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.
References:
Dupuis C, Gronnier P, Kachaner J, et al. Bacterial pericarditis in
infancy and childhood. Am J Cardiol. 1994;74:807-809
Friedland IR, du Plessis J, Cilliers AJ. Cardiac complications in
children with Staphylococcus aureus bacteremia. J Pediatr.
1995;127:746-748
Jain A, Daum RS. Staphylococcal infections in children: Part 1.
Pediatr Rev. 1999;20:183-191
Roodpeyma S, Sadeghian N. Acute pericarditis in childhood: a 10-year
experience. Pediatr Cardiol. 2000;21:363-367