Background

Bacterial, fungal, and viral infections may involve the pericardium (pericarditis), although viral pericarditis is more common than bacterial pericarditis in both children and adults.^[1]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).^[2]The disease can be severe and even lethal, especially in children with immunosuppression. The infection may also involve the myocardium (myopericarditis).^{[2, 3, 4]}

The infection involves the pericardium and leads to 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. (See Workup.)

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.

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Media Gallery

Two-dimensional echocardiograph shows a large pericardial effusion.
M-mode echocardiograph shows moderate pericardial effusion.
Plain chest radiograph in a 2-year-old boy with viral pericarditis and massive pericardial effusion.
Left: Chest radiograph in a patient with bacterial pericarditis reveals cardiomegaly and left lower lobe infiltrate with marked increase in pulmonary vascular markings. Right: The same patient after placement of a pigtail pericardial catheter and pulmonary artery catheter.
Apical four-chamber view from a patient with bacterial pericarditis. The large pericardial effusion (EF) appears as an echo clear space in this view surrounding the right atrium (RA) and left ventricle (LV). The RA wall is collapsed, indicating tamponade. The longer the duration of RA inversion into systole correlates with increasing hemodynamic severity.
A 12-lead ECG from a patient with bacterial pericarditis demonstrating marked ST elevation in multiple leads.
This ECG shows markedly decreased QRS voltage and electrical alternans (especially in lead V1)

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Author

Poothirikovil Venugopalan, MBBS, MD, FRCPCH Consultant Pediatrician with Cardiology Expertise, Department of Child Health, Brighton and Sussex University Hospitals, NHS Trust; Honorary Senior Clinical Lecturer, Brighton and Sussex Medical School, UK

Poothirikovil Venugopalan, MBBS, MD, FRCPCH is a member of the following medical societies: British Congenital Cardiac Association, Paediatrician with Cardiology Expertise Special Interest Group, Royal College of Paediatrics and Child Health

Disclosure: Nothing to disclose.

Coauthor(s)

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, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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 Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, Western Society for Pediatric Research, American College of Cardiology, American Heart Association, American Pediatric Society

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD Executive Director of The Heart Center, Interim Division Chief of Pediatric Cardiology, Lurie Childrens Hospital; Professor, Department of Pediatrics, Northwestern University, The Feinberg School of Medicine

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, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

Ira H Gessner, MD Professor Emeritus, Pediatric Cardiology, University of Florida College of Medicine

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, Society for Pediatric Research

Disclosure: Nothing to disclose.

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