Identifying Pericarditis: Viral vs Bacterial

Pericarditis, an inflammation of the pericardium (the sac surrounding the heart), can be caused by both viral and bacterial infections. Understanding the causes, symptoms, and treatments of these two types can help individuals recognise the signs and seek prompt medical attention.

Viral pericarditis is more common and usually follows a flu-like prodrome. Characterised by sharp chest pain that worsens with deep breathing or coughing, this condition often resolves without specific antiviral treatment. Symptomatic management is the primary approach, using non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. Common viral culprits include Coxsackieviruses A and B, Echovirus, Adenoviruses, Influenza virus, HIV, and Herpes viruses like Epstein-Barr virus and cytomegalovirus.

Bacterial pericarditis, while less common, can be severe and life-threatening. It often occurs through bloodstream infections, direct extension from adjacent infected tissues, or post-surgical complications or trauma. Common bacteria responsible for bacterial pericarditis include Staphylococcus, Streptococcus pneumoniae, and Neisseria meningitidis. Additionally, Gram-negative bacteria like Neisseria meningitidis, anaerobes like Prevotella intermedia, and atypical organisms such as Mycoplasma species have been identified as causative agents.

Symptoms of bacterial pericarditis may include severe chest pain, fever, shortness of breath, and general malaise. Treatment involves immediate initiation of appropriate antibiotics based on culture results or empirical therapy, along with anti-inflammatory medications for symptom management.

Lyme disease, caused by Borrelia burgdorferi, is a notable bacterial cause of pericarditis. Particularly in cases of disseminated Lyme disease, pericarditis can occur. Lyme disease requires targeted antibiotic treatment for effective care.

Diagnostic tests for both viral and bacterial pericarditis include clinical evaluation, laboratory tests, imaging studies, and electrocardiogram (EKG). The importance of prompt medical attention cannot be overstated for suspected Lyme disease or related cardiac issues.

In addition to the usual symptoms such as chest pain, fever, shortness of breath, and general malaise, complications like arrhythmias, palpitations, lightheadedness or dizziness, and even fainting (syncope) may occur due to inflammatory effects on the heart muscle or conduction system.

In conclusion, while viral pericarditis is more common, bacterial pericarditis can be severe and life-threatening. Recognising the symptoms and seeking prompt medical attention is crucial for effective treatment and recovery.

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