Q: Purulent pericarditis is the severe form of infectious pericarditis?
The objective of the question is to teach the pearl that not necessarily all purulent pericarditis are infectious. The distinction between purulent pericarditis and infectious pericarditis is important. Clinically they require different management. Purulent pericarditis by definition is a localized infection of the pericardial space characterized by gross pus in the pericardium or microscopic purulence with > 20 leukocytes per oil immersion field. It should be noted that not all infections lead to purulent effusions such as Mycoplasma hominis or viral infections. On contrast, many non-infectious inflammatory diseases may create a pericardial exudate with >50,000 white cells/microL.
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2. Pankuweit S, Ristić AD, Seferović PM, Maisch B. Bacterial pericarditis: diagnosis and management. Am J Cardiovasc Drugs. 2005;5(2):103-12. doi: 10.2165/00129784-200505020-00004. PMID: 15725041.