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Primary Streptococcus pneumoniae pericarditis

Matthew N Peters1, Kathleen S Hesterman, Morgan J Katz

  • 1Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana.

Proceedings (Baylor University. Medical Center)
|February 6, 2013
PubMed

Insights

Bacterial pericarditis, often fatal and difficult to diagnose, is rarely caused by Streptococcus pneumoniae in immunocompetent individuals. This case highlights a rare instance of primary S. pneumoniae pericarditis successfully treated with antibiotics and drainage.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Bacteriology

Background:

  • Bacterial pericarditis is a rare but serious condition, often fatal and difficult to diagnose antemortem due to its infrequent occurrence and rapid progression.
  • Historically, Streptococcus pneumoniae was the primary cause, but it now predominantly affects immunocompromised individuals with a known infection site.
  • The decline in S. pneumoniae as a cause is linked to widespread vaccination and improved treatments for pneumococcal infections.

Purpose of the Study:

  • To report a rare case of primary Streptococcus pneumoniae pericarditis in an immunocompetent adult.
  • To discuss the diagnostic challenges and clinical presentation of this uncommon infection.
  • To emphasize the importance of considering S. pneumoniae in the differential diagnosis of bacterial pericarditis, even in immunocompetent patients.

Main Methods:

  • Case report of a 45-year-old immunocompetent male presenting with symptoms suggestive of pericarditis.
  • Clinical evaluation including diagnostic imaging and laboratory tests to identify the causative agent.
  • Therapeutic intervention involving pericardial fluid drainage and antibiotic administration.

Main Results:

  • The patient developed cardiac tamponade, a life-threatening complication requiring urgent management.
  • Cultures confirmed Streptococcus pneumoniae as the causative pathogen, establishing a primary pericarditis diagnosis.
  • The patient experienced rapid clinical improvement and symptom resolution after pericardial drainage and targeted antibiotic therapy.

Conclusions:

  • Primary Streptococcus pneumoniae pericarditis can occur in immunocompetent individuals, challenging the current understanding of its epidemiology.
  • Prompt diagnosis, pericardial drainage, and appropriate antibiotic treatment are crucial for favorable outcomes.
  • This case underscores the need for vigilance in diagnosing bacterial pericarditis, irrespective of the patient's immune status.

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