Staphylococcus aureus pericardial abscess in an infant: an unknown entity
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Staphylococcus aureus pericardial abscess in an infant: an unknown entity Pramod Reddy Kandakure & Nagarajan Ramodass & Mrutunjay Rao Ivatury & Samba Murthy Kona
Received: 6 May 2011 / Accepted: 23 May 2012 / Published online: 30 January 2013 # Indian Association of Cardiovascular-Thoracic Surgeons 2013
Abstract Purulent pericarditis usually presents as an acute illness with diffuse involvement of the whole pericardium, but can rarely present as a localized effusion. Here, we present an infant with a pericardial abscess caused by Staphylococcus aureus resulting in tamponade, without systemic manifestation of sepsis. The patient made a good recovery after surgical drainage of the abscess and pericardiectomy. To the best of our knowledge, such a case has not been reported. Keywords Left ventricular . Pericardium . Infant
Introduction Purulent pericarditis is a well-known although rare complication of Staphylococcus aureus infection in modern practice. Purulent pericarditis in infants, usually presents as an acute, fulminant infectious illness with diffuse involvement of the whole pericardium, but can rarely present as an encapsulated intrapericardial abscess, causing embarrassment of right heart function consistent with pericardial tamponade and without systemic manifestation of sepsis. Increased awareness of this unusual presentation among clinicians is required to allow prompt diagnosis and institution of appropriate therapy. Delayed diagnosis of this entity may result in serious complications. P. R. Kandakure (*) : N. Ramodass : M. R. Ivatury : S. M. Kona Innova Childrens Heart Hospital, White House, Near St. Ann’s School, Moulali Road, Tarnaka, Hyderabad 500017, India e-mail: [email protected]
Case report A 2 months 21 days old female infant, weighing 3.7 kg was admitted in our hospital with difficulty in feeding and tachypnoea. She had a history of respiratory tract infection at age of 1 month which was treated with intravenous antibiotics by local paediatrician. Physical examination was remarkable for revealing acute respiratory distress, jugular venous distention and hepatomegaly. The patient was afebrile and had a white blood cell count of 11.1×103/μL. C-Reative Protein level was normal and screening for Human Immunodeficiency Virus and HbsAG (Hepatitis B antigen) was negative. Ancillary investigations included an electrocardiogram, which showed sinus tachycardia with nonspecific T-wave changes, and a chest radiograph, which showed a globular configuration of the heart. Transthoracic Echocardiography (TTE) revealed a large mass (4.3×2.3 cm) lying anteriorly suspected to be extracardiac and restricting right ventricular diastolic filling. Retrograde flow into the hepatic veins was present. Left ventricular function was normal, however with decreased stroke volume due to significant compression by the right ventricle (Fig. 1). Surgery was performed on urgent basis because of unstable hemodynamics. Median sternotomy was done and 500 mL of loculated, walled-off pus under moderate pressure was d
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