pericarditis resolved after ultrasound-guided percutaneous aspiration and systemic antimicrobial therapy. Serial echocardiographic examinations showed a slowly vanishing effusion. Long term follow-up revealed no evidence of pericardial constriction. This case illustrates that life-threatening purulent pericarditis in an immunocompromised patient may respond well to non-surgical treatment.     

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series

Objective:

In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular.

Methods:

We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity.

Results:

In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis.

Conclusions:

In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis.     

Hemophilus influenzae pericarditis

Although Hemophilus influenzae infections have long been considered to be a disease of childhood, recent reports have demonstrated an increasing frequency of serious Hemophilus influenzae infections in adults. A case of purulent H. influenzae pericarditis in a previously healthy adult without evidence of concurrent H. influenzae infection is reported.     

Purulent pericarditis caused by Candida: report of three cases and identification of high-risk populations as an aid to early diagnosis

Purulent pericarditis due to fungal organisms is rare and often unrecognized because of the subtle clinical clues and insidious onset. The records of 11 cases of purulent pericarditis were selected from records of 11,000 cases of pericarditis at Duke University Medical Center and reviewed, and experience with three cases of candida purulent pericarditis (CPP) was evaluated. One case occurred in a patient recovering from complicated cardiac surgery, one in a patient with hematologic malignancy, and one in an alcoholic patient requiring intubation for a severe respiratory infection. Each case is representative of a group at increased risk for the development of CPP. Given the poor prognosis for CPP, treatment should include both medical and surgical interventions. Although amphotericin B achieves good penetration into the inflamed pericardial space, the only survivors of CPP have received both amphotericin B and pericardiectomy. Careful attention to clinical indications of pericardial inflammation and systemic infection in the three groups of patients may lead to earlier recognition of CPP, implementation of appropriate therapy, and perhaps a higher rate of cure.     

Cardiac tamponade from acute pericarditis associated with a cystic fibrosis (CF) lung infection

Cystic fibrosis (CF) is a genetically inherited autosomal recessive disease characterized by dehydration of the airway surface liquid and impaired mucociliary clearance leading to chronic respiratory infections, bronchiectasis and ultimately death from respiratory causes. Common pulmonary related complications resulting from bronchiectasis include pneumothorax and hemoptysis. A rare, seldom reported complication is acute pericarditis complicating cystic fibrosis. Our review of the literature identified only a single case of culture-proven purulent pericarditis attributed to Pseudomonas aeruginosa in a patient receiving systemic corticosteroids. A second reported case of acute pericarditis in a CF patient was attributed to Mycoplasma pneumoniae which is a known cause of infectious-related pericarditis independent of CF. Both cases required open pericardial drainage with 1 fatality. Here we present a case of cardiac tamponade from a fibrinous pericardial effusion in a 21-year-old female as a complication of CF related parenchymal lung disease. To our knowledge, this is the first reported case of a non-infectious parapneumonic pericardial effusion causing near fatal cardiac tamponade as a complication of CF lung disease.     

A case of pulmonary abscess in which Haemophilus parainfluenzae and Streptococcus intermedius were isolated by percutaneous needle aspiration]

Some microbes, including the Bacteroides species, Staphylococcus aureus and Streptococcus milleri groups, can cause pulmonary abscess. Haemophilus parainfluenzae is usually categorized as one of the normal flora which colonizes in the ears and the nasopharynx, and it has been long considered that H. parainfluenzae has little pathogenicity in the lower respiratory tract and lung parenchymal. In this report, we present a case of pulmonary abscess caused by both H. parainfluenzae and Streptococcus intermedius. The patient was a 75-year-old man who had had total esophageo-gastrectomy because of esophageal cancer. He presented with purulent sputum, and chest X-ray film showed a dense consolidation in the right upper lung field. CT-guided transcutaneous fine needle aspiration was performed as a diagnostic procedure. Since both H. parainfluenzae and S. intermedius had been isolated from the lesion, pulmonary abscess caused by these two pathogens was diagnosed. The patient was treated with panipenem/betamipron, and his symptoms and pulmonary infiltrates on the chest X-ray film improved thereafter. So far, very few cases have been reported in which H. parainfluenzae caused lower respiratory tract infection. Although S. intermedius is known as one of the pathogens of pulmonary abscess, it is possible that H. parainfluenzae could also be pathogenic in infectious diseases of the lung.     

