Nonviral infectious pericarditis.

Infections of the pericardium can occur as incidental findings in patients with systemic disease or dominate the clinical situation, representing a major threat to life. These infections appear to arise from the contiguous spread of infected tissue or from hematogenous dissemination. The clinical manifestations can resemble the "textbook description," but more often are subtle, nonspecific, or altered by the patient's basic disease. The diagnosis should never be discarded because dyspnea or chest pain are not elicited, friction rub and pulsus paradoxus are not detected, and chest x-rays and electrocardiograms are not "confirmatory." It is generally conceded that there has been a recent shift in the etiology of infectious pericarditis. This change has been attributed to the increased average age of hospitalized patients, modern diagnostic and therapeutic advances, and the impact of antibiotics. However, three concepts have stood the test of time: accurate diagnosis is the cornerstone of treatment; the availability of antibiotics must not relegate the role of surgery to a secondary position; and therapy must be directed against the pericarditis and the additional sources of infected tissue.