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Purulent Pericardial Effusion: An Elusive Diagnosis

Shaker Al-Nabulsi1, Dania Hammadi1, Ahmed Abozenah2

  • 1Medicine, Royal College of Surgeons in Ireland - Bahrain, Muharraq, BHR.

Cureus
|July 23, 2026
PubMed

Insights

Purulent pericardial effusion (PPE) is a rare but deadly infection. Prompt diagnosis and drainage with antimicrobial therapy are crucial for managing this condition.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Purulent pericardial effusion (PPE) is a severe infection of the pericardial space.
  • Despite rarity in the antimicrobial era, PPE poses significant morbidity and mortality due to rapid progression and diagnostic challenges.
  • Increasing recognition of polymicrobial and fungal infections alongside common Gram-positive bacteria.

Purpose of the Study:

  • To review current literature on purulent pericardial effusion.
  • To highlight epidemiology, microbiology, clinical manifestations, and diagnostic challenges.
  • To examine management strategies and outcomes, addressing existing knowledge gaps.

Main Methods:

  • Literature review of current research on purulent pericardial effusion.
  • Analysis of epidemiological data and microbiological findings.
  • Evaluation of diagnostic modalities including clinical findings, fluid analysis, and imaging.

Main Results:

  • Gram-positive bacteria are the most frequent cause, but polymicrobial and fungal infections are rising.
  • Early diagnosis relies on high clinical suspicion, pericardial fluid analysis, and imaging.
  • Drainage and antimicrobial therapy are primary management strategies.

Conclusions:

  • Prompt diagnosis and intervention are critical for improving outcomes in purulent pericardial effusion.
  • Gaps remain in optimal treatment duration, surgical necessity, and follow-up protocols.
  • Further research is needed to refine management guidelines for this life-threatening condition.
Keywords:
cardiac tamponadefungal pericarditispericardiocentesispolymicrobial infectionpurulent pericardial effusiontuberculous pericarditis

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