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Anaerobic pericarditis: case report and review
D J Skiest1, D Steiner, M Werner
1Department of Medicine, University of Connecticut School of Medicine, Farmington.
Abstract:
Purulent pericarditis is uncommon and is rarely caused by anaerobic bacteria. We describe a 58-year-old man with purulent pericarditis secondary to infection with Bacteroides fragilis; the most likely source for the B. fragilis infection was subsequently found to be a ruptured appendix. His pericarditis eventually resolved after drainage of purulent fluid and treatment with antibiotics directed against B. fragilis. We also review 29 cases of anaerobic pericarditis previously reported in the English-language literature (we excluded those cases due to actinomyces). In 17 cases only anaerobic bacteria were isolated, while in 13 anaerobes were isolated with a mixture of facultative and/or aerobic bacteria. The cases were secondary to a contiguous focus of infection or occurred via hematogenous seeding. Treatment of both anaerobic pericarditis and purulent pericarditis due to aerobic bacteria entails adequate drainage and appropriate antibiotic therapy, and in all cases there should be a search for the source of the organism infecting the pericardium.
Insights
Purulent pericarditis is rare, especially from anaerobic bacteria like Bacteroides fragilis. Prompt diagnosis, surgical drainage, and targeted antibiotics are crucial for treating this serious infection.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Purulent pericarditis is an uncommon condition.
- Anaerobic bacteria are rarely identified as causative agents.
Observation:
- A case of purulent pericarditis caused by Bacteroides fragilis, likely from a ruptured appendix, is presented.
- A literature review identified 29 additional cases of anaerobic pericarditis.
Findings:
- Bacteroides fragilis was the causative agent in the presented case.
- In reviewed cases, anaerobic bacteria were isolated alone or with other bacteria.
- Infections often originated from contiguous sites or hematogenous spread.
Implications:
- Effective treatment requires pericardial fluid drainage and appropriate antibiotic therapy.
- Identifying the source of infection is essential for successful management.
- This highlights the importance of considering anaerobic pathogens in purulent pericarditis.