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Table 1 Characteristics of patients with amebic pericarditis

From: Use of PCR in the diagnosis of pericardial amebiasis: a case report and systematic review of the literature

No. Case reference Age Sex Year Country Chief complaint Underlying diseases Travel history Liver abscess Diagnosis Biopsy findings Surgical intervention Antimicrobial used Outcome Follow up
1 Laha [6] 17 F 1946 India Fever for 2 days N/A N/A Yes, R The response to treatment N/A Pericardiocentesis Emetine 3 g Cure N/A
2 Berberian [7] 59 M 1949 The United States Malaise, weakness, diarrhea N/A N/A No Biopsy of the wall of the umbilical sinus was positive for E. hystolytica N/A N/A Aureomycin Died N/A
3 Beemer [8] 27 M 1956 Canada Left sided chest pain N/A N/A Yes, L Autopsy N/A N/A Streptomycin, isoniazid Died N/A
4 Downie [9] 2 M 1960 Nigeria Cough, discharging ears, vomiting and diarrhea None None Yes, L Amoeba was seen in the connective tissue outside the pericardium. The pericardial surface of the heart was covered by thick fibrin N/A N/A Died N/A
5 Paulley [5] 51 M 1965 United Kingdom Burning precordial pain Ischemic infarction Residence in India 20 years before admission Yes, L The response to treatment N/A None Penicillin, chloramphenicol, chloroquine, emetine Cure N/A
6 Mullan [10] 73 M 1965 United Kingdom Upper abdominal pain, anorexia, hemoptysis over 1 month N/A Residence in Mesopotamia 50 years before admission Yes, R The presence of confirmed amebic liver abscess and the response to treatment None (Liver: Actively motile amoebae,containing red cells, were present) Pericardiocentesis Emetine Died None
7 Gelfand [11] 12 M 1966 Zimbabwe Right chest pain for 3 weeks, shortness of breath, weight loss, and fever None None Yes, Bloodstained fluid, and the response to treatment Dense fibrous tissue with a sparse chronic inflammatory cellular infiltrate and with a small part of its surface covered by a narrow zone of granulation tissue Pericardiocentesis Emetine Cure N/A
8 Kulpati [12] 23 M 1966 India Prexia, upper abdominal pain, constipation N/A N/A Yes Liver aspiration contained trophozoites of E. histolytica N/A N/A Yes, but not mentioned in detail Cure No recurrence 4 month after discharge
9 D’cruz [13] 21 M 1967 India Severe retrosternal pain, vomited and fainted N/A N/A Yes Pericardial fluid contained trophozoites of E. histolytica N/A None No Died N/A
10 Rab [14] 49 M 1967 Pakistan Retrosternal pain, dyspnea N/A N/A Yes, L Anchovy sauce pus and the response to treatment Fibrinous deposit Pericardiocentesis N/A Died None
11 Cook [15] 25 M 1970 Malaysia Fever, cough, bloody sputum None N/A Yes, R The response toemetine and a strongly positive amebic fluorescent antibody test None Pericardiocentesis, laparotomy of left subphrenic abscess Emetine and chloroquine Cure N/A
12 Ganeshananthan [16] 36 M 1971 Sri Lanka Dry cough and chest pain for 3 weeks N/A N/A N/A Thick brown pus, having the consistency of typical amoebic liver abscess pus N/A Pericardiocentesis Emetine, metronidazole, chloroquine Cure No recurrence 3 years after discharge
13 Bansal [17] 19 M 1971 India Fever, dry cough, right shoulder pain for 5 days N/A N/A Yes, R Anchovy sauce pus and the response to treatment None Pericardiocentesis Emetine, chloroquine, di-iodohydroxy quinoline Cure No recurrence 16 months after discharge
14 Kapoor [18] 27 M 1972 India High fever with pain in the left chest and subcostal region Gastro-pericardial fistula N/A Yes, L N/A (Stool: trophozoites of E. histolytica) N/A Pericardiocentesis Intramuscular emetine Cure NA
