title: Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series.
abstract: OBJECTIVE
  In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular.
  
  
  METHODS
  We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity.
  
  
  RESULTS
  In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis.
  
  
  CONCLUSIONS
  In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis.
authors.affiliation: Instituto de Investigación Biomédica Agustí Pi i Sunyer, Universidad de Barcelona, ES.
authors.forename: Catia
authors.initials: C
authors.lastname: Cillóniz
authors.affiliation: Facultad de Medicina, Universidad Autónoma de Nayarit, Tepic, MX.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Rangel
authors.affiliation: Ospedale Generale di Sestri Levante, Sestri Levante, IT.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Barlascini
authors.affiliation: Ospedale Generale di Sestri Levante, Sestri Levante, IT.
authors.forename: Ines Maria Grazia
authors.initials: IM
authors.lastname: Piroddi
authors.affiliation: Instituto de Investigación Biomédica Agustí Pi i Sunyer, Universidad de Barcelona, ES.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.affiliation: Ospedale Generale di Sestri Levante, Sestri Levante, IT.
authors.forename: Antonello
authors.initials: A
authors.lastname: Nicolini
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000150:complications*; D011018:Pneumonia, Pneumococcal / Q000150:complications*; D013296:Streptococcus pneumoniae; D013492:Suppuration / Q000150:complications* / Q000382:microbiology