Table 1 Characteristics of cases with Chlamydia pneumoniae-associated pericarditis after systematic literature search
Case | 1 | 2 | 3 | 4 | 5 | 6 |
|---|---|---|---|---|---|---|
Study | Kyriakoulis et al (present study) | Oztek Celebi et al. [7] | Suesaowalak et al. [8] | Rýzlová et al. [9] | Tenenbaum et al. [10] | Zver et al. [11] |
Year | 2020 | 2020 | 2008 | 2008 | 2005 | 1997 |
Country | Greece | Turkey | Thailand | Czech Republic | Germany | Slovenia |
Age (years) | 40 | 13 | 11 | 52 | 13 | 27 |
Sex | Female | Male | Male | Male | Female | Male |
Main diagnosis | Pleuropericarditis | Pericarditis | Myopericarditis | Pericarditis | Pericarditis | Pericarditis |
Signs/Symptoms | Fever Shortness of breath after excessive physical activity Chest pain | Chest pain Rhinitis for 3 weeks Cough for 3 weeks No fever | Fever Rash Headache Myalgia Neck pain Intermittent vomiting | Fever Shortness of breath after excessive physical activity Dry cough Chest pain | Fever Tachypnoea Shortness of breath exacerbated by exertion Throat pain Nausea | Fever Dry cough Pericardial friction rub Chest pain Cardiac tamponade |
Pre-existing medical conditions | Arterial hypertension | No | No | Respiratory tract infection 2 weeks ago (clarithromycin) | Skeletal dysplasia of unknown cause, scoliosis, generalized gingivitis, mild aortic valve regurgitation | Acute myeloblastic leukemia, pancytopenia |
Pleural effusion | Bilateral | Bilateral | Small bilateral | Left | No | NR |
Pericardial effusion | Yes (mild) | Yes (large) | Yes (small) | Yes (large) | Yes | Yes |
Pericardiocentesis | No | Yes, 1000 ml hemorrhagic | No | No | Yes, 500 ml hemorrhagic | Yes, 320 ml sanguinous exudate |
ECG | Sinus tachycardia (112 bpm), PVCs, ventricular trigeminy, inverted T-wave in V1-V6 | NR | Sinus tachycardia (129 bpm), low QRS voltage, inverted T-wave in III, aVF, and V1–V4 | Sinus tachycardia (106 bpm), 1 mm elevations ST in II, III, aVF, V2–V6 | NR | NR |
WBC | 13.25 × 109/l (neutrophils 89%) | 12.9 × 109/l (neutrophils 80%) | 11.6 × 109/l (neutrophils 70%) | Normal | 12.6 × 109/l | NR |
Troponin | < 1.9 pg/ml (r < 15.6) | 0 ng/ml (r < 0.06) | 0.9 ng/ml (r < 0.04) | Negative | NR | NR |
BNP | 95 pg/ml (r < 100) | NR | 2.493 pg/ml (r < 100) | NR | NR | NR |
CRP | 8 mg/dl (r < 0.70) | 719 nmol/L (r < 48) | 16.18 mg/dl (r < 0.75) | 302 mg/l (r NR) | 20 mg/l (r NR) | NR |
ESR | 120 mm/h (r < 10) | 13 mm/h (r < 10) | 92 mm/h (r < 10) | NR | NR | NR |
ANA | Negative | Negative | NR | 1: 160 | NR | NR |
RF | < 10.2 (r < 15) | NR | NR | NR | NR | NR |
Chest X-ray | Small amount of bilateral pleural effusion mainly left, cardiomegaly | Bilateral pleural effusions, lung infiltrations, cardiomegaly | Pulmonary venous congestion, small amount of bilateral pleural effusion, cardiomegaly | Left side infiltrate 3 × 2 cm | Central bilateral infiltration and an enlarged cardiac silhouette | Bronchopneumonia of right middle lobe |
Echocardiography | Mild pleural effusion, normal systolic function, mild mitral and triscupid valve regurgitation | Large pericardial effusion | Mildly depressed left ventricular systolic function, EF 51%, small pericardial effusion | Pericardial effusion up to 18 mm, no signs of tamponade | Pericardial effusion | Pericardial effusion up to 27 mm, fibrous strands attached to pericardium |
Chest CT | Pericardial and bilateral pleural effusion, negative for pulmonary embolism (CTPA) | Consolidations in the superior and inferior lobes of the left lung and the inferior lobe of the right lung | NR | Pericardial and left-sided pleural effusion, left side infiltrate 3 × 2 cm | NR | NR |
Diagnosis | IgM 20 U/ml (r < 15), IgG 14 (r < 12)–10 days later IgM 11 U/ml (r < 15), IgG 17 (r < 12)–10 days later IgM 11 U/ml (r < 15), IgG 22 (r < 12) | IgM 5.63 (r < 0.9), IgG 1.63 (r < 0.9)–2 weeks later IgM 3.49 (r < 0.9), IgG 2.31 (r < 0.9) | IgM ≥ 1:160 (r < 1:10), IgG ≥ 1:1024 (r < 1:64), IgA ≥ 1:256 (r < 1:16) | Positive IgG and IgA | Positive IgG and IgA, Taq-Man PCR with the pericardial fluid | Cultures and direct immunofluorescence of the pericardial fluid using specific monoclonal amtibodies revealed elementary bodies, IgG 1:64, ΙgM negative |
Treatment | Moxifloxacin and ceftriaxone 5 weeks ago for previous CAP, Methylprednisolone, Colchicine | Ceftriaxone 100 mg/kg once daily for 14 days, Clarithromycin 15 mg/kg was added on the third day of ceftriaxone therapy for 10 days | Azithromycin 10 mg/kg once daily for 7 days | Clarithromycin 500 mg 1 × 2 for 6 weeks, Prednisone 60 mg with careful slow tapering | Azithromycin, Cefuroxime, Ibuprofen | Erythromycin 0.5 g 1 × 4 |
Follow-Up | Discharged after 18 days, follow-up visits every 3–4 weeks, in excellent clinical condition | Discharged after 14 days, follow-up after 2 weeks with new C. pneumoniae IgM and IgG evaluation | Discharged after 9 days (well controlled with anticongestive medication in subsequent visit) | Relapse 4 weeks after stopping treatment; retreated with antibiotic therapy (clarithromycin + metronidazole); now 9 months without symptoms | Discharged after 14 days | Discharged after 14 days; died several months later (first relapse of acute leukemia, intracerebral hemorrhage) |