We appreciate the thoughtful letters of Drs. Joshi and Spodick. Dr. Joshi is correct in pointing out two additional cases of Nocardia asteroides pericarditis in patients infected with the human immunodeficiency virus (HIV). The addition of these two cases further strengthens our conclusions regarding management of this disease. Neither patient in that series underwent pericardiectomy, and both subsequently died of complications of Nocardia infection (Holtz HA: Personal communication). Of note, the Centers for Disease Control does not routinely code the diagnosis of nocardiosis in patients with HIV infection, and the HIV Division is unaware of any association between HIV infection and nocardiosis (Selik R: Personal communication).
Dr. Spodick appropriately condemns the use of the term “pericardial window” in describing treatment options for purulent pericarditis, and we heartily agree. As we emphasized in our review, only patients who underwent pericardiectomy and received appropriate antibiotics for nocardiosis survived. We hope that our article will serve to encourage physicians to deal aggressively with this otherwise lethal disease.
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© 1990 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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- Nocardia asteroides PericarditisMayo Clinic ProceedingsVol. 65Issue 9
- PreviewIn the June 1990 issue of the Proceedings (pages 819 to 824), Poland and colleagues contributed a valuable article on Nocardia pericarditis, including a critical review of the literature. In a discussion of surgical treatment options for purulent pericarditis, they included “creation of a pericardial window.” Such an approach would be contraindicated, if the correct definition of pericardial “window” is applied. Unfortunately, the authors join a wide company of others who have mistakenly used this label.
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