Purulent Pericarditis

Purulent pericarditis is the presence of suppuration in the pericardium. It is typically caused by localized infections, but other etiologies are also possible. It is commonly seen in patients with underlying systemic or pericardial conditions. The most common source of infection is direct inoculation by perforation or from a local infection focus, followed by hematogenous dissemination and spread from a distant focus of infection. Depending on the geographical location, gram-positive cocci and Mycobacterium tuberculosis are the most common causative agents. Fever is almost universally present and accompanied by tachycardia, cough, and rarely chest pain. Although subacute courses can be seen, the presentation is usually acute. Specific physical examination findings are rare, and laboratory findings are generally not discriminative. Electrocardiography and imaging techniques are helpful in diagnosis. However, a definite diagnosis requires pericardiocentesis. Treatment involves drainage of pericardial fluid and antibiotics, started empirically and tailored according to the microbiological identification. It could lead to cardiac tamponade in the acute phase, and constrictive pericarditis is a possible late complication. Prognosis depends on diagnostic and therapeutic dynamics and patient characteristics, with survival rates being around 70 to 80 percent. This chapter will address the clinical and diagnostic features of purulent pericarditis, as well as therapeutic options.