Management of Hemophilus influenza pericarditis.

Hemophilus influenza is the causative organism in only 7%-11% of the cases of pyogenic pericarditis in children. A total of 36 cases have been reported in the literature since 1942. This report analyzes those cases, adds four more (ages 8 mo, 4 yr, 5 yr, and 7 yr), and recommends a plan of management. The diagnosis is suspected in a child with an acute febrile illness of less than seven days' duration who has an enlarged heart shadow on chest x-ray. Most patients have major associated conditions such as pneumonia or meningitis. The echocardiogram is the best modality for establishing the diagnosis. The characteristic feature of the disease is the thick fibropurulent pericardial fluid produced. This cannot be adequately managed with pericardiocentesis or tube peridcardiostomy. Complete anterior pericardiectomy is required to achieve adequate drainage. This must be combined with maximal doses of ampicillin and chloramphenicol. The overall mortality has been 20%, however, when aggressive surgical and medical therapy is used, the mortality rate is reduced to 7.4%. All of our patients treated in this manner survived.