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Infective pericarditis in Nigerian children
Insights
Infective pericarditis in children is often misdiagnosed, with high mortality. Suspect cardiac failure in children with lung infections to improve diagnosis and treatment outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Infective pericarditis presents diagnostic challenges in pediatric patients.
- Early recognition is crucial due to high mortality rates.
Purpose of the Study:
- To analyze the clinical features, pathogens, and outcomes of infective pericarditis in children.
- To highlight diagnostic difficulties and suggest improved diagnostic approaches.
Main Methods:
- Retrospective review of 53 pediatric cases of infective pericarditis from 1967-1976.
- Analysis of patient demographics, symptoms, identified pathogens, associated infections, and mortality.
Main Results:
- Most cases (53%) occurred in children aged 5 years or younger.
- Common pathogens included Mycobacterium tuberculosis and Staphylococcus aureus.
- Diagnostic errors were frequent (72% missed ante-mortem), and mortality was high (36%).
Conclusions:
- Cardiac decompensation in children with bronchopneumonia, empyema, or lung abscess should prompt suspicion of infective pericarditis.
- Improved diagnostic awareness is critical for reducing mortality in pediatric infective pericarditis.
Abstract:
53 children with infective pericarditis were seen at the University College Hospital, Ibadan, between 1967 and 1976. Their ages ranged from 10 days to 15 years but 53% of them were aged 5 years and below. Cough, fever, and breathlessness were the most common symptoms; cardiac decompensation was evident in over 30% of them, 23% had muffled heart sounds, but a pericardial friction rub was audible in only one. The main pathogens identified were Mycobacterium tuberculosis (11 cases), Staphylococcus aureus (11 cases), Escherichia coli (4 cases), Pneumococcus and Pseudomonas (3 cases each). Most of the patients had some other associated infection--such as, bronchopneumonia (12 cases), empyema thoracis (10 cases), lung abscess (10 cases), septicaemis (6 cases), and osteomyelitis (3 cases). Errors in diagnosis were common, the diagnosis having been missed in 72% of the cases identified at necropsy. Even if the correct diagnosis had been made during life and appropriate treatment given, the mortality rate (36%) was high. It is suggested that the onset of cardiac failure in any child with bronchopneumonia, empyema, or lung abscess should always arouse a suspicion of infective pericarditis.