[Bacterial pericarditis].
METHODS
A 65-year-old previously healthy man was referred because of high fever, progressive dyspnea and retrosternal pain for 2 days. On admission, the patient was already in a reduced general condition, blood pressure was 120/70 mmHg, heart rate irregular at 75/min and temperature at 39.7 degrees C. Auscultation of the heart revealed distant heart sounds, murmurs were not present, but mild rales were heard over both lung bases. Jugular veins were congested.


METHODS
ECG showed a generalized ST-segment elevation with preserved R-waves, slightly depressed PR-segment and atrial bigemini. Chest X-ray revealed an enlarged cardiac silhouette with signs of a pneumopericardium. Transthoracic echocardiography showed a circular pericardial effusion and haemodynamic impairment. Percutaneous pericardiocentesis revealed a purulent effusion with microbiological proof of pneumococci. The primary infectious focus was a maxillary sinusitis caused by pneumococci.


METHODS
Bacterial pericarditis due to by haematogenous spread of pneumococci.


METHODS
Antibiotic therapy consisted of intravenous ceftriaxon and gentamicin. To rinse the pericardial space and drain the thick, purulent effusion subxiphoidal, pericardiocentesis and insertion of a drainage tube were done. Physiological saline was put into the pericardial space several times a day, drained and analysed microbiologically. In the meantime rinsing of the infected maxillary sinus was performed. Transthoracic echocardiography was done repeatedly to rule out complications of bacterial pericarditis, especially constrictive pericarditis. The pericardial tube was removed after proof of a sterile drainage 9 days after insertion. The patient was discharged after 4 weeks of hospitalization without clinical or echocardiographic signs of diastolic dysfunction.


CONCLUSIONS
Suspected bacterial pericarditis must be treated as an emergency and confirmed or ruled out by percutaneous pericardiocentesis.
Schoen
S P
SP
Technische Universität Dresden, Herzzentrum Dresden, Universitätsklinik, Medizinische Klinik/Kardiologie. kardiologie@email.de
Zimmermann
T F
TF
Boscheri
A
A
Schmeisser
A
A
Strasser
R H
RH
D000368:Aged; D002443:Ceftriaxone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004417:Dyspnea / Q000209:etiology; D005335:Fever of Unknown Origin / Q000209:etiology; D005500:Follow-Up Studies; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008297:Male; D015523:Maxillary Sinusitis / Q000175:diagnosis / Q000188:drug therapy; D008826:Microbial Sensitivity Tests; D010493:Pericarditis / Q000175:diagnosis* / Q000188:drug therapy; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013396:Suction; D007507:Therapeutic Irrigation
D005839:Gentamicins; D002443:Ceftriaxone