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Bone and joint infections 

Bone and joint infections
Chapter:
Bone and joint infections
DOI:
10.1093/med/9780198729228.003.0007
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date: 26 June 2019

Myocarditis and pericarditis often occur together and have overlapping microbiological causes. Myocarditis, defined as an inflammatory infiltrate in the cardiac muscle, has many possible viral, as well as bacterial, fungal, and non-infective (toxin, autoimmunity), causes. Presentation may be with pain, arrhythmias, or heart failure. The mainstays of diagnosis are biochemical tests (markers of cardiomyolysis), echocardiography, microbiological tests, including blood polymerase chain reaction testing for a range of viruses, and endomyocardial biopsy for histological and microbiological studies. Treatments include those for arrhythmias and cardiac failure, and, if available, specific antiviral therapies. Routine use of immunosuppression and/or high-dose immunoglobulin is controversial. Pericarditis can be acute or insidious in onset. Constrictive pericarditis may be a sequel to pyogenic or tuberculous infection. Acute pericarditis can present with fever, chest/abdominal pain, tachypnoea, or symptoms of reduced cardiac output. Echocardiography confirms an effusion, and a pericardial tap may be important for improving cardiac output and for obtaining a sample for microbiological diagnosis. Treatment involves appropriate antimicrobial therapy, combined with non-steroidal anti-inflammatory drugs, and therapeutic drainage of fluid, if indicated. Surgery, in the form of creating a pleuro-pericardial window or pericardectomy, is indicated for chronic or recurrent (usually non-infective) pericarditis and constrictive pericarditis.

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