Molecular analysis of pericardial fluid: a 7-year experience
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Published on: January 14, 2014
Pierre-Yves Levy1, Pierre-Edouard Fournier, Remy Charrel
1Unité des Rickettsies, CNRS UMR 6020, IFR48, Faculté de Médecine, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France.
Aims:
Aetiological investigations of pericardial effusion are often negative. We evaluate the interest of systematic analysis of fluid in order to diminish the number of pericarditis classified as idiopathic.
Methods And Results:
We performed a systematic analysis of pericardial fluid and biopsy specimens, using cultures and molecular analyses for the identification of bacteriological, fungal, and viral agents, as well as histopathological examination of 106 pericardial fluid samples. The aetiological diagnosis was determined clinically and by non-invasive procedures in 40 and nine patients, respectively. In the remaining 57 patients, 14 neoplasias and 17 infections were diagnosed. Molecular procedures identified seven viral (Enterovirus, Herpes simplex virus, and Epstein-Barr virus in four, two, and one of the cases, respectively), one fungal (Cryptococcus neoformans), and nine bacterial infections. Four of these bacteria were not diagnosed by culture because of prior antibiotics treatment (Mycobacterium tuberculosis in two cases, Streptococcus pneumoniae in one case, and Actinomyces neuii in one case). The aetiology remained undetermined in 26 patients.
Conclusion:
The systematic use of molecular techniques permitted a significant increase in aetiological diagnoses of punctured pericardial effusions when compared with cultures (39.5 vs. 13.9%, respectively; P<0.01). It is particularly beneficial for patients with a previous antibiotic regimen or suspicion of tuberculosis.
Insights
Systematic molecular analysis of pericardial fluid significantly increases diagnoses of pericarditis, especially in patients with prior antibiotic treatment or suspected tuberculosis. This approach reduces cases classified as idiopathic pericarditis.
Area of Science:
- Infectious Diseases
- Oncology
- Pathology
Background:
- Pericardial effusion investigations frequently yield negative results, leading to many idiopathic pericarditis classifications.
- Accurate etiological diagnosis is crucial for effective treatment and patient management.
Purpose of the Study:
- To evaluate the efficacy of systematic pericardial fluid analysis in determining the cause of pericardial effusion.
- To reduce the number of pericarditis cases classified as idiopathic.
Main Methods:
- Systematic analysis of 106 pericardial fluid samples using cultures, molecular techniques (bacteriological, fungal, viral), and histopathology.
- Clinical and non-invasive procedures were used for etiological diagnosis in some patients.
Main Results:
- Molecular techniques identified 17 infections (7 viral, 1 fungal, 9 bacterial) and 14 neoplasias.
- Prior antibiotic treatment or suspicion of tuberculosis complicated culture-based diagnoses, but molecular methods identified these pathogens.
- The etiological diagnosis rate increased significantly with molecular techniques (39.5%) compared to cultures (13.9%).
Conclusions:
- Systematic molecular analysis substantially improves etiological diagnosis rates for pericardial effusions.
- Molecular techniques are particularly valuable in cases with prior antibiotic use or suspected tuberculosis, aiding in the diagnosis of challenging infections like Mycobacterium tuberculosis.
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