Cytokine activation in pericardial fluids in different forms of pericarditis

There are many causes of pericardial effusion and it is useful to classify them etiologically, since this disorder is the most common pathologic proce ss involving the pericardium. This report details our experience with peric ardioscopy and epicardial biopsy in 101 patients with pericardial effusions in whom pericardioscopy was performed. By means of clinical data and polymerase chain reaction we tried to elucida te the etiology of the pericardial effusion which were classified as follow s: we found 41 effusions to be induced by primary malignant tumors or tumor s metastatic to the pericardium. Specific diagnosis of viral and bacterial pericarditis was established in 17 patients by examination of the pericardi al effusion with PCR, where we found 3 patients positive for adenovirus, 5 patients positive for cytomegalovirus, 2 patients positive for enterovirus- RNA and 5 patients positive for borrelia Burgdorferi-DNA. Additionally, idi opathic effusions (lymphocytic and autoreactive) were seen in 35 patients. In summary immunological and molecular biology investigations seem to provi de an additional tool in the diagnostic of pericardial effusion with unknow n etiology. If we focus on the ELISA results, there is some evidence, that the demonstration of activation markers and soluble mediators of inflammati on such as Il-6, Il-8 and IFN-gamma in pericardial effusion and the simulta neously lack of these mediators in sera of the patients first may be helpfu l in the discrimination of autoreactive and lymphocytic effusion. Second, t his cytokine pattern or distribution indicates a possible local inflammator y process, where these cytokines were all released from activated T lymphoc ytes present in lymphocytic effusion. In the future, this may have therapeu tic implications.