Pericarditis - bacterial

Alternative names
Purulent pericarditis

Definition

Bacterial pericarditis is an inflammation (irritation and swelling) of the sac that surrounds the heart (pericardium), caused by a bacterial infection.

Causes, incidence, and risk factors

Bacterial infections are one cause of pericarditis. Since the advent of antibiotics, bacterial pericarditis has become relatively rare.

It most often occurs in men between the ages of 20 and 50, usually after some type of respiratory infection. It can also occur after skin or oral infections that produce bacteremia (bacterial infection of the blood) and after heart surgery.

The bacterial infection causes inflammation of the pericardium. Pain occurs as a result of the inflamed pericardium rubbing against the heart. Fluid may accumulate in the pericardial sac.

The most common organisms that cause this condition are staphylococci, streptococci, pneumococci, hemophilus influenza (also called H.flu), and meningococci.

Symptoms

     
  • Chest pain       o radiating to the neck, shoulder, back or abdomen       o described as sharp, stabbing       o increases with breathing  
  • the preferred position to relieve the pain is upright, standing or sitting  
  • difficulty breathing  
  • splinting of ribs with deep breathing (bends over of holds chest when breathing)  
  • dry cough  
  • anxiety  
  • fatigue  
  • fever  
  • sweating  
  • chills

Signs and tests

When listening to the heart through a stethoscope, the health care provider may be able to hear a pericardial rubbing sound, and heart sounds may be faint or distant. There may be other signs of fluid in the pericardium (pericardial effusion).

If the disorder is severe, there may be signs of fluid in the space around the lungs (pleural effusion), such as decreased breath sounds. The person may appear toxic (septic shock) and critically ill. There may be signs of associated pneumonia.

Doctors may suspect this disorder when one of the following tests shows an abnormal amount of fluid in the pericardial sac:

This condition is diagnosed when the fluid around the pericardial sac is shown to be infected with bacteria. The following tests help doctors make this diagnosis

     
  • blood cultures  
  • pericardial fluid Gram stain  
  • pericardial fluid culture  
  • a CBC showing increased WBC count

Treatment

The goal of treatment is to cure the infection.

Antibiotics are used aggressively to treat bacterial infections. Other medications may include analgesics to relieve pain and diuretics to remove excess fluid. Aspirin, ibuprofen, other nonsteroidal anti-inflammatory medications (NSAIDS), or corticosteroids may be prescribed to relieve inflammation of the pericardium.

Bedrest with the head of the bed elevated may be recommended to reduce the workload on the heart.

Pericardiocentesis (removal of fluid from the pericardial sac) is necessary to drain infected pericardial fluid and to prevent or treat Cardiac tamponade. Surgical pericardiectomy (cutting or removal of part of the pericardium) may be recommended if bacterial pericarditis is chronic or recurrent.

Expectations (prognosis)
The disorder may be life threatening if untreated. The outcome is good if bacterial pericarditis is treated promptly. Most people recover completely with treatment.

Complications

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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