Extensive Infectious Panel Testing for Acute Pericarditis: A Ghost Hunt?

sequelae include cardiac tamponade, pericardial constriction, and recurrent pericarditis [5, 6] . Therapy is primarily aimed at the relief of chest pain and inflammation. However, such treatment does nothing to prevent the above-mentioned complications [1] . On the above basis, since acute viral/idiopathic pericarditis most often has a brief and benign course with empirical treatment, many experts propose that patients with uncomplicated acute pericarditis could be evaluated and followed up as outpatients [7] . Exceptions include those patients with high-risk characteristics, such as high fever ( 1 38 ° C), subacute onset, traumatic pericarditis, myopericarditis, no response to nonsteroidal anti-inflammatory drugs, large effusions ( 1 2 cm) with or without evidence of tamponade, and those receiving oral anticoagulants [1, 7] . The performance of full diagnostic evaluation in all patients with acute pericarditis is still an open and debated issue. As already mentioned, the majority of unselected cases of pericarditis in immunocompetent patients from developed countries have idiopathic or viral causes. In the latter cases the performance of tests to establish a causal diagnosis seems unnecessary as it does not provide any valuable prognostic information or therapeutic directions. In the guidelines of the European Society of Cardiology for the diagnosis and management of pericardial diseases (notably the American Acute inflammation of the pericardium, with or without an associated pericardial effusion, is observed in a variety of diseases, mainly infectious and systemic disorders [1] . In the latter cases, as well as in cases of a specific infection, the identification of the underlying pathology is very important since the treatment of the primary condition is expected to resolve pericardial involvement (for example, uremic pericarditis usually resolves with adequate renal dialysis). However, with current diagnostic algorithms, in immunocompetent patients and in developed countries, 80–90% of the cases of acute pericarditis will end up being classified as idiopathic [2] . Indeed, with standard laboratory tests an etiological approach to acute pericarditis is seldom possible, especially if molecular biological techniques are not used [3] . Most probably, in the so-called idiopathic cases the underlying condition is a nonapparent viral infection, so that for practical purposes the terms acute, ‘viral’ and ‘idiopathic’ pericarditis might be considered as representing the same entity [2] . The clinical manifestations of acute viral/idiopathic pericarditis range from asymptomatic subclinical forms to life-threatening cases leading to circulatory shock [1, 4] . Most of the above cases represent a self-limited disease that promptly responds to short course treatment with nonsteroidal anti-inflammatory agents [5] and most patients recover without complications; however, possible Received and accepted: August 8, 2011 Published online: September 21, 2011