Effectiveness of Intrapericardial Administration of Streptokinase in Purulent Pericarditis

BACKGROUND AND PURPOSE: Purulent pericarditis is very rare. However, among patients suffering from this disease the mortality rate is very high. The aim of this study was to evaluate the effectiveness and side effects of intrapericardial streptokinase administration in patients with confirmed purulent pericarditis. PATIENTS AND METHODS: Three patients, one 50-year-old man and two women aged 64 and 40 years, who were admitted to the intensive care unit (ICU) due to purulent pericarditis, entered the study. In all three cases a subxiphoid pericardiotomy followed by insertion of a drainage line into the pericardial space was performed. Antibiotic therapy was started immediately on admission to the hospital. Despite continued antibiotic therapy in all three patients, daily drainage from the pericardium--during several days after surgery--staggered between 50-200 ml/day. Due to considerable purulent pericardial drainage loculations and/or fibrin deposits confirmed by echocardiography, streptokinase (500,000 IU dissolved in 50 ml of normal saline) was administered into the pericardial space over 10 min, using the previously inserted drainage catheter. This regimen was repeated after 12 and 24 h. The total dose of streptokinase was 1,500,000 IU. RESULTS: The clinical effect of intrapericardial streptokinase administration was excellent. Several days after intrapericardial administration of streptokinase, drainage of purulent pericardial fluid stopped. No complications associated with intrapericardial streptokinase administration were observed. In the follow-up echocardiography (in two patients repeated 6 and 9 months after delivery of streptokinase), pericardial fluid and echocardiographic signs of pericardial constriction were not observed. CONCLUSION: Intrapericardial administration of streptokinase in purulent pericarditis is effective and safe.     

Pericardite purulenta e Pasteurella multocida: uma associação raríssima

Purulent pericarditis is a rare entity, defined as the presence of neutrophilic pericardial effusion which is infected by a bacterial, fungus or parasite agent. The diagnosis can be challenging, especially if patients have taken previous antibiotic therapy; on the other hand the recognition of this pathology is often made late, with the onset of severe symptoms or signs of cardiac tamponade or even only at the autopsy. The authors describe the case of a 82‐year‐old woman with history of extensive laceration of the right lower limb from a dog bite in July 2016, admitted to the Cardiology Department one month later for Acute Pericarditis. During hospitalization she maintained recurrent fever peaks despite the treatment with non‐steroidal anti‐inflammatory drugs and colchicine. She collected blood cultures and repeated echocardiogram showed increased pericardial effusion with no signs of hemodynamic compromise. Blood cultures revealed the presence of Pasteurella multocida. Due to clinical suspicion of purulent pericarditis, pericardiocentesis was performed with drainage of liquid compatible with exudate and the patient was presented to the Cardiothoracic Surgery Department for pericardiotomy and adequate drainage of the liquid. Histological examination confirmed the diagnosis of Acute Pericarditis. It should be noted that Pasteurella is a very frequent agent (50‐90%) in the gastrointestinal tract and nasopharynx of many domestic animals, namely dogs.The authors emphasize the need to aggressively treat this pathology, since untreated death is inevitable.     

Haemophilus influenzae type B genital infection and septicemia in pregnant woman: a case report

Haemophilus influenzae (H. influenzae) type B a non-motile, aerobic, gram negative cocobacillus is a commensal of upper respiratory tract. Genitourinary infection due to H. influenzae has been reported but bacteremia associated with such infection appears to be rare. We report a case of 19 years young primigravida with complaints of amenorrhea of 32 weeks and 5 days, pyrexia, abdominal pain and blood stained discharge per vaginum. H. influenzae type B was recovered from the genital tract as well as blood of the mother indicating maternal septicemia. Septicemia caused by H. influenzae type B in pregnant women following vaginal colonization and infection is rare. It has been reported in many parts of world over the years; to the best of our knowledge this is the first reported case from Nepal. H. influenzae should be considered as a potential maternal, fetal, and neonatal pathogen.     

