eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Pericarditis, Bacterial: Follow-up

Author: John Berger, MD, Associate Professor, Department of Pediatrics, George Washington University School of Medicine, Director, Cardiac Intensive Care and Pulmonary Hypertension Program, Children's National Medical Center
Contributor Information and Disclosures

Updated: Jul 15, 2008

Follow-up

Further Inpatient Care

  • Almost all patients have critical illness and require admission to an ICU.

Further Outpatient Care

  • Once the patient has recovered from the acute infection, follow-up with a cardiologist is recommended to monitor for the development of constrictive pericarditis.

Transfer

  • Critically ill patients with suspected purulent pericarditis require transfer to a tertiary pediatric center with cardiac, cardiac surgical, and critical care medicine expertise. Bacterial pericarditis is a life-threatening disease that requires a full complement of pediatric subspecialty care.
  • Do not delay treatment of a critically ill infant in shock. Every hospital with echocardiographic capability should have someone who can perform an emergency pericardiocentesis.

Deterrence/Prevention

  • Pericarditis is often preceded by other severe bacterial infections such as pneumonia with empyema. Proper treatment of those infections prevents some cases of pericarditis.
  • Immunization against H influenzae has led to dramatic decreases in the incidence of invasive H influenzae disease, including pericarditis.

Complications

  • Acutely, serial ECGs may indicate the presence of occult arrhythmia, suggesting additional myocardial involvement.
  • Most patients recover without significant complications.
  • Constrictive pericarditis is a rare complication. Acute constriction has been reported as early as 8 days but generally develops within weeks of diagnosis.
    • Patient symptoms include increased systemic venous pressure, weight gain, hepatomegaly, dyspnea, and decreased urine output. Presence of continued heart failure without a large cardiac silhouette suggests constriction.
    • After recovery from the acute infection, patients should have follow-up with a cardiologist to monitor for the development of constrictive pericarditis. Once identified, pericardiectomy is indicated.

Prognosis

  • Bacterial pericarditis is a life-threatening infection with a high mortality rate unless timely therapy with antibiotics and pericardial drainage is instituted. Despite optimal therapy, the mortality rate can be as high as 20%.
  • Patients who survive the acute infection generally do well, without long-term sequelae. Patients infrequently develop constrictive pericarditis requiring pericardiectomy.

Patient Education

The following items should be disguised with patients and/or their families:

  • Bacterial pericarditis is a life-threatening disease.
  • Proper treatment includes a prolonged course of antibiotics and drainage of the pericardium.
  • If the patient survives, prognosis is good.
  • If symptoms suggestive of congestive heart failure develop after treatment (eg, dyspnea, fatigue, weight gain), the patient should seek evaluation for possible constrictive pericarditis.

Miscellaneous

Medicolegal Pitfalls

  • Bacterial pericarditis is a life-threatening illness that requires proper antibiotics and adequate pericardial drainage.
  • The signs and symptoms are often nonspecific and subtle; thus, a high index of suspicion is required.
  • Consider the diagnosis in any infant or young child with septic shock and abnormal cardiovascular physical findings.
 


More on Pericarditis, Bacterial

Overview: Pericarditis, Bacterial
Differential Diagnoses & Workup: Pericarditis, Bacterial
Treatment & Medication: Pericarditis, Bacterial
Follow-up: Pericarditis, Bacterial
Multimedia: Pericarditis, Bacterial
References
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References

  1. Dupuis C, Gronnier P, Kachaner J, et al. Bacterial pericarditis in infancy and childhood. Am J Cardiol. Oct 15 1994;74(8):807-9. [Medline].

  2. Feldman WE. Bacterial etiology and mortality of purulent pericarditis in pediatric patients. Review of 162 cases. Am J Dis Child. Jun 1979;133(6):641-4. [Medline].

  3. Jayashree M, Singhi SC, Singh RS, Singh M. Purulent pericarditis: clinical profile and outcome following surgical drainage and intensive care in children in Chandigarh. Ann Trop Paediatr. Dec 1999;19(4):377-81. [Medline].

  4. Kocheril AG, Luttmann C, Sadaniantz A. Pneumococcal pericarditis successfully treated with catheter drainage and intravenous antibiotics. Cathet Cardiovasc Diagn. Dec 1991;24(4):286-7. [Medline].

  5. Morgan RJ, Stephenson LW, Woolf PK, Singh M. Surgical treatment of purulent pericarditis in children. J Thorac Cardiovasc Surg. Apr 1983;85(4):527-31. [Medline].

  6. Sinzobahamvya N, Ikeogu MO. Purulent pericarditis. Arch Dis Child. Jul 1987;62(7):696-9. [Medline].

  7. Strauss AW, Santa-Maria M, Goldring D. Constrictive pericarditis in children. Am J Dis Child. Jul 1975;129(7):822-6. [Medline].

  8. Zahn EM, Houde C, Benson L, Freedom RM. Percutaneous pericardial catheter drainage in childhood. Am J Cardiol. Sep 1 1992;70(6):678-80. [Medline].

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Further Reading

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Keywords

bacterial pericarditis, purulent pericarditis, inflammation of the pericardium, bacterial infection, pericardium, pericardial effusion, pneumonia, empyema, tamponade, constrictive pericarditis, Haemophilus influenzae, malnutrition, Staphylococcus aureus, respiratory distress, meningitis, acute myocarditis, acute osteomyelitis, arthritis, soft tissue infection, hypovolemia, small airway obstruction, epiglottitis, asthma, Neisseria meningitidis, Streptococcus pneumoniae, Pseudomonas aeruginosa, Salmonella species, Francisella tularensis, anaerobic bacteria and fungi, Histoplasma species, coccidioidomycosis, blastomycosis, Aspergillus species, Candida species, Mycoplasma pneumoniae

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Contributor Information and Disclosures

Author

John Berger, MD, Associate Professor, Department of Pediatrics, George Washington University School of Medicine, Director, Cardiac Intensive Care and Pulmonary Hypertension Program, Children's National Medical Center
John Berger, MD is a member of the following medical societies: American Academy of Pediatrics and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Ira H Gessner, MD, Professor Emeritus, Pediatric Cardiology
Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Hugh D Allen, MD, Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine
Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Gilbert Z Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center
Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD, Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin
Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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