Published time: 3 April 2019
Authors: Poothirikovil Venugopalan, MBBS, MD, FRCPCH; Chief Editor: Stuart Berger, MD
Bacterial, fungal, and viral infections may involve the pericardium (pericarditis), although viral pericarditis is more common than bacterial pericarditis in both children and adults. Awareness of this disease has increased because of the introduction of noninvasive diagnostic techniques, such as echocardiography, computed tomography (CT) scanning, and cardiac magnetic resonance imaging (CMRI). The disease can be severe and even lethal, especially in children with immunosuppression. The infection may also involve the myocardium (myopericarditis).
The infection involves the pericardium and leads to the accumulation of pericardial effusion that, if untreated, can lead rapidly to hemodynamic collapse, tamponade, and death. The fluid is generally purulent but can be serosanguineous; however, the causative agent can usually be identified from the pericardial fluid by culture or more sensitive tests (eg, polymerase chain reaction (PCR) or from samples of pericardial biopsy in cases that require open drainage of the fluid. Workup of the patient with infective pericarditis may include laboratory studies, imaging studies (CT scanning and CMRI), electrocardiography (ECG), pericardioscopy, and pericardial biopsy.
Management of pediatric infective pericarditis is influenced by the cause of the pericarditis and the rapidity of pericardial fluid accumulation. It may involve supportive care, pain control, and antibiotic therapy if necessary, as well as pericardiocentesis (indicated in symptomatic patients or when the etiology is in doubt and essential in suspected tamponade), pericardial drainage, or pericardiectomy as required.
See Infective Endocarditis for more detailed information on this topic.
Pediatric Infective Pericarditis