Clinical and therapeutic aspects of Haemophilus influenzae pericarditis in pediatric patients.

Two cases of Haemophilus influenzae type B pericarditis are presented which demonstrate the major clinical features and sequelae of this serious illness. These cases are analyzed together with 77 others from the literature to characterize the clinical features, natural history, and optimal therapy. H. influenzae pericarditis is an increasingly frequent disease of young children. A mild prodromal illness is often followed by rapid progression of cardiac compromise until death ensues, unless pericarditis is diagnosed and treated appropriately. The development of cardiomegaly in a febrile patient with a Haemophilus infection is an indication for echocardiography, which is diagnostic of the pericardial effusion. Initial cultures of pericardial aspirates will be positive in 75% of cases even when antibiotic therapy has been initiated. Use of appropriate parenterally administered antibiotics, in combination with early surgical pericardial drainage or partial pericardiectomy, should minimize morbidity and mortality and prevent acute constrictive sequelae.