What are the viral and bacterial etiologies of pericardial effusion?

From the Guidelines

Pericardial effusion is commonly caused by viral and bacterial etiologies, with viral pericarditis being the most common infection of the pericardium, often caused by coxsackievirus, influenza virus, cytomegalovirus, and human immunodeficiency virus (HIV) 1. Bacterial pericardial effusion, on the other hand, is often caused by Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, and Mycobacterium tuberculosis 1.

Viral Etiologies

• Coxsackievirus: a common cause of viral pericarditis, with treatment typically involving supportive care with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 600-800mg every 6-8 hours 1.
• Influenza virus: another common cause of viral pericarditis, with treatment similar to coxsackievirus 1.
• Cytomegalovirus: a cause of pericarditis, particularly in immunocompromised patients, with treatment involving hyperimmunoglobulin or antiviral therapy 1.
• Human immunodeficiency virus (HIV): a cause of pericarditis, particularly in patients with advanced disease, with treatment involving antiretroviral therapy and management of opportunistic infections 1.

Bacterial Etiologies

• Streptococcus pneumoniae: a common cause of bacterial pericardial effusion, with treatment involving antibiotic therapy with penicillin G 2-4 million units IV every 4 hours or ceftriaxone 1-2 grams IV every 12-24 hours for a duration of 2-4 weeks 1.
• Staphylococcus aureus: another common cause of bacterial pericardial effusion, with treatment similar to Streptococcus pneumoniae 1.
• Klebsiella pneumoniae: a cause of bacterial pericardial effusion, particularly in patients with underlying medical conditions, with treatment involving antibiotic therapy with cephalosporins or fluoroquinolones 1.
• Mycobacterium tuberculosis: a cause of bacterial pericardial effusion, particularly in patients with tuberculosis, with treatment involving antitubercular therapy 1.

Treatment

Treatment of pericardial effusion depends on the underlying cause, with viral pericarditis typically involving supportive care with NSAIDs, and bacterial pericardial effusion involving antibiotic therapy 1. In severe cases, pericardiocentesis or pericardial window procedure may be necessary to drain the effusion and prevent cardiac tamponade 1.

From the Research

Viral Etiologies of Pericardial Effusion

• Viral pericarditis is one of the most common causes of pericardial effusion in developed countries 2
• COVID-19 infection can cause pericarditis and pericardial effusion, even in asymptomatic cases 3
• Other viral etiologies, such as acute idiopathic pericarditis, can also cause pericardial effusion 4, 5

Bacterial Etiologies of Pericardial Effusion

• Bacterial pericarditis is a rare disease in the era of antibiotics, but can be caused by Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae 6
• Haemophilus parainfluenzae is a rare cause of purulent pericarditis, but should be considered in patients with signs and symptoms of pericardial tamponade 6
• Tuberculous pericarditis is a common cause of pericardial effusion in developing countries 4, 2

Other Etiologies of Pericardial Effusion

• Idiopathic pericarditis is a common cause of pericardial effusion, especially in cases where no underlying disease is present 4, 5
• Neoplastic pericardial effusion is a concern in patients with underlying neoplasia, and can be challenging to manage 4, 5
• Parasitic etiologies are less common, but can also cause pericardial effusion 2