1370 - Three of Hearts: A Case Series and Literature Review of Pediatric Purulent Pericarditis

Background: Purulent pericarditis is rare in the pediatric population. Three children with purulent pericarditis complicated by tamponade were seen at a children’s hospital from 2018-2019. A review of the literature was conducted to investigate the clinical significance and features of purulent pericarditis.

Methods: Cases of purulent pericarditis in children (age < 18 years) published in English from 2000 to 2020 were reviewed. Patients were included if there was presence of purulent pericardial fluid or if a bacterial pathogen was isolated from pericardial fluid.

Results: Three children with purulent pericarditis and tamponade with associated pneumonia were cared for at our institution. These infections were caused by methicillin-susceptible Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pyogenes. Review of the literature identified 93 children with purulent pericarditis. The median age of the cohort is 4 years old. In 68.8% of children the etiology was identified from culture of pericardial fluid. The most common organism detected was S. aureus (38.7%) and a concurrent infection was seen in 49.4% -pneumonia (36.5%), osteomyelitis (17.2%), soft tissue (7.5%), and meningitis (2.1%). In North America specifically, methicillin-resistant S. aureus was most common 35% (7/20) and associated infection was seen in 80% (16/20). Clinical course was complicated by pericardial tamponade in 68.5% (37/54) of patients, 48.6% (18/37) of those children with tamponade also had pneumonia. Pericardiocentesis is the most frequent initial intervention, performed in 77.4% of cases. The mortality rate was 4.3%.

Conclusion: In pediatric purulent pericarditis, Gram-positive organisms account for 81.2% of all children with positive pericardial fluid culture, and 75% of infections in North America. A bacterial pathogen can be isolated from the pericardial fluid in a majority of patients with purulent pericarditis. There is a high rate of concurrent infection, most notably pneumonia, and there is a strikingly high percentage of tamponade in those cases.