A 23-year-old man comes to the physician with a 1-week history of sharp, substernal chest pain that is worse with inspiration and relieved with leaning forward. He has also had nausea and myalgias. He has end-stage kidney disease related to polycycstic kidney disease and receives intermittent hemodialysis through a tunneled catheter. Temperature is 39 C (102.2 F), blood pressure is 108/64 mm Hg, and pulse is 120/min. The patient is ill-appearing. Cardiac examination shows a high-pitched rubbing sound between S1 and S2 that is best heard at the left sternal border. Echocardiography reveals a moderate-sized pericardial effusion. Pericardiocentesis yields turbid fluid with a large number of neutrophils. Microbiologic analysis of this patient's pericardial fluid is most likely to reveal which of the following pathogens?

Question

A 23-year-old man comes to the physician with a 1-week history of sharp, substernal chest pain that is worse with inspiration and relieved with leaning forward. He has also had nausea and myalgias. He has end-stage kidney disease related to polycycstic kidney disease and receives intermittent hemodialysis through a tunneled catheter.  Temperature is 39 C (102.2 F), blood pressure is 108/64 mm Hg, and pulse is 120/min.  The patient is ill-appearing. Cardiac examination shows a high-pitched rubbing sound between S1 and S2 that is best heard at the left sternal border. Echocardiography reveals a moderate-sized pericardial effusion.  Pericardiocentesis yields turbid fluid with a large number of neutrophils.  Microbiologic analysis of this patient's pericardial fluid is most likely to reveal which of the following pathogens?

Quizplus · Accepted Answer

Eductional Objective: Purulent pericarditis is usually caused by hematogenous dissemination from distant infection or direct extension from an adjacent infection or chest wall trauma.  Although a variety of organisms cause purulent pericarditis, Staphylococcus aureus is the most common pathogen, particularly in the setting of a portal from the skin to the bloodstream (eg, catheter) or pericardium (eg, recent chest surgery, penetrating injury

A 23-Year-Old Man Comes to the Physician with a 1-Week