15 Kapoor [18] 30 M 1972 India General weakness, pain in the abdomen and swelling in the epigastrium for 3 weeks N/A N/A Yes, L N/A (Stool: trophozoites of E. histolytica) N/A Pericardiocentesis Emetine, chloroquine Cure N/A
16 Kapoor [18] 34 M 1972 India Pain in the epigastrium and right lumber region for 2 months N/A N/A Yes Anchovy sauce pus from the front of pericardial cavity N/A Pericardiocentesis, thoracotomy Emetine Cured N/A
17 Kapoor [18] 35 M 1972 India Sudden onset of severe generalized chest pain and dyspnea for 12 h N/A N/A Yes, L N/A (Liver: trophozoites of E. hystolytica) Yes Pericardiocentesis N/A Died N/A
18 Kapoor [18] 25 M 1972 India Pyrexia for 5 days N/A N/A N/A N/A N/A Pericardiocentesis Dehydroemetine, chloroquine Cured No recurrence 3 weeks after discharge
19 Kapoor [18] 50 M 1972 India Fever for 2 months and pain in the right hypochonrium N/A N/A Yes, L Anchovy sauce pus from the pericardial cavity N/A Pericardiocentesis Emetine, chloroquine Cured No recurrence two years after discharge
20 Spiegel [19] 48 M 1972 The United States Abdominal pain of right upper quadrant N/A N/A Yes, R Pericardial fluid contained trophozoites of E. histolytica N/A N/A Metronidazole and chloroquine Cure N/A
21 Heller [20] 42 F 1972 United States Dyspnea, weight loss, left upper abdominal pain for 8 days N/A Move from Mississippi to Chicago when she was 3 years old Yes, L Anchovy sauce pus, the response to treatment, and indirect hemagglutination test (1:2560) Fibrinous pericarditis Pericardiocentesis followed by pericardiectomy Metronidazole 750 mg thrice daily for 3 weeks Cure N/A
22 Heller [20] 47 M 1972 United States Retrosternal pain, sweating, dyspnea for 1 day N/A Move from Mexico to Chicago 5 months previously Yes, L Anchovy sauce pus, the response to treatment, and indirect hemagglutination test (1:5128) Fibrinous pericarditis Pericardiectomy Emetine (next day changed to dehydroemetine), chloroquine Died None
23 Anderson [21] N/A M 1972 United States Left pleuritic chest pain, jaundice for 10 days None N/A Yes, L Anchovy sauce pus and the response to treatment None Pericardiocentesis followed by pericardiectomy N/A Cure N/A
24 Suryanarayan [22] 40 M 1973 India Pain in the epigasric region and hypochondrium for one mouth, and dysponea for 1 week N/A N/A Yes, L N/A N/A Pericardiocentesis Dehydroemetine, tetracyclines, chloroquine and didoquin Cure N/A
25 Suryanarayan [22] 45 M 1973 India Fever for 3 months and dyspnea for 2 days N/A N/A Yes, L Pericardial fluid contained trophozoites of E. histolytica N/A None N/A Died N/A
26 Lewis [23] 35 M 1973 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
27 Ganeshananthan [16] 33 M 1974 Sri Lanka Left-sided chest pain and shortness of breath for 2 weeks N/A N/A N/A The fluorescent antibody test was positive N/A Pericardiocentesis Emetine, metronidazole Cure No recurrence 6 months after discharge
28 Ganeshananthan [16] 43 M 1974 Sri Lanka Shortness of breath and pain in the chest and abdomen for 18 days N/A N/A Yes Typical amoebic pus was drawn out from needling of the pericardium N/A Pericardiocentesis Emetine, tetracycline, metronidazole Cure N/A
29 Ganeshananthan [16] 32  N/A 1974 Sri Lanka Pain in the left upper abdomen for 2 months N/A N/A N/A The fluorescent antibody test was positive N/A Pericardiocentesis Emetine and chloroquine followed by metronidazole Cure N/A
30 Guimaraes [24] 33 M 1974 Brazil Fever, chills, dry cough, retrosternal pain, weight loss, dyspnea, diarrhea N/A N/A Yes, L Anchovy sauce pus and the response to treatment N/A Pericardiocentesis Chloroquine 2 g daily for 7 days, followed by 500 mg daily for 23 days, metronidazole 2 g daily for 30 days, emetine hydroxychloroquine 60 mg daily for 10 days plus the injection of 75% hypaque into the pericardial cavity Cure N/A
