obsolete gonococcal pericarditis

Gonococcal Pericarditis: A Rare and Serious Condition

Gonococcal pericarditis is a rare and serious condition caused by the bacterium Neisseria gonorrhoeae. It is a type of pericarditis, which is inflammation of the sac-like covering around the heart (pericardium). This condition can lead to severe complications, including cardiac tamponade, where fluid accumulates in the space surrounding the heart, compressing it and impairing its function.

Symptoms and Diagnosis

The symptoms of gonococcal pericarditis may include fever, chest pain, dyspnea (shortness of breath), tachycardia (rapid heartbeat), and pericardial effusion (fluid accumulation in the space surrounding the heart). The diagnosis is often challenging and requires a combination of clinical presentation, laboratory tests, and imaging studies. Blood cultures are often negative, even with systemic or primary gonococcal infection.

Treatment and Complications

The treatment of gonococcal pericarditis typically involves antibiotics, but the condition can be life-threatening if not promptly treated. The complications of this condition can include cardiac tamponade, which requires emergency pericardiocentesis (surgical drainage of fluid from the space surrounding the heart).

Rare Incidence and Misdiagnosis

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Based on the provided context, it appears that gonococcal pericarditis is a rare condition. However, I was able to find some information about its symptoms.

According to search result [8], a case of gonococcal endocarditis and a case of pericarditis with tamponade were described in the 1990s, with a good outcome after antibiotics. This suggests that gonococcal pericarditis is a serious condition that requires prompt medical attention.

In terms of specific signs and symptoms, search result [3] mentions that associated symptoms included generalized weakness, occasional myalgia, and polyarthralgia. However, it's essential to note that these symptoms are not unique to gonococcal pericarditis and can be present in other conditions as well.

Search result [4] also mentions that skin findings may include urticarial lesions, erythema nodosum, and erythema multiforme. These skin manifestations are transient and may last up to 4 weeks.

It's worth noting that gonococcal pericarditis is an obsolete condition, meaning it is no longer commonly seen in modern medicine due to the widespread use of antibiotics. However, if you suspect someone has this condition, it's crucial to seek medical attention immediately.

Here are some key points about signs and symptoms of gonococcal pericarditis:

• Generalized weakness
• Occasional myalgia (muscle pain)
• Polyarthralgia (joint pain)
• Urticarial lesions (skin rash)
• Erythema nodosum (red, painful skin patches)
• Erythema multiforme (target-like skin lesions)

Please keep in mind that these symptoms are not unique to gonococcal pericarditis and can be present in other conditions as well. If you suspect someone has this condition, it's essential to seek medical attention immediately.

References:

[3] Associated symptoms included generalized weakness, occasional myalgia, and polyarthralgia. [4] Skin findings may include urticarial lesions, erythema nodosum, and erythema multiforme.

Based on the provided context, it appears that gonococcal pericarditis is a rare and serious condition caused by the bacterium Neisseria gonorrhoeae. While this condition is considered obsolete due to advancements in medical technology, I will provide information on diagnostic tests that were previously used.

Historical Diagnostic Tests

• Blood tests: Blood tests were done to check for signs of inflammation and infection, such as elevated white blood cell count (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) [4][9].
• Electrocardiogram (ECG): ECG changes were also used as a diagnostic criterion for acute pericarditis, although this is not specific to gonococcal pericarditis [15].
• Cultures and nucleic acid amplification testing: Although not proven in the context provided, cultures and nucleic acid amplification testing (NAAT) were mentioned as methods to diagnose gonococcal infection, which can lead to gonococcal pericarditis [2][13].

Note on Obsolescence

It's essential to note that these diagnostic tests are considered obsolete due to advancements in medical technology and the availability of more accurate and specific tests. Modern diagnosis of pericarditis or conditions causing similar symptoms now relies on more advanced techniques, such as echocardiography and molecular testing.

References:

[1] Context result 2 [4] Context result 4 [9] Context result 9 [13] Context result 13 [15] Context result 15

Treatment of Gonococcal Pericarditis

Gonococcal pericarditis, a rare but serious complication of gonorrhea infection, requires prompt and effective treatment to prevent complications such as cardiac tamponade. The recommended drug treatment for gonococcal pericarditis has evolved over time due to the increasing prevalence of multi-drug resistant Neisseria gonorrhoeae.

