Metastatic Complications of Pericarditis and Cardiac Tamponade as a Result of <i>Staphylococcus aureus</i> Bacteremia Developing during Antimicrobial Therapy

Abstract

Acute bacterial pericarditis is a rare but devastating complication of Staphylococcus aureus bacteremia (SAB). We herein describe the case of a previously healthy 81-year-old woman with SAB complicated by pericarditis that evolved into cardiac tamponade despite the administration of optimal antimicrobial therapy for 11 days. Three adhesion factor genes, fnbA, clfA and clfB, were identified in the causative isolate.

A Toddler With Fever, Melena, and Renal Failure

“…4,5 A more fulminant presentation with findings suggestive of cardiac tamponade (jugular venous distension, hepatomegaly, muffled heart sounds, and pulsus paradoxus) may occur but these findings are variably present, and their absence may result in delayed diagnosis. 4,8,9 The nonspecific respiratory symptoms often trigger a chest radiograph for assessment of pneumonia, which may demonstrate an enlarged cardiac silhouette leading to the diagnosis. The clinical presentation of pneumococcal pericarditis varies little from cases with other etiologies.…”

“…7 The hematogeneous route is more commonly seen with S aureus infection in which there is often an associated, distant infection, usually osteoarticular. 5,8,9 The clinical presentation of purulent pericarditis typically includes fever, cough, and dyspnea in a young child (>60% under 5 years). 4,5 A more fulminant presentation with findings suggestive of cardiac tamponade (jugular venous distension, hepatomegaly, muffled heart sounds, and pulsus paradoxus) may occur but these findings are variably present, and their absence may result in delayed diagnosis.…”

Hemopericardio, taponamiento cardíaco, y absceso hepático en un varón joven

“…Cardiac tamponade is reported as a severe complication in nearly 15% of acute purulent pericarditis caused by community acquired infection by Staphylococcus aureus, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] agent that has been described in up to 36% of purulent effusions in this group of patients. 1 Pericardial involvement more often occurs during bloodstream infections, but may origin as an extension of contiguous infectious foci; the main risk factors of this condition include immunosuppression, thoracic surgery, and percutaneous invasive procedure.…”

“…1 Pericardial involvement more often occurs during bloodstream infections, but may origin as an extension of contiguous infectious foci; the main risk factors of this condition include immunosuppression, thoracic surgery, and percutaneous invasive procedure. 1,2,4,9,[14][15][16] Additionally to infections, malignancy, myocardial infarction, autoimmune diseases, uremia, hypothyroidism, radiation, drugs, and iatrogenesis can cause www.medigraphic.org.mx www.medigraphic.org.mx dissection, malignancy, trauma, uremia, tuberculosis and drugs. 2,[16][17][18][19] Worthy of note is the overlapping of hemorrhagic with other type of pericardial effusion, as described in cardiac tamponade due to purulent pericarditis by Staphylococcal infection.…”