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Purulent meningococcal pericarditis: chronic percutaneous drainage with a modified catheter aided by echocardiography
Abstract:
A 7-month-old infant presented with suspected sepsis. On the third day of illness signs of cardiac tamponade developed. Tamponade was relieved by pericardiocentesis, and countercurrent immunoelectrophoresis (CIE) analysis of the fluid was positive for meningococcus group B. Antibiotic treatment was changed to penicillin G. After echocardiography demonstrated reaccumulation of fluid, a modified #16 gauge angiocatheter was placed percutaneously in the pericardial space. When drainage slowed it was repositioned using two-dimensional echocardiography. After 24 h the catheter was removed and no further accumulation occurred. The antibiotics were continued an additional 10 days and the infant recovered uneventfully. Modification of the catheter and echographic repositioning may decrease the need for surgical drainage in such patients.
Insights
A 7-month-old infant with meningococcus B sepsis developed cardiac tamponade. A modified angiocatheter and echocardiography successfully drained the pericardial fluid, avoiding surgery.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Sepsis in infants can lead to serious complications, including cardiac tamponade.
- Meningococcus group B is a significant pathogen causing severe infections in children.
- Cardiac tamponade, a life-threatening condition, requires prompt diagnosis and management.
Observation:
- A 7-month-old infant with suspected sepsis presented with signs of cardiac tamponade.
- Pericardiocentesis provided temporary relief, and analysis revealed meningococcus group B.
- Echocardiography guided the placement and repositioning of a modified angiocatheter for continuous pericardial drainage.
Findings:
- Pericardial fluid analysis confirmed meningococcus group B infection.
- Percutaneous drainage using a modified angiocatheter, guided by echocardiography, effectively managed the recurrent fluid accumulation.
- The infant recovered uneventfully after 10 days of penicillin G treatment.
Implications:
- Modified angiocatheter drainage with echocardiographic guidance offers a minimally invasive alternative to surgical intervention for pediatric cardiac tamponade.
- This approach may reduce the need for surgical drainage in complex pediatric cases.
- Early recognition and management of sepsis-related cardiac complications are crucial for favorable outcomes.