Katz Lior H, Pitlik Silvio, Porat Eyal, Biderman Phillippe, Bishara Jihad
Infectious Diseases Unit, Department of Internal Medicine D, Rabin Medical Centre, Beilinson Hospital, Petah Tiqwa, Israel.
Scand J Infect Dis. 2008;40(10):785-91. doi: 10.1080/00365540802169106.
Pericarditis as a presenting sign of infective endocarditis is rare. Here we describe 2 cases and an additional 19 cases of pericarditis as a presenting sign of infective endocarditis reported during the last 40 y. 71% of patients were young males (mean age 43.2 y). The most commonly reported underlying conditions were diabetes mellitus type 2 (5 patients, 24%), and substance or alcohol abuse (4 patients, 19%). The native aortic valve was the most frequently involved valve. The most common symptoms were fever, cough or dyspnoea, and chest pain. Overt tamponade was diagnosed in 47% of the patients. However, pulsus paradoxus and pericardial friction rub were rare. A heart murmur was heard in 12 patients (57%). Staphylococcus aureus was the most commonly isolated pathogen concomitantly from blood and pericardial fluid. 16 patients (76%) were operated. Six underwent a pericardial procedure, 5 underwent valve replacement, 4 both, and 1 patient was operated for pseudoaneurysm. Mortality rates were 60% and 31% of patients treated with antibiotics alone versus antibiotics and surgical intervention, respectively. In patients presenting with pericarditis with or without cardiac tamponade, the possibility of infective endocarditis should be considered. Optimal therapy should consist of antibiotics and surgical intervention.
心包炎作为感染性心内膜炎的首发体征较为罕见。本文描述了2例心包炎作为感染性心内膜炎首发体征的病例，并补充了过去40年中报道的另外19例此类病例。71%的患者为年轻男性（平均年龄43.2岁）。最常报告的基础疾病是2型糖尿病（5例，24%）和药物或酒精滥用（4例，19%）。天然主动脉瓣是最常受累的瓣膜。最常见的症状是发热、咳嗽或呼吸困难以及胸痛。47%的患者被诊断为明显的心包填塞。然而，奇脉和心包摩擦音很少见。12例患者（57%）可闻及心脏杂音。金黄色葡萄球菌是血液和心包液中最常分离出的病原体。16例患者（76%）接受了手术。6例接受了心包手术，5例接受了瓣膜置换，4例两者都做了，1例患者因假性动脉瘤接受了手术。单独使用抗生素治疗的患者死亡率为60%，而使用抗生素并进行手术干预的患者死亡率为31%。对于有心包炎伴或不伴心脏填塞的患者，应考虑感染性心内膜炎的可能性。最佳治疗应包括抗生素和手术干预。
