Bacterial pericarditis

Introduction to bacterial pericarditis Bacterial pericarditis (bacterial pericarditis) is more common in the past, with higher morbidity and mortality. Since the clinical application of antibiotics and sulfonamides, the disease has been greatly reduced. The pericardial exudate is initially serous fibrinous, and then converted to suppurative. As the disease progresses, the inflammation causes the exudate to become thick, and the mechanization leads to pericardial adhesion, which causes the pericardial space to disappear, and the pericardium is thickened or calcified. It is easy to develop into constrictive pericarditis. In some cases, the adjacent sternum, pleura, and diaphragm are involved, and adhere to the parietal pericardium. The path of pericardial infection has undergone great changes. Suppurative pericarditis, which spreads directly from pneumococcal pneumonia or empyema to the pericardium, accounts for only 20% of suppurative pericarditis. Contemporary, adult bacterial pericarditis occurs mainly in: 1 chest surgery or traumatic infection: 2 associated with infective endocarditis: 3 extensive myocardial abscess: 4 septic coronary embolus caused by infectious myocardial infarction: 5 main The arterial dissection is broken. basic knowledge The proportion of illness: 0.0025% Susceptible people: no specific population Mode of infection: non-infectious Complications: constrictive pericarditis Myocardial infarction complicated with left ventricular aneurysm

Causes of bacterial pericarditis

Bacterial infection (20%):

Previous bacterial pericarditis was associated with pneumococcal pneumonia or empyema, or uncontrollable disease due to staphylococcus or streptococci, with the use of antibiotics, the development of resistant strains and cardiac surgery and interventional procedures. Extensively, the range of microorganisms causing bacterial or suppurative pericarditis has expanded, including Gram-negative bacilli, Brucella, Salmonella, Neisseria gonorrhoeae, Acidophilus influenzae, anaerobic bacteria and other unusual pathogens.

Pathology (20%):

The pericardial exudate is initially serous fibrinous, and then converted to suppurative. As the disease progresses, the inflammation causes the exudate to become thick, and the mechanization leads to pericardial adhesion, which causes the pericardial space to disappear, and the pericardium is thickened or calcified. It is easy to develop into constrictive pericarditis. In some cases, the adjacent sternum, pleura, and diaphragm are involved, and adhere to the parietal pericardium.

Pathway to infection (25%):

The path of pericardial infection has undergone great changes. The suppurative pericarditis, which is directly spread to the pericardium by pneumococcal pneumonia or empyema, accounts for only 20% of suppurative pericarditis. Contemporary, adult bacterial pericarditis occurs mainly. There are: 1 chest surgery or traumatic infection: 2 associated with infective endocarditis: 3 extensive myocardial abscess: 4 septic coronary embolus caused by infectious myocardial infarction: 5 aortic dissection.

Bacterial pericarditis prevention

1. Active and effective treatment of primary disease, treatment of pneumococcal pneumonia and empyema.

2. Early diagnosis, use a sufficient amount of antibiotics, if necessary, pericardial incision and drainage, must be completely drained to prevent the occurrence of constrictive pericarditis.

Bacterial pericarditis complications Complications, constrictive pericarditis, myocardial infarction, and left ventricular aneurysm

The disease is prone to complications such as pericardial tamponade, pericardial constriction and pseudoventricular ventricular aneurysm.

1. Pericardial filling of bacterial pericarditis has serous fibrin exudation, and then converted into purulent serous; at the same time, the pericardial tamponade can be formed due to the progressive enlargement and rupture of the pseudo-ventricular aneurysm cavity.

2. Pseudo-ventricular aneurysm The pathogenic bacteria of bacterial pericarditis are mostly Staphylococcus aureus. Bacterial pericarditis such as pus has not been promptly and thoroughly removed. Suppurative inflammation further invades myocardial tissue and causes myocardial tissue necrosis. Necrotic myocardium ruptures under the impact of left ventricular high blood flow, blood leaks into the pericardial cavity, forming a hematoma and adhesion, fibrotic pericardium, forming pseudo-ventricular aneurysm, pseudo-ventricular aneurysm is more common in the left ventricle, Occasionally the left atrium.

