From the Guidelines
Purulent pericarditis, including cases caused by Strep B, should be managed aggressively with intravenous antimicrobial therapy and drainage to achieve a good long-term outcome, as comprehensive therapy has been reported to result in 85% of cases surviving the episode. The management of pericardial effusion due to Strep B infection involves a combination of antibiotics and drainage of the effusion. According to the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1, intravenous antimicrobial therapy should be started empirically until microbiological results are available. The choice of antibiotic may depend on the severity of the infection and the patient's allergy status, but typically involves penicillin G or ampicillin for 2-4 weeks.
- Key considerations in the management of Strep B-related pericardial effusion include:
- Aggressive antimicrobial therapy
- Drainage of the pericardial effusion, which may involve pericardiocentesis, subxiphoid pericardiostomy, or intrapericardial thrombolysis for loculated effusions
- Supportive care with anti-inflammatory medications to reduce inflammation and prevent further complications
- Close monitoring for signs of hemodynamic compromise or recurrent effusion, which may require more invasive interventions such as pericardial window or pericardiectomy. The goal of treatment is to prevent complications, such as cardiac tamponade, and to achieve a good long-term outcome, as reported in the 2015 ESC guidelines 1.
From the Research
Strep B and Pericardial Effusion
- Strep B, also known as Streptococcus agalactiae, is a rare cause of purulent pericarditis, which is a serious and potentially life-threatening condition 2.
- Purulent pericarditis is characterized by the presence of gross pus in the pericardium or microscopically purulent effusion, and is often fatal if left untreated 3.
- The symptoms of purulent pericarditis can be non-specific, making diagnosis challenging, but may include fever, chest pain, and shortness of breath 2.
- Streptococcus agalactiae is a common cause of infections in newborns, but can also cause infections in adults, particularly those with underlying medical conditions or compromised immune systems 2.
- The management of purulent pericarditis typically involves urgent pericardial drainage and intravenous antibiotic therapy, and may require surgical intervention in some cases 3, 4.
Causes and Risk Factors
- Bacterial infections, including Streptococcus agalactiae, are a common cause of pericardial effusion 3, 2.
- Other causes of pericardial effusion include tuberculosis, cancer, and systemic inflammatory diseases 5.
- Risk factors for developing pericardial effusion include underlying medical conditions, such as diabetes, and compromised immune systems 2, 6.
Diagnosis and Treatment
- Diagnosis of purulent pericarditis typically involves imaging studies, such as echocardiography or computed tomography (CT) scans, and laboratory tests, including blood cultures and pericardial fluid analysis 2, 4.
- Treatment of purulent pericarditis typically involves urgent pericardial drainage and intravenous antibiotic therapy, and may require surgical intervention in some cases 3, 4.
- Early recognition and prompt intervention are critical for a successful outcome in cases of purulent pericarditis 2, 4.