Purulent pericarditis in children: an analysis of 28 cases.

Weir, E. K., and Joffe, H. S. (1977). Thorax, 32, 438-443. Purulent pericarditis in children: an analysis of 28 cases. Bacterial pericarditis was diagnosed in 28 children under the age of 13 years during a five-year period at one hospital. The diagnosis was established clinically in 26 cases; in two the condition was first recognised at necropsy. Staphylococcus aureus was isolated in 22 patients, including all 12 with associated osteitis. The other principal primary condition was pneumonia. While 11 patients were treated with antibiotics only, 13 required one or more pericardial aspirations. Acute constrictive pericarditis occurred in two children, both of whom survived pericardiectomy. Of the 26 children with a clinical diagnosis of bacterial pericarditis, eight died in hospital (31%). The pericarditis probably caused death in two cases and was contributory in six. Septic pericarditis tends to occur in children who are already ill because of other foci of bacterial infection and may easily be overlooked, especially in infants. The large numbers reported reflect a high incidence of osteitis in this community. Electrocardiographic and radiological changes are almost always demonstrable, but these are not diagnostic. Antibiotic therapy is imperative and drainage of the pericardium is usually indicated. Bacterial pericarditis is associated with a high mortality. However, while early recognition and treatment is important, death is more often due to the gereral septicaemia than to pericardial tamponade. In this respect the pericarditis is one indication of the severity of the systemic illness.