Bacterial Pericarditis

Prior to the general advent of vaccination against Haemophilus influenzae type B, purulent bacterial pericarditis in infants and toddlers was a well-described pediatric emergency. Characterized by toxic appearance, fever, muffled heart tones, and signs of hypotension and cardiac tamponade, bacterial pericarditis caused by this organism  required urgent pericardiocentesis, surgical drainage, and vigorous antibiotic treatment. Presumably, involvement of the pericardium is via the hematogenous route, similar to the spread from the blood to  the meninges and cerebrospinal fluid that results in meningitis. Both of these serious complications of H influenzae type B infection have become rare in the postvaccine era.

Staphylococcus aureus now is the most common cause of the rare cases of bacterial pericarditis. Most cases do not occur in previously well children, although this is possible. Children who have indwelling catheters, immune defects, and chronic illnesses that may be associated with sterile but recurrent pericardial effusions appear to be at increased risk. This includes children who have malignancy, renal failure, and serious chronic illness. Tuberculosis and Neisseria meningitidis are other unusual causes of pericarditis.

Coagulase-negative staphylococci represent a far less frequent cause of proven purulent or bacterial pericarditis, even though children who have the serious chronic health conditions noted previously may develop coagulase-negative staphylococcal  bacteremia and, in somecases, coagulase-negative staphylococcal endocarditis.

Streptococcus viridans is a common cause of bacterial endocarditis but not bacterial pericarditis. Group A Streptococcus pyogenes is the cause of acute rheumatic fever.

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