fungal pericarditis
Introduction
Introduction to fungal pericarditis Various fungal diseases such as histoplasmosis, coccidioplasmosis, actinomycosis and nocardiosis can affect the pericardium. Although fungal pericarditis (fungalpericarditis) is rare, patients with susceptibility to fungi, Especially for patients with lymphoma, leukemia and other systemic diseases who are undergoing immunosuppressive therapy, if there is a sign of pericarditis, the possibility of having this disease should be considered. basic knowledge The proportion of the disease: the disease is more common in HIV patients and patients with extremely low body constitution, the incidence rate is about 0.004%-0.006% Susceptible people: no specific population Mode of infection: non-infectious Complications: constrictive pericarditis, pericardial effusion
Cause
Cause of fungal pericarditis
Tissue sporicidal infection (30%):
Tissue spore bacterium is the most common cause of fungal pericarditis. It is more common in the United States. Young and healthy people suffer from inhalation of spores from birds or bat feces, and in cities are related to excavation or building blasting. .
Other fungal infections (30%):
Other fungal infections cause pericarditis including Aspergillus, yeast, Candida albicans, etc., which cause risk factors for the spread of fungal infections, including drug addicts, low immune function, broad-spectrum antibiotic treatment or cardiac surgery recovery period.
Chlamydia spores (30%):
Coccidioidomycosis is associated with inhalation of Chlamydia spores from soil and dust.
Pathogenesis
Tissue spore-like pericarditis, pericardial fluid grows rapidly, large amount, can be serous or bloody, protein amount increases, polymorphonuclear leukocytes increase, other pathogenic fungal pericarditis, exudate grows slowly, tissue spore And other fungal pericarditis, pericardial exudate occasionally can be mechanized, pericardial thickening, pericardial constriction and calcification.
Prevention
Fungal pericarditis prevention
1. Minimize the travel and residence to the epidemic area of the disease, and take necessary protective measures to reduce the incidence rate when contacting epidemic areas of dust, birds or bat feces.
2. Active treatment of the primary disease.
Complication
Fungal pericarditis complications Complications, constrictive pericarditis, pericardial effusion
Visible pericardial tamponade, constrictive pericarditis and other complications.
1. Pericardial tamponade, sporotrolosis, pericarditis, a large number of pericardial effusions can occur rapidly, and pericardial tamponade can occur.
2. Constrictive pericarditis The pericardial exudation of fungal pericarditis is generally slow, and there may be pericardial thickening, calcification, and formation of constrictive pericarditis.
Symptom
Fungal pericarditis symptoms Common symptoms Lymph node enlargement Pericardial inflammatory leukopenia reduces pleural effusion
Almost all patients with sporozoite pericarditis have respiratory diseases, obvious "pericardial pain" and typical ECG changes, chest X-ray abnormalities, 95% increased heart shadow, pleural effusion and 2/3 patients with intrathoracic lymphadenopathy The tissue sporicidal pericarditis is typically characterized by acute self-limited disseminated infection. More than 40% of patients have hemodynamic changes or cardiac tamponade symptoms, and rare long-term disseminated infections such as fever, anemia, and leukopenia are rare. Pneumonia-thoracic syndrome, hepatomegaly, meningitis, myocarditis or endocarditis are not common, and most of the severely transmitted infections are in infants, older men and immunosuppressive drugs.
Examine
Fungal pericarditis
The complement-binding antibody titer was increased by at least 1:32 and the immunodiffusion test was positive.
1. X-ray chest radiograph 95% of patients with increased heart shadow, pleural effusion.
2. Pericardial and pericardial biopsy histology found that the appearance of the fungus and subsequent culture positive can confirm the diagnosis.
Diagnosis
Diagnosis and identification of fungal pericarditis
Diagnostic points
1. Diagnosis basis of tissue sporotitis pericarditis
1 permanent residence or travel to an epidemic area;
2 When young or healthy adults are suspected of pericarditis, the complement binding titer is increased by at least 1:32;
3 immunodiffusion test is positive, most patients do not have a progressive increase in titer, because pericarditis usually occurs after mild or asymptomatic pneumonia, the titer has increased in the first measurement, tissue sporotin skin test Diagnosis does not help, tissue sporotitis pericarditis occurs in severely disseminated infections. Histological examination and culture is important, can be inoculated from the liver, bone marrow, ulcer exudate or sputum in Sabro bone marrow, ulcers The exudate or sputum is inoculated on Sabouraud agar medium or Dutch pigs, followed by subculture.
2. Diagnosis basis of coccidioidoxin pericarditis
1 has a history of exposure to dust in epidemic areas;
2 characteristic clinical manifestations of sporozoite disseminated to the lungs and other organs;
3 In the early stage of infection, serological examination of the precipitation reaction, positive complement binding test;
4 The pathological examination of living tissue showed characteristic corpuscles, and the coccidiostat skin test was often negative, and the clear diagnosis was based on Sabron agar culture.
Other fungal pericarditis, such as pericarditis caused by other fungi, should be done with the corresponding complement-binding test. Candida pericarditis is not sensitive to serological and precipitation tests, nor specific, and the pericardial biopsy sees fungi. The characteristics of infection and pericardial exudate culture have fungal growth, which is of great significance for the diagnosis of candida pericarditis.
Differential diagnosis
The disease must be differentiated from sarcoidosis, tuberculosis, Hodgkin's disease, and brucellosis.
