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Pericarditis purulenta in children
Insights
Surgical pericardiotomy with antibiotics offers a 100% recovery rate for children with non-tuberculous bacterial pericarditis. This effective treatment prevents long-term complications like pericardial constriction.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Non-tuberculous bacterial pericarditis is a serious condition in children.
- Initial symptoms can mimic pneumonia, angina, or pseudocroup, delaying diagnosis.
- Distinguishing between myocardial disease and pericardial effusion requires careful evaluation.
Purpose of the Study:
- To report on the management and outcomes of pediatric non-tuberculous bacterial pericarditis.
- To highlight the importance of surgical intervention for diagnosis and treatment.
- To emphasize the need to avoid certain anesthetic agents during procedures.
Main Methods:
- Retrospective case series of seven children aged 1.5 to 5.75 years.
- Diagnosis based on clinical presentation, chest X-ray, and non-invasive imaging (scintigraphy, echocardiography).
- Treatment involved surgical pericardiotomy with drainage and antibiotic therapy.
Main Results:
- All seven children achieved 100% recovery with surgical pericardiotomy and antibiotics.
- No cases of constrictive pericarditis were observed during follow-up (1-8 years).
- Diagnostic pericardiocentesis was often insufficient due to thick pus.
Conclusions:
- Surgical pericardiotomy with drainage is the mandatory approach for pediatric bacterial pericarditis.
- Antibiotic therapy is crucial for successful treatment and recovery.
- Early surgical intervention leads to excellent long-term outcomes without constriction.
Abstract:
The case history of seven children aged 1 5/12 to 5 9/12 years with non tuberculous bacterial pericarditis, observed in the last 8 years at the University children's hospitals of Basle, Berne and Zurich is reported. The history showed febrile illness of 3--14 days duration, which led to an admission diagnosis of pneumonia, angina or pseudocroup. From the signs of heart failure and cardiomegaly on chest X-ray the differential diagnosis of myocardial disease or pericardial effusion was made. The ECG-changes were uncharacteristic, and a friction rub and pulsus paradoxus was encountered once only. The effusion diagnosis should preferably be substantiated by a non-invasive method (scintigram, echocardiogram) as diagnostic pericardiocentesis does often not allow to aspirate the thick pus through the needle. Diagnostic and therapeutic surgical pericardiotomy with consecutive drainage is therefore mandatory. Halothane should be avoided as an anesthetic for this procedure of hemodynamic reasons. With surgery and antibiotics the recovery rate in our series was 100%, and no pericardial constriction was observed on follow-up 1 to 8 years later.