Purulent pericarditis

• Bacterial pericarditis causing purulent pericardial effusion

Microbiology

• Bacteria
  • Staphylococcus aureus (~30%)
  • Streptococcus pneumoniae (previously more common; associated with pneumonia)
  • Haemophilus influenzae
    • Salmonella typherium
  • Less common
    • Proteus
    • Escherichia coli
    • Pseudomonas aeruginosa
    • Klebsiella pneumoniae
    • Neisseria meningitis
    • Bacteroides spp.
    • Nocardia asteroides
• Mycobacteria
  • Tuberculosis (subacute or chronic presentation)
• Fungi
  • Candida
  • Aspergillus

Pathophysiology

• Most commonly from hematogenous spread
• Can also result from direct spread from lungs, endocarditis, or trauma with direct inoculation

Clinical Presentation

• Classic signs of pericarditis, including chest pain and cardiac rub, may be absent

Further Reading

• The changed spectrum of purulent pericarditis: An 86 year autopsy experience in 200 patients. Am J Med. 1997;63(5):666-673. doi: 10.1016/0002-9343(77)90150-4
• Clinical, microbiologic and therapeutic aspects of purulent pericarditis. Am J Med. 1975 Jul;59(1):68-78. doi: 10.1016/0002-9343(75)90323-x