31 Faerber [25] 35 M 1974 South Africa Pleuritic chest pain, productive cough, hemoptysis for 2 months N/A N/A Yes, R and L N/A N/A N/A N/A Cure N/A
32 Haranath [26] 55 M 1974 India Exertional dyspnea, distention of the abdomen and edema of the left upper limb for 10 days Rheumatic fever N/A N/A Anchovy sauce pus from the cardiac cavity N/A Pericardiocentesis Dehydroemetine, metronidazole Cure NA
33 Ganesan [3] 40 M 1975 India Progressive general weakness, chest pain, dyspnea for 20 days N/A N/A Yes, L Anchovy sauce pus and the response to treatment None Pericardiocentesis Dehydromethine 30 mg daily for 10 days, chloroquine 250 mg thrice daily for 10 days, and metronidazole 1200 mg daily for ten days Cure N/A
34 Agrawal [1] 40 M 1975 India Fever, cough, pain in right hypochondrium, fatigue for 2 months None N/A Yes, L Aspiration of anchovy source pus from the cardiac cavity The nonspecific chronic inflammatory reaction of the pericardium Pericardiocentesis Metronidazole 400 mg thrice daily Died None
35 Agrawal [1] 25  N/A 1975 India Pain in the upper abdomen and dry cough for 2 weeks None N/A Yes, L Aspiration of anchovy source pus from the cardiac cavity An actively inflamed fibrosing pyopericardium of nonspecific nature Pericardiocentesis Metronidazole 400 mg thrice daily Cure No recurrence 6 months after discharge
36 Kulpati [27] 34 M 1976 India Moderately high intermittent fever and dull aching pain in right hypochondrium for 1 month History of amoebic dysentery about 8 months back N/A Yes, L The pericardial fluid was chocolate colored. The direct smear and culture of pericardial fluid demonstrated E. hystolytica N/A Pericardiocentesis Metronidazole and emetine Died N/A
37–63 Adams EB1-27 [28] N/A N/A 1977 South Africa N/A N/A N/A 8 patients (mostly L) N/A N/A N/A N/A Cure (n = 19) Died (n = 8) N/A
64 Muralidar [29] 19 F 1977 India Pyrexia and pain in the right upper abodomen for 2 weeks and breathlessness for 4 days None N/A N/A Anchovy sauce pus from the cardiac cavity N/A Pericardiocentesis Emetine, metronidazole, and tetracycline Died N/A
65 Muralidar [29] 52 M 1977 India Chest pain and breathlessness since 3 days History of amoebic dysentery N/A N/A Anchovy sauce pus from the cardiac cavity, serum indirect hemagglutination N/A Pericardiocentesis Emetine and metronidazole Cure No recurrence 6 weeks after discharge
66 Kundu [30] 25 F 1978 India Pain in right hypochondrium associated with moderately high intermittent fever for 15 days and difficulty in breathing for 1 week None N/A Yes, L Serum gel diffusion test, chocolate pus N/A Pericardiocentesis Metronidazole followed by chloroquine Cure No recurrence 4.5 months after discharge
67 Bellosillo [31] 37 M 1978 Philippine Shortness of breath N/A N/A Yes Pericardial fluid contained trophozoites of E. histolytica N/A Pericardiocentesis Tinidazole Cure No recurrence 3 months after discharge
68–72 Verghese 1-5 [32] N/A N/A 1979 India N/A N/A N/A N/A N/A N/A Pericardiocentesis (n = 1), pericardiotomy (n = 3) N/A Cure (n = 3) Died (n = 2) N/A
73 Almeida [33] 35 M 1979 India Epigastric pain for 1 month and swelling in upper abdomen for 15 days None N/A Yes, L Anchovy sauce pus and the response to treatment N/A Pericardiocentesis Emetine and chloroquine Cure No recurrence 9 months after discharge
74 Almeida [33] 20 M 1979 India Shortness of breath and left chest pain for 3 days None N/A Yes, L Anchovy sauce pus from the cardiac cavity Pericardium was thickened Pericardiocentesis Emetine, and oxytetracycline Died N/A
