Sano J, Saitoh H, Kobayashi Y, Ikeda M, Kodani E, Takayama M, Kishida H, Takano T, Yano A
First Department of Internal Medicine, Nippon Medical School, Tokyo.
J Cardiol. 2000 Jan;35(1):47-54.
There have been several case reports, a total of 22 up to the present, of toxoplasma pericarditis. Out of them, in only a few cases the diagnosis was properly made with a proof of the microscopic presence of Toxoplasma gondii. This is the first report of toxoplasma pericarditis in which the presence of Toxoplasma gondii was detected by polymerase chain reaction of pericardial effusion. In addition, the previous reports will be reviewed, and compared to this present case. A 29-year-old woman, without immunosuppressant disorder, suffering from fever and orthopnea was admitted to our hospital. Blood chemistry findings indicated mild liver dysfunction and inflammation. Chest radiography showed cardiac enlargement. Electrocardiography showed sinus tachycardia and ST elevation. Echocardiography revealed a massive pericardial effusion. Pericardiocentesis demonstrated 638 ml of bloody fluid. Cytologic study of the fluid was class II for malignancy, and polymerase chain reaction to tuberculosis was negative. However, a high titer of the anti-toxoplasma antibody of 1: 20,480 (passive hemagglutination) indicated pericarditis caused by Toxoplasma gondii. Subsequently, Toxoplasma gondii was identified in the pericardial effusion by polymerase chain reaction. Clinical symptoms improved after pericardiocentesis, but 2 months later pericarditis recurred. Treatment was started with 800 mg acetylspiramycin daily but failed to improve the symptoms. Because of the development of pleuritis, treatment was changed to sulfadoxine 1,000 mg/pyrimethamine 50 mg. After the treatment with them, her symptoms improved. Only 22 cases of toxoplasma pericarditis have been reported worldwide and 15 of those cases were without immunosuppressant disorder. The usual symptoms at the onset of pericarditis without immunosuppressant disorder are fever, dyspnea and chest pain. Seven patients developed cardiac tamponade. Pericardiocentesis was performed in 8 cases and the pericardial fluid was hemorrhagic in 6. Pericardial thickening was detected in 5 cases. The diagnosis of toxoplasma infection is very difficult, because asymptomatic infection of Toxoplasma gondii is very common. Pericarditis is a disease difficult to confirm the etiology. Detection of Toxoplasma gondii in pericardial effusion by the polymerase chain reaction is very useful for its diagnosis.
已有多篇关于弓形虫性心包炎的病例报告，截至目前共有22例。其中，仅有少数病例通过显微镜下发现刚地弓形虫得以确诊。本文是首例通过心包积液聚合酶链反应检测出刚地弓形虫而确诊的弓形虫性心包炎报告。此外，将对既往报告进行回顾，并与本病例进行比较。一名29岁无免疫抑制疾病的女性，因发热和端坐呼吸入院。血液化学检查结果显示轻度肝功能障碍和炎症。胸部X线检查显示心脏扩大。心电图显示窦性心动过速和ST段抬高。超声心动图显示大量心包积液。心包穿刺抽出638毫升血性液体。液体的细胞学检查为恶性II级，结核聚合酶链反应为阴性。然而，抗弓形虫抗体高滴度为1:20480（被动血凝试验），提示为弓形虫引起的心包炎。随后，通过聚合酶链反应在心包积液中鉴定出刚地弓形虫。心包穿刺后临床症状改善，但2个月后心包炎复发。开始每日用800毫克乙酰螺旋霉素治疗，但症状未改善。由于胸膜炎的出现，治疗改为磺胺多辛1000毫克/乙胺嘧啶50毫克。使用它们治疗后，她的症状有所改善。全世界仅报告了22例弓形虫性心包炎病例，其中15例无免疫抑制疾病。无免疫抑制疾病的心包炎起病时的常见症状为发热、呼吸困难和胸痛。7例患者发生心脏压塞。8例进行了心包穿刺，6例心包液为血性。5例检测到心包增厚。弓形虫感染的诊断非常困难，因为刚地弓形虫无症状感染非常常见。心包炎是一种难以明确病因的疾病。通过聚合酶链反应在心包积液中检测刚地弓形虫对其诊断非常有用。
