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Successful treatment of acute purulent pericarditis in children was achieved using prompt diagnosis and intervention. An aggressive approach, including subxyphoid drainage, ensured survival without sequelae.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
Background:
- Acute purulent pericarditis is a rare but serious condition in children.
- Early diagnosis and treatment are crucial for favorable outcomes.
Observation:
- Five pediatric cases of acute purulent pericarditis were successfully treated.
- Causative organisms included Hemophilus influenzae type b, Meningococcus, Pneumococcus, and Staphylococcus aureus.
Findings:
- Diagnosis was facilitated by echocardiograms and pericardiocentesis.
- Antibiotic therapy was guided by Gram stain results.
- All patients underwent pericardial window placement, primarily via the subxyphoid approach.
Implications:
- The subxyphoid approach is a safe, effective, and easily performed method for pericardial drainage in children.
- An aggressive diagnostic and therapeutic strategy is recommended for pediatric purulent pericarditis.
Abstract:
Acute purulent pericarditis was treated successfully in five children between the ages of 27 months and 11 1/2 years during the past 5 years. The responsible organism was Hemophilus influenzae, type b, in two cases and Meningococcus, Pneumococcus, and coagulase-positive Staphylococcus aureus in one case each. No primary source of infection could be identified in two patients. A high index of suspicion, combined with immediate echocardiograms and pericardiocentesis, led to the diagnosis. Immediate antibiotic therapy was instituted on the basis of the gram stain of the pericardial fluid. All five patients had a pericardial window established--four through subxyphoid approach and the fifth, because of a left pleural effusion, through a left thoracotomy. When the subxyphoid approach was used, sump drains were left for postoperative suction and irrigation. All five patients survived without sequalae during follow-up periods of from 18 months to 5 years. We advocate an aggressive approach to the diagnosis and treatment of this problem. This report documents the safety, ease, and effectiveness of the subxyphoid approach as a means of drainage.