Definition/General
Introduction:
Bacterial pericarditis is purulent infection of pericardium
Rare but life-threatening condition
Common organisms: Staphylococcus aureus, Streptococcus pneumoniae
High mortality (20-30%)
Cardiac tamponade common.
Origin:
Results from hematogenous spread
Direct extension from pneumonia
Post-cardiac surgery
Penetrating chest trauma.
Classification:
Based on organism: Gram-positive (Staph, Strep)
Gram-negative (E
coli, Pseudomonas)
Post-surgical vs community-acquired.
Epidemiology:
Rare: 1% of acute pericarditis
Male predominance
Immunocompromised patients at risk
High mortality without treatment.
Clinical Features
Presentation:
High fever with rigors
Severe chest pain
Rapid clinical deterioration
Cardiac tamponade
Sepsis syndrome.
Symptoms:
High fever (95% cases)
Severe chest pain (90% cases)
Dyspnea (85% cases)
Tachycardia (80% cases)
Hypotension (tamponade).
Risk Factors:
Immunocompromised state
Post-cardiac surgery
Penetrating trauma
Infective endocarditis.
Screening:
Emergency echocardiography
Immediate pericardiocentesis
Blood cultures
Gram stain.
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Microscopic Description
Histological Features:
Massive neutrophilic infiltration (>95% neutrophils)
Very high cell count (>10,000/μL)
Degenerative neutrophils
Bacteria visible on Gram stain.
Cellular Characteristics:
Mature neutrophils
Degenerative changes
Toxic granulation
Abundant debris.
Architectural Patterns:
Sheets of neutrophils
Purulent background
Bacterial colonies
Necrotic debris.
Grading Criteria:
Very high protein (>5 g/dL)
Very low glucose
Positive Gram stain
High lactate.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
URGENT NOTIFICATION
CRITICAL: Bacterial pericarditis - Emergency treatment required
Specimen Information
Pericardial fluid, volume [X] mL, purulent
Cell Differential
Neutrophils: [X]% (>95%), Lymphocytes: [X]%, Other: [X]%
Gram Stain
Gram stain: [Positive/Negative] - [Organism description]
Final Diagnosis
BACTERIAL PERICARDITIS - Medical emergency