3. Constrictive pericarditis Bacterial pericarditis has serous fibrin exudation, and then converted to suppurative, with the progress of the disease, inflammation can make the exudate pus thick, mechanized lead to pericardial adhesion, so that the pericardial space disappears, Pericardial thickening or calcification, easily develop into constrictive pericarditis.

Bacterial pericarditis symptoms common symptoms tachycardia chills pericardial fiber thickening dyspnea high fever jugular vein septicemia pericarditis pericardial inflammation chest pain

Bacterial pericarditis is often acute, fulminant disease, prodromal symptoms are only 3 days on average, usually have high fever, chills, systemic poisoning symptoms and dyspnea, most patients do not have typical chest pain, almost all patients have tachycardia, no To half of the patients have pericardial friction, prominent symptoms and signs associated with known infections, such as severe pneumonia, empyema, thoracic surgery or trauma, jugular vein engorgement and odd veins, may be the first manifestation of pericardial effusion, purulent pericardium The effusion can be developed into pericardial tamponade and pericardial constriction.

Anyone with symptoms of sepsis such as chills, high fever and unexplained dyspnea, jugular vein engorgement, tachycardia should consider the possibility of complicated bacterial pericarditis. Combined with laboratory examination, white blood cells are significantly elevated, blood culture is positive. ECG ST-T wave changes, X-ray heart shadow contour increases, cardiac ultrasound prompts pericardial effusion, etc., especially pericardial puncture to extract purulent or pericardial fluid to culture bacteria can make a positive diagnosis, stressing that bacterial pericarditis sometimes Can be overshadowed by the symptoms of its primary disease.

Bacterial pericarditis

1. Peripheral blood leukocytes rise and the left side of the nucleus.

2. Pericardial fluid examination is purulent, multinucleated white blood cells are increased, sugar quantification level is lowered, and protein content is increased.

3. Lactate dehydrogenase (LDL) is significantly increased.

4. Pericardial cytology and aerobic, anaerobic culture can be found in more than half of the growth of pathogenic bacteria, Staphylococcus aureus is the most common, blood culture or wound secretion culture has bacterial growth, can also be sepsis sepsis, etc. Provide a basis for infectious diseases.

5. Electrocardiogram: ST-T is characterized by acute pericarditis. Alternating voltage often indicates cardiac tamponade, prolonged PR, atrioventricular septum or bundle branch block.

6. Chest X-ray: The heart shadow is enlarged and the mediastinum is widened.

7. Cardiac ultrasound: suggesting pericardial effusion.

8. Pericardial puncture: Pull out the purulent liquid, and the culture of the pericardial fluid can make a positive diagnosis.

Diagnosis and identification of bacterial pericarditis

The disease should be differentiated from myocardial infarction, cardiomyopathy, acute abdomen and infective endocarditis. The pus from the pericardial puncture for smear examination and bacterial culture can help differential diagnosis.

In the pre-cardiac area, the pericardial friction sound is heard, and the diagnosis of pericarditis can be established. In the course of a disease that may be complicated by pericarditis, such as chest pain, dyspnea, tachycardia and unexplained systemic venous congestion or enlarged heart, it should be considered as a possibility of pericarditis with exudate. The identification of oozing pericarditis and cardiac enlargement caused by other causes is often difficult. Jugular vein dilatation with odd pulse, weak apex beat, weak heart sound, no valve murmur, early extra tone of diastole; X-ray examination or cardiac phonography shows that the normal contour of the heart disappears, the beat is weak; ECG shows low voltage, ST- The change of T and the prolongation of QT interval are beneficial to the diagnosis of the former.

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