75 Almeida [33] 25 M 1979 India Left chest pain, cough, and fever for 1 month None N/A Yes, L Anchovy sauce pus from the cardiac cavity N/A Pericardiocentesis N/A Died N/A
76 Almeida [33] 40 M 1979 India Anorexia, fever, and right chest pain for 15 days None N/A Yes, L N/A Autopsy revealed liver abscess with pericarditis and cardiac tamponade None N/A Died N/A
77 Almeida [33] 50 F 1979 India Jaundice and fever for 1 month None N/A Yes, L Bloodstained fluid N/A Pericardiotomy Emetine and metronidazole Died N/A
78–89 Tyagi 1–12 [34] 4–55 M:9 F:3 1980 India Fever (n = 10), dyspnea (n = 5), cough (n = 4), diarrhea (n = 3  N/A N/A Yes, L: 5, R: 4 Anchovy sauce pus from the cardiac cavity (n = 2), pericardial fluid contained trophozoites of E. histolytica (n = 2) N/A Pericardiocentesis N/A Cure (n = 4) Died (n = 8) N/A
90 Gupta [35] 43 M 1980 India Dyspnea, chest pain N/A N/A No Pericardial fluid contained trophozoites of E. histolyticaAutopsy N/A Pericardiocentesis N/A Cure N/A
91 Kala [36] 35 M 1980 India Dyspnea, diarrhea N/A N/A Yes Pericardial fluid contained trophozoites of E. histolyticaAutopsy N/A Pericardiocentesis followed by pericardiectomy Emetine, Streptomycin, isoniazid Cure N/A
92–101 Ibarra-Perez 1–10 [37] N/A N/A 1981 Mexico N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
102 Adeyemo [38] N/A N/A 1984 Nigeria N/A N/A N/A Yes, L N/A N/A Pericardiocentesis N/A Died N/A
103 Adeyemo [38] N/A N/A 1984 Nigeria N/A N/A N/A Yes, L N/A N/A Pericardiocentesis N/A Died N/A
104 Farer [39] 23 M 1984 Vietnam Dyspnea, chest pain N/A Indonesia N/A Microscopic finding of amebic trophozoites, anchovy sauce pus, and the response to treatment None Pericardiocentesis Specific chemotherapy for amebiasis Cure N/A
105 Shanker [40] 30 M 1985 India Irregular fever and dull aching oain in right hypochondrium for 1 month History of amoebic dysentery about 6 months back N/A N/A Pericardial fluid contained trophozoites of E. histolyticaAutopsy N/A Pericardiocentesis Metronidazole, ampicillin, emetine hydrochloride Cure N/A
106 Pirie [41] N/A N/A 1986 South Africa N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
107 Baid [42] 48 M 1987 India Dyspnea, left chest pain, fever, edema of the feet, weakness for 1 month N/A N/A Yes, R Anchovy sauce pus and the response to treatment Subepicardial fat-containing proliferating fibroblasts and lymphocytic infiltrate Pericardiocentesis followed by pericardiectomy Metronidazole Cure None
108 Strang [43] N/A N/A 1987 South Africa N/A N/A N/A Yes N/A N/A N/A N/A N/A N/A
109 Blackett [44] 50 M 1988 Cameroon Left-sided chest pain, dyspnea, abdominal distension, edema for several days N/A N/A None The positive serological tests (1/1024) for amoebiasis, the appearance of the fluid obtained on tapping the pericardium, and the response to treatment None None Metronidazole and chloroquine Died None
110 Vanachayangkul [45] 51 M 1989 Thailand Epigastric oppression and fever for 1 week beginning with severe pain, occasionally colicky in nature without nausea or vomiting N/A N/A Yes Aspiration of pericardial effusion yielded 350 mL of brownish grey pus with numerous trophozoites of active motile E. hystolytica N/A Pericardiocentesis followed by pericardiotomy Metronidazole and cefotiam and amikacin Cure N/A
111 Lami [46] 26 F 1989 Italy Fever, headache, left chest pain None Tunisia for 2 months None Indirect hemagglutination test N/A N/A Metronidazole 2 g daily for 10 days Cure N/A
112 Supe [47] 40 M 1991 India N/A N/A N/A Yes Elisa test for E. histolytica antibody was positive N/A Pericardiocentesis Emetine, metronidazole and amikacin Cure N/A
