A case of purulent pneumococcal pericarditis

Background

Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge.

Enhanced safety surveillance study of ACAM2000 smallpox vaccine among US military service members

ObjectivesTo evaluate the rates of myopericarditis (primary objective) and rates of cardiovascular and neurological adverse events (secondary objectives) in temporal association with ACAM2000® smallpox vaccine.MethodsObservational cohort study conducted through monthly surveillance from 2009 to 2017 of electronic medical records of military service members (SM) for pre-specified cardiac and neurological International Classification of Diseases (ICD) codes reported in the 30 days following smallpox vaccination. ICD codes potentially predictive of myopericarditis and codes for encephalitis, Guillain-Barré syndrome, and sudden death were classified into Group 1. All other cardiovascular and neurological ICD codes were classified into Group 2. Medical records containing Group 1 codes were individually reviewed to confirm coding accuracy and to seek additional data in support of myopericarditis adjudication, which was performed by an independent clinical panel. Chart reviews were not performed for Group 2 codes, which were reported in aggregate only.Results897,227 SM who received ACAM2000 smallpox vaccine and 450,000 SM who received Dryvax smallpox vaccine were included in the surveillance population. The rate of adjudicated myopericarditis among ACAM2000 smallpox vaccine recipients was 20.06/100,000 and was significantly higher for males (21.8/100,000) than females (8.5/100,000) and for those < 40 years of age (21.1/100,000) than for those 40 years or older (6.3/100,000). Overall rates for any cardiovascular event (Group 1 plus Group 2) were 113.5/100,000 for ACAM2000 vaccine and 439.3/100,000 for Dryvax vaccine; rate ratio, 0.26 (95% CI, 0.24–0.28). The rates of subjects with one or more defined neurological events were 2.12/100,000 and 1.11/100,000 for ACAM2000 and Dryvax vaccines respectively; rate ratio, 1.91 (95% CI, 0.71–5.10).ConclusionsElectronic records surveillance of the entire vaccinated SM population over a ten-year period found rates of myopericarditis, of defined neurological events, and of overall cardiac events that were consistent with those of prior passive surveillance studies involving Dryvax or ACAM2000 smallpox vaccines.Clinical trials registration: ClinicalTrials.gov NCT00927719.     

Manifestaciones cardiovasculares en pacientes hospitalizados con dengue

IntroductionCardiac complications in dengue patients are not uncommon and are not diagnosed, since they are usually mild and self-limiting.ObjectivesTo characterize the cardiovascular manifestations in hospitalized patients with dengue infection.MethodsWe conducted an observational, analytical, longitudinal, prospective epidemiological study, which included 427 patients treated at Manuel Fajardo Clinical-Surgical Teaching Hospital with diagnosis of dengue infection since April 2017 to April 2018.ResultsCardiovascular manifestations (19.7%), mainly heart rate disorders (sinus bradycardia [13.8%], atrial [4.9%] and ventricular [4.0%] extrasystoles) were frequent in dengue infection patients. Pericarditis and myocarditis were diagnosed in 1.6% and 0.2% respectively. These disorders were self-limiting in 83.3% of cases and occurred in the first days of the onset of fever in 75.0%. Advanced age (OR = 1.70), male sex (OR = 1.94), decreased platelet count (OR = 1.13) and dengue with warning signs (OR = 3.29) were related to a higher probability of presenting cardiovascular disorders in the course of a dengue infection.ConclusionsCardiovascular manifestations in dengue patients are frequent, and are related to advanced age, male sex, as well as severe forms of the disease.     

Cardiac Tamponade,Sever Hypothyroidism and Acute Respiratory Distress Syndrome (ARDS) with COVID-19 Infection

A 21-years-old with Down syndrome presented with respiratory distress. Initial investigations revealed a cardiac tamponade. On further evaluation, he had positive coronavirus disease-2019 (COVID-19), severe chest infection and severe hypothyroidism. He responded well to urgent pericardiocentesis, levothyroxine, hydrocortisone and tocilizumab.     