Mycoplasma hominis pericarditis in a lung transplant recipient: review of the literature about an uncommon but important cardiothoracic pathogen

D. Mitsani, M.H. Nguyen, F.P. Silveira, C. Bermudez, Y. Toyoda, A.W. Pasculle, C.J. Clancy. Mycoplasma hominis pericarditis in a lung transplant recipient: review of the literature about an uncommon but important cardiothoracic pathogen.
Transpl Infect Dis 2010: 12: 146–150. All rights reserved Abstract: Purulent pericarditis due to Mycoplasma hominis is rare, and is usually associated with mediastinitis or pleuritis following cardiothoracic surgery. We report the first case to our knowledge of isolated purulent pericarditis caused by M. hominis in a lung transplant recipient and review previously reported cases of this disease.     

Diagnosis and management of pericardial effusion

Pericardial effusion is a common finding in everyday clinical practice.The first challenge to the clinician is to try to establish an etiologic diagnosis.Sometimes,the pericardial effusion can be easily related to a known underlying disease,such as acute myocardial infarction, cardiac surgery,end-stage renal disease or widespread metastatic neoplasm.When no obvious cause is apparent,some clinical findings can be useful to establish a diagnosis of probability.The presence of acute inflammatory signs(chest pain,fever,pericardial friction rub) is predictive for acute idiopathic pericarditis irrespective of the size of the effusion or the presence or absence of tamponade.Severe effusion with absence of inflammatory signs and absence of tamponade is predictive for chronic idiopathic pericardial effusion,and tamponade without inflammatory signs for neoplastic pericardial effusion.Epidemiologic considerations are very important,as in developed countries acute idiopathic pericarditis and idiopathic pericardial effusion are the most common etiologies,but in some underdeveloped geographic areas tuberculous pericarditis is the leading cause of pericardial effusion.The second point is the evaluation of the hemodynamic compromise caused by pericardial fluid.Cardiac tamponade is not an"all or none"phenomenon,but a syndrome with a continuum of severity ranging from an asymptomatic elevationof intrapericardial pressure detectable only through hemodynamic methods to a clinical tamponade recognized by the presence of dyspnea,tachycardia,jugular venous distension,pulsus paradoxus and in the more severe cases arterial hypotension and shock.In the middle,echocardiographic tamponade is recognized by the presence of cardiac chamber collapses and characteristic alterations in respiratory variations of mitral and tricuspid flow.Medical treatment of pericardial effusion is mainly dictated by the presence of inflammatory signs and by the underlying disease if present.Pericardial drainage is mandatory when clinical tamponade is present.In the absence of clinical tamponade,examination of the pericardial fluid is indicated when there is a clinical suspicion of purulent pericarditis and in patients with underlying neoplasia.Patients with chronic massive idiopathic pericardial effusion should also be submitted to pericardial drainage because of the risk of developing unexpected tamponade.The selection of the pericardial drainage procedure depends on the etiology of the effusion.Simple pericardiocentesis is usually sufficient in patients with acute idiopathic or viral pericarditis.Purulent pericarditis should be drained surgically,usually through subxiphoid pericardiotomy. Neoplastic pericardial effusion constitutes a more difficult challenge because reaccumulation of pericardial fluid is a concern.The therapeutic possibilities include extended indwelling pericardial catheter,percutaneous pericardiostomy and intrapericardial instillation of antineoplastic and sclerosing agents.Massive chronic idiopathic pericardial effusions do not respond to medical treatment and tend to recur after pericardiocentesis, so wide anterior pericardiectomy is finally necessary in many cases.     

Pneumococcal purulent pericarditis

INTRODUCTION: Purulent pneumoccocal pericarditis are extremely rare since the introduction of antibiotics. EXEGESIS: A 59-year-old woman presented to the emergency room with a seven-day history of dyspnea and fever. No signs of heart failure or cardiac friction rub were evidenced. Laboratory tests disclosed elevated acute phase reactants and elevated white blood cells with a high neutrophil count. Chest radiograph showed cardiomegaly and a bilateral pleural effusion. Chest-computed tomography confirmed the pleural effusion and evidenced a large pericardial effusion. Streptoccocus pneumoniae grew up form pericardial fluid and blood cultures. In addition to the pericardial drainage, the patient received intravenous amoxicillin therapy. Outcome was favourable. There was no evidence of immunodeficiency. CONCLUSION: Although exceptional, diagnosis of purulent pneumococcal pericarditis should not be missed as it may compromise vital prognosis. Therapy should combine pericardial drainage and antibiotics.