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Table 1 Characteristics of cases with Chlamydia pneumoniae-associated pericarditis after systematic literature search

From: Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature

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
Neck pain
Intermittent vomiting
Shortness of breath after excessive physical activity
Dry cough
Chest pain
Shortness of breath exacerbated by exertion
Throat pain
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)
  1. ANA antinuclear antibodies, BNP brain natriuretic peptide, bpm beats per minute, CAP community acquired pneumonia, CRP C-reactive protein, CT computed tomography, CTPA computed tomography pulmonary angiography, ECG electrocardiography, ESR erythrocyte sedimentation rate, NR not reported, RF rheumatoid factor, PVCs premature ventricular contractions, r reference, WBC white blood cells