Fungal Pericarditis - Symptoms and Treatment

Introduction:

The pericardium is a membranous sac enclosing the heart with the outer fibrous layer, middle parietal, and inner serous membrane. It mechanically protects the heart and blood vessels and provides a lubricant effect between the heart and surrounding structures. The inflammation of this layer surrounding the heart is called pericarditis. It can occur suddenly and can last for several weeks to months.

What Are the Types of Pericarditis?

Various types of pericarditis are classified based on their cause and duration of onset of symptoms.

The common types of pericarditis are:

• Acute Pericarditis: This condition is characterized by inflammation of the pericardium, presenting with sudden onset of symptoms.

• Chronic Pericarditis: If the initial acute attack of pericarditis lasts more than three months, it is called chronic pericarditis.

• Constrictive Pericarditis: Multiple episodes of acute pericarditis tend to stiffen the inflamed pericardium and develop scar tissue. This will eventually result in a defect in the heart’s normal function.

• Infectious Pericarditis: This type of pericarditis may be due to bacterial, viral, fungal, or parasitic infection.

• Idiopathic Pericarditis: There is no known cause.

• Traumatic Pericarditis: The inflammation of the pericardium might be due to trauma to the chest region.

• Uremic Pericarditis: This type of inflammation occurs due to kidney failure.

• Malignant Pericarditis: This type of pericarditis can occur if a malignant lesion grows in the body.

What Is Fungal Pericarditis?

Fungal pericarditis is the type of pericarditis caused due to a fungal infection. This uncommon condition may be caused due to fungal microorganisms such as Histoplasma, Candida, Coccidiodes, and Blastomyces.

Who Is At a Risk of Pericarditis?

Pericarditis most commonly occurs in men between the ages of 16 and 65. And the risk is higher in individuals who underwent a heart attack, open heart surgery, radiation therapy, and cardiac catheterization.

What Are the Symptoms of Pericarditis?

The typical symptom of pericarditis is chest pain. The pain may be sharp that worsens even when the individual coughs or swallows. The individual will feel better while sitting and leaning forward. The individual will feel difficulty breathing until they lean forward. The other symptoms include fever, dry cough, palpitations, swelling of the legs, feet, and ankles, and pain in the back, neck, and left shoulder. Constrictive pericarditis is a severe type where the individual has difficulty breathing every time they exert it.

What Are the Causes of Pericarditis?

In most cases of pericarditis, the cause is unknown. The common reasons are:

• Viral infection.

• Bacterial infection.

• Fungal infection.

• Autoimmune diseases like scleroderma, rheumatoid arthritis, and lupus.

• Trauma to the chest.

• Kidney failure.

• Lymphoma.

• The medication suppresses the immune system.

• Genetic diseases.

How to Diagnose Pericarditis?

Pericarditis is a condition that can be clinically diagnosed by the healthcare professional with the history of onset, duration, and type of pain the individual has experienced. As we know, pericarditis pain may be sharp, with difficulty breathing and feeling better when leaning forward. These clues help the doctors to come up with a provisional diagnosis. The complete history of medical conditions, symptoms, previous surgeries, and medications taken are also assessed for diagnostic purposes. The doctor can also hear the pericardial rub when the patient leans forward. This sound indicates the inflamed lining of the heart, giving a rubbing sound. There are a variety of tests required for diagnosis. They are:

• Chest X-ray: The X-ray reveals if there is any fluid accumulation in the lungs and the size of the heart.

• Electrocardiogram (ECG): This investigation helps in monitoring the heart rhythm. In patients with pericarditis, there are changes noted in the heart rhythm, which may be temporary. However, in some patients, there are no visible changes in the heart rhythm.

• Echocardiogram (Echo): This helps identify the constrictive type of pericarditis, where the pericardial lining becomes stiff and restricts the heart's movement. They are also used to assess the fluid surrounding the heart, called pericardial fluid.

• Cardiac Magnetic Resonance Imaging (MRI): The doctor will provide a contrast agent like gadolinium to the patient to check the status of the pericardial lining and the fluid.

• Computed Tomography (CT) Scan: The CT scan is also good at diagnosing constrictive pericarditis. The doctor uses an iodine dye to look for inflammation and fluid accumulation.

• Cardiac Catheterization: This test is also done to confirm constrictive pericarditis.

• Blood Tests: The blood tests help evaluate the pericardial fluid and inflammation. The elevation of ESR (Erythrocyte Sedimentation Rate) and C-reactive protein levels indicate the presence of infection and inflammation.

• Other tests required for identifying autoimmune diseases can also be carried out.

How to Treat Pericarditis?

The treatment for pericarditis depends on its type and cause of it. A constrictive type indicates surgery, whereas if it is due to infection, medications will help. And drainage of fluid, if it gets, accumulates around the heart.

• Medications: Ibuprofen and Aspirin are commonly prescribed to relieve pain and inflammation. But depending on the cause, antibiotics, and antifungal drugs are prescribed. If symptoms persist for a long time, Colchicine can be administered to control inflammation. Individuals with kidney disease who cannot take Ibuprofen and Colchicine are advised to take Prednisone.

• Pericardiocentesis: This procedure is performed when fluid accumulates and compresses the heart. The doctor uses a catheter to drain the fluid. The needle and catheter are inserted under the guidance of a CT (Computed Tomography) scan or echocardiography.

• Pericardial Window: In this procedure, a chest incision is placed to drain the fluid if the drainage is improper during the pericardiocentesis procedure.

• Pericardiectomy: This surgical procedure of removing the pericardial layer is performed when the inflammation of the pericardium has developed scar tissue, as in the case of constrictive pericarditis.

Conclusion:

Best way to prevent pericarditis according to doctor recommendation are exercise and remain active. However, preventing acute infectious pericarditis is not possible. Getting identified, treated earlier, and reducing the risk is the best approach. Hence, if individual experience any significant symptoms mentioned in the article, report immediately to the physician for further management.