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Management of Hemophilus influenza pericarditis
Insights
Pyogenic pericarditis in children, often caused by Hemophilus influenza, requires prompt diagnosis via echocardiogram. Aggressive surgical drainage and antibiotic therapy significantly reduce mortality rates.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Pyogenic pericarditis is a rare but serious condition in children.
- Hemophilus influenza accounts for a small percentage of pediatric pyogenic pericarditis cases.
- Previous literature reports 36 cases since 1942.
Observation:
- Diagnosis is suspected in children with acute febrile illness, enlarged cardiac silhouette on chest x-ray, and often associated pneumonia or meningitis.
- Echocardiography is the preferred diagnostic imaging modality.
- Characteristic finding is thick, fibropurulent pericardial fluid.
Findings:
- Pericardiocentesis and tube pericardiostomy are insufficient for managing thick pericardial fluid.
- Complete anterior pericardiectomy is necessary for adequate drainage.
- Combined treatment with ampicillin and chloramphenicol is recommended.
Implications:
- Aggressive surgical and medical management reduces mortality from 20% to 7.4%.
- Prompt and comprehensive treatment can lead to survival, as demonstrated by the reported cases.
Abstract:
Hemophilus influenza is the causative organism in only 7%-11% of the cases of pyogenic pericarditis in children. A total of 36 cases have been reported in the literature since 1942. This report analyzes those cases, adds four more (ages 8 mo, 4 yr, 5 yr, and 7 yr), and recommends a plan of management. The diagnosis is suspected in a child with an acute febrile illness of less than seven days' duration who has an enlarged heart shadow on chest x-ray. Most patients have major associated conditions such as pneumonia or meningitis. The echocardiogram is the best modality for establishing the diagnosis. The characteristic feature of the disease is the thick fibropurulent pericardial fluid produced. This cannot be adequately managed with pericardiocentesis or tube peridcardiostomy. Complete anterior pericardiectomy is required to achieve adequate drainage. This must be combined with maximal doses of ampicillin and chloramphenicol. The overall mortality has been 20%, however, when aggressive surgical and medical therapy is used, the mortality rate is reduced to 7.4%. All of our patients treated in this manner survived.