Pericardial and pulmonary involvement in rheumatoid arthritis in Turkey

Summary Pericardial and lung involvement in rheumatoid arthritis (RA), suspected to be less severe in a developing nation (Turkey), have been evaluated. We have studied clinical, echocardiographic and pulmonary findings (radiological and functional) in 93 consecutive Turkish patients with definite/classical RA. Findings were compared with those of a group of patients with osteoarthritis or local rheumatological conditions (n=60) in a blind protocol. Fifty patients with systemic lupus (SLE) were studied as a high risk control group for pericardial involvement. While pericardial disease was detected in 5.5% (5/90) of RA patients, it was detected in 6.6% (4/60) of the control patients. SLE patients had a 26% (13/50) prevalence. Interstitial lung disease was found in 27.7% of RA patients but it was present in 6.6% (4/60) of the control patients. We observed that a group of patients with RA in Turkey had a low prevalence of pericardial disease. This is further evidence that RA has a mild course in developing countries.     

Pericardite – apresentação e características numa população pediátrica

Introduction

Pericarditis is an inflammation of the pericardium. It may be infectious or secondary to a systemic disease. The aim of this study was to analyze the clinical findings, course, treatment and follow‐up of children diagnosed with pericarditis at our center.

Pericarditis in infective endocarditis

Three patients with infective endocarditis who presented withsevere precordial pain and pericardial rubs are described inwhom sterile pericardial and pleural effusions were found. Thepericardial pain disappeared and the effusions regressed withsuccessful antibiotic treatment. A similar mechanism to thepostmyocardial infarction syndrome is suggested.     

结核所致缩窄性心包炎的临床病理分析

目的 总结结核所致缩窄性心包炎的临床特点与病理改变.方法 对北京协和医院2000至2007年诊断的150例缩窄性心包炎病例的临床表现与病理特征进行回顾性分析.结果 在150例患者中,61例(40.7%)无心包积液史.超声心动图诊断心包缩窄149例,与手术诊断的一致率为98.7%(107/109).118例(78.7%)诊断为结核性,24例(16.0%)为肿瘤转移或浸润、放射性损伤、心脏手术后等其他原因,8例(5.3%)原因不明.经病理或病原学检查确诊为结核性心包炎者占16.7%(25/150);有心包外活动性结核病理证据者占5.3%(8/150);有典型的结核病临床表现或因抗结核治疗有效诊断者占44.0%(66/150);临床怀疑结核者占12.7%(19/150).108例患者接受心包剥脱术,1例行心包活检和心包切开引流术.死亡13例(8.7%),4例为结核.结论 结核仍然是缩窄性心包炎的最常见病因.心包结核多为全身结核病的一部分,但心包病理和病原学检查阳性率低.超声心动图对诊断缩窄性心包炎具有较高的实用价值.     

Cardiac involvement in mixed connective tissue disease: A systematic review

Objective

To report the clinical characteristic of cardiac disease in patients with mixed connective tissue disease (MCTD).

Method

We identified published case series that reported cardiac manifestations of patients with MCTD by searching the PubMed database using the search terms “mixed connective tissue disease”. We identified 11 case series that met our eligibility criteria.

Result

616 patients were included. Prevalence of cardiac involvement varied from 13% to 65% depending on patient selection and method used for detection. Pericarditis was the most common cardiac diagnosis with a prevalence of 30% and 43% in two prospective studies. Non-invasive cardiac tests, including electrocardiogram and echocardiogram, detected subclinical cardiac abnormalities in 6%–38% of patients. These abnormalities included conduction abnormalities, pericardial effusion and mitral valve prolapse. Diastolic dysfunction and accelerated atherosclerosis were well-documented in a case–control study. Three prospective studies revealed an overall mortality of 10.4% over the period of follow-up of 13–15 years. 20% of the mortality was directly attributable to cardiac cause.

Conclusion

Cardiac involvement was common among patients with MCTD though the involvement was often clinically inapparent. Non-invasive cardiac tests might have a role for subclinical disease screening for early diagnosis and timely treatment as cardiac involvement was one of the leading causes of mortality.