Emergency centre diagnosis and treatment of purulent pericarditis: A case report from Tanzania

• Type of Material: Article
• Authors: Catherine R. Shari, Muhimbili University of Health and Allied Sciences; Hendry R. Sawe, Muhimbili University of Health and Allied Sciences; Kevin Davey, University of California San Francisco; Brittany Murray, Emory University
• Language: English
• Date: 2018-03-01
• Publisher: Elsevier: Creative Commons Attribution Non-Commercial No-Derivatives License
• Publication Version: Final Published Version
• Copyright Statement: © 2018 African Federation for Emergency Medicine
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.afjem.2017.12.002
• Title of Journal or Parent Work: African Journal of Emergency Medicine
• ISSN: 2211-419X
• Volume: 8
• Issue: 1
• Start Page: 37
• End Page: 39
• Grant/Funding Information: The compilation of this case report used no specific funding.
• Keywords: diagnosis; Tanzania; emergency care; pericarditis; purulent pericarditis
• Research Categories: Health Sciences, Public Health

Abstract

Introduction: Purulent pericarditis poses diagnostic and therapeutic challenges, especially in resource-limited settings due to the unavailability of diagnostic tools, equipment, and expertise. Case report: A three-year-old female presented to the emergency centre at Muhimbili National Hospital in Dar es Salaam, Tanzania with altered mental status, lethargy, intermittent fevers, worsening difficulty in breathing, and progressive lower extremity swelling over two months. The child was in shock upon arrival. Point-of-care ultrasound demonstrated cardiac tamponade secondary to purulent pericarditis. An ultrasound guided pericardiocentesis and lavage was successfully done in the emergency centre and antibiotics were started. Though definitive management (pericardiectomy) was delayed, the child survived to hospital discharge. Conclusion: Pericardiocentesis, pericardial lavage, and the initiation of broad spectrum antibiotics are the mainstay of early treatment of purulent pericarditis. This treatment can be done safely in an emergency centre with little specialised equipment aside from point-of-care ultrasound.