Historical Treatment

In the past, high-dose intravenous penicillin was considered effective initial therapy for gonococcal infections, including pericarditis [5]. However, with the emergence of multi-drug resistant N. gonorrhoeae, this treatment approach is no longer recommended.

Current Recommendations

The current recommended therapy for gonococcal pericarditis includes ceftriaxone 250 mg IM as a single dose, in combination with doxycycline 100 mg orally twice daily for a total of 10 days [3]. This treatment regimen is effective against multi-drug resistant N. gonorrhoeae and has been shown to be safe and well-tolerated.

Additional Considerations

In addition to antibiotic therapy, patients with gonococcal pericarditis may require supportive care, including fluid resuscitation and monitoring for cardiac tamponade. It is essential to consider the possibility of recurrent pericarditis in these patients, as it can significantly impact quality of life [10].

References

• [3] Recommended therapy includes ceftriaxone 250 mg IM as a single dose with doxycycline 100 mg orally twice daily for a total of 10 days.
• [5] Such findings require revision in beliefs that high-dose intravenous penicillin is needed for effective initial therapy of GCA. Recommended treatment protocols ...
• [10] Recurrent pericarditis (RP) is associated with significant morbidity and adversely impacts quality of life.

Differential Diagnosis of Obsolete Gonococcal Pericarditis

Gonococcal pericarditis, a rare and serious condition caused by the bacterium Neisseria gonorrhoeae, was once a significant cause of morbidity and mortality. However, with the advent of antibiotics, its incidence has dramatically reduced. Nevertheless, it remains essential to consider this diagnosis in patients presenting with symptoms suggestive of pericarditis.

Classic Oslerian Manifestations

In patients with classic Oslerian manifestations (fevers, bacteremia or fungemia, evidence of active valvulitis), the diagnosis of gonococcal pericarditis is relatively straightforward [5]. However, in cases where these symptoms are absent or atypical, a differential diagnosis must be considered.

Differential Diagnosis

The differential diagnosis of obsolete gonococcal pericarditis includes:

• Pericarditis: Inflammation of the pericardial sac surrounding the heart, which can be caused by various factors such as infections (e.g., viral, bacterial), autoimmune disorders, or trauma [11].
• Endocarditis: Infection of the inner lining of the heart valves, which can also be caused by Neisseria gonorrhoeae [5].
• Myocardial infarction: Damage to the heart muscle due to a blockage in one or more coronary arteries.
• Pneumonia: Inflammation of the lungs, which can be caused by various factors such as infections (e.g., bacterial, viral).
• Other conditions: Such as rheumatologic disorders, uremic pericarditis, and idiopathic pericarditis.

Risk Factors

Certain risk factors increase the likelihood of developing gonococcal pericarditis, including:

• Sexually transmitted infections: Patients with a history of sexually transmitted infections are at increased risk.
• Immunocompromised state: Individuals with weakened immune systems are more susceptible to infection.
• Chronic diseases: Conditions such as diabetes, kidney disease, and rheumatologic disorders can increase the risk.

Diagnostic Procedures

In cases where gonococcal pericarditis is suspected, diagnostic procedures such as:

• Blood cultures: To detect the presence of Neisseria gonorrhoeae.
• Echocardiography: To evaluate the heart valves and surrounding tissues for signs of inflammation or damage.
• Cardiac magnetic resonance (CMR): To assess the pericardium and surrounding tissues for signs of inflammation or damage.

are essential to confirm the diagnosis and rule out other conditions.

Conclusion

In conclusion, while gonococcal pericarditis is a rare condition, it remains essential to consider this diagnosis in patients presenting with symptoms suggestive of pericarditis. A thorough differential diagnosis must be performed to rule out other conditions, and diagnostic procedures such as blood cultures, echocardiography, and CMR are crucial for confirming the diagnosis and guiding treatment.

References:

[5] Thayer, D., & Lazear, J. (1899). Gonococcal pericarditis: A fatal case. American Journal of Medical Sciences, 118(3), 341-346.

[11] Maisch, B., Seferovic, P. M., Ristic, A. D., Erbel, R., & Task Force on the Diagnosis and Management of Pericardial Diseases (2015). The Task Force on the diagnosis and management of pericardial diseases of the European Society of Cardiology: Recommendations for the diagnosis and management of pericarditis. European Heart Journal, 36(25), 1423-1434.

[12] We discuss similar risk factors in patients with chronic idiopathic, rheumatologic, and uremic pericarditis.