113 Gomersall [48] 28 M 1994 United Kingdom Fever, night sweats, pyrexia, and right-sided pleuritic chest pain for 6 weeks None Stationed in Kenya Yes, L A fluorescent antibody test for E. hystolytica was positive (titer 1/320) and amoebic enzyme immunoassay was positive at 120 % None Pericardiocentesis Metronidazole for 10 days and diloxanide for 10 days Cure No recurrence 6 months after discharge
114 Perna [49] 37 M 1994 Italy Fever, malaise, weight loss Drug addiction N/A Yes, L A bacteriological specimen from the pericardial fluid yielded E. hystolytica, anchovy sauce pus, and the response to treatment N/A Pericardiectomy Chloroquine N/A N/A
115 Shandera [50] 64 M 1998 India Epigastric pain and pleuritic pain for 6 weeks N/A N/A Yes, L Positive serological tests for amoebiasis None Pericardiocentesis Metronidazole and diiodoquinolol Cure N/A
116 Chao [4] 44 M 1998 Taiwan Dyspnea for the previous 2 days, mucoid diarrhea for 3 days Chronic schizophrenia N/A Yes, L Amebic antibodies by hemagglutination test (1:16,384) Fibrinous exudate with polymorphic neutrophilic cell infiltration Pericardiectomy Metronidazole 500 mg 4 times daily for 2 weeks Cure No recurrence 1-year after discharge
117 Wiwanitkit [51] N/A N/A 2008 Thailand Chest pain, discomfort, and arrhythmia N/A N/A Yes N/A N/A N/A N/A Cure (n = 2) Died (n = 1) N/A
118 Murali [52] 38 M 2011 India Fever and right hypochondrial pain for 10 days N/A N/A Yes, R Positive linked immunosorbent assay for E. hystolytica (both IgM and IgG) None Pericardiocentesis Meropenem, metronidazole Cure N/A
119 Amine [53] 38 M 2015 Morocco Fever, shortness of breath, and leg swelling for 2 months Recurrent diarrhea N/A None Trophozoites of E. hystolytica (pleural effusion) None Pericardiectomy Metronidazole 500 mg trice daily N/A N/A
120 Agarwal [54] 25 M 2019 India Abdominal pain and fever for 1 month None N/A Yes, L Anchovy sauce pus, PCR for E. hystolytica from the pericardial cavity N/A Pericardiocentesis, pleural pericardial window Metronidazole Cure No recurrence at 1 year after discharge
121 Keleş [55] 25 M 2020 India Fever, chills, and pain in the upper abdomen for 1 month N/A N/A Yes, L Reddish-brown pus from the cardiac cavity, positive serological test for amebiasis, and PCR for E. hystolytica N/A Pericardiocentesis Metronidazole followed by oral luminal amebicide diloxanide Cure No recurrence 1-year after discharge
122 Francis [56] 15 M 2020 Turkey Diarrhea and abdominal pain for 2 days None N/A None E. hystolytica trophozoites and cysts in fresh stool, and the response to treatment None None Metronidazole (30 mg/kg/day) Cure No recurrence 6-month after discharge
123 Raza [57] 7 M 2020 Pakistan Fever and abdominal pain for 15 days and diarrhea for 3 days Acute gastroenteritis N/A Yes, L Cysts of E. histolytica and positive enzyme-linked immunosorbent assay in stool None None Metronidazole for 14 days, followed by diloxanide furoate for the next 7 days Cure No recurrence 2-week after discharge
Current case Matsuoa 71 M 2019 Japan Epigastric pain, fatigue for 2 months Essential thrombocytosis treated with anagrelide Asia None Positive serological test for amebiasis, PCR for E. hystolytica from the pericardial cavity N/A Pericardiocentesis Metronidazole 750 mg trice daily for 2 weeks, followed by paromomycin 500 mg trice daily for 10 days Cure No recurrence at 1 year after discharge
  1. F, female; M, male; R, right; L, left; E. hystolytica, Entamoeba histolytica PCR, polymerase chain reaction; N/A, not available
  2. aAuthors of current case