The changed spectrum of purulent pericarditis : An 86 year autopsy experience in 200 patients

Purulent pericarditis continues to be a problem of diagnosis and therapy. To determine its current spectrum we studied the 55 patients with purulent pericarditis examined at autopsy at The Johns Hopkins Hospital since 1943 (group 2) and compared the findings with those in the 145 patients with purulent pericarditis so examined from 1889 to 1943 (group 1). Since 1943, the patients' median age was 49 years; two-thirds were over 40 years of age, and 30 (55 per cent) were men. Gram-negative bacilli were isolated in over a third of the patients; Staphylococcus aureus in 22 per cent, Streptococcus in 13 per cent and Pneumococcus in 9 per cent. Infection spread from intrathoracic foci in 24 (44 per cent) patients, including 13 (24 per cent) in whom this occurred after thoracic surgery. Pericardial effusions were greater than 300 cc in six patients. Myocardial abscess or endocarditis was present in 16 patients (29 per cent) and the presence of aseptic pericarditis, as with uremia or thoracic surgery, predisposed the 26 (47 per cent) affected patients to purulent pericarditis. Diagnosis was made antemortem in only 10 patients (18 per cent) and infection alone caused 22 per cent of the deaths.