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Pericardial actinomycosis: case report and review
T D Fife1, S M Finegold, T Grennan
1Department of Internal Medicine, University of California, Davis, Sacramento.
Abstract:
Pericardial actinomycosis is rare and frequently goes unrecognized during life, a circumstance due in part to a paucity of clinical manifestations and to a low rate of positivity in cultures. We present a case report of pericardial actinomycosis and a review of 18 other cases reported in the literature since 1950. Possible risk factors include aspiration pneumonia, alcohol abuse, and periodontal disease. Actinomyces may cause purulent pericarditis that evolves into cardiac tamponade or constrictive pericarditis. Clues to the identity of the causative organism (e.g., draining sinus tracts and the presence of sulfur granules) are frequently absent, and cultures often fail to yield the organism. Histologic examination of material obtained by biopsy is often necessary to make the diagnosis. Most cases originate from a thoracopulmonary site of actinomycosis and spread directly to the pericardium. Widespread dissemination to extrathoracic organs is uncommon. Treatment consists of high-dose, long-term antimicrobial therapy as well as drainage of the pericardial space.
Insights
Pericardial actinomycosis, a rare infection, often goes undiagnosed due to subtle symptoms and difficult diagnosis. Early recognition and treatment with antibiotics and drainage are crucial for managing this serious condition.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Pericardial actinomycosis is an uncommon infection with nonspecific clinical presentations.
- Diagnosis is often delayed due to low culture positivity and absent pathognomonic signs.
Observation:
- This report details a case of pericardial actinomycosis and reviews 18 previously reported cases since 1950.
- Risk factors include aspiration pneumonia, alcohol abuse, and periodontal disease.
- Thoracopulmonary actinomycosis is the most common origin, spreading directly to the pericardium.
Findings:
- Actinomyces can cause purulent pericarditis, potentially leading to cardiac tamponade or constrictive pericarditis.
- Histologic examination of biopsy material is frequently essential for diagnosis.
- Extrathoracic dissemination is rare.
Implications:
- Prompt diagnosis and management are vital for patient outcomes.
- Treatment involves high-dose, long-term antimicrobial therapy and pericardial drainage.
- Increased awareness among clinicians may improve early detection rates.