The frequency of pericardial effusions in bacterial meningitis.

Because of our experience with four cases of purulent pericarditis complicating bacterial meningitis during a 13-month period, we performed a prospective study to determine the frequency of this complication. Echocardiograms were done on 100 patients with bacterial meningitis. Small or moderate pericardial effusions were detected in 19 patients, but none had symptoms or signs related to the effusion. Pericardiocentesis was done in one infant; all the other effusions resolved spontaneously. Patients with effusion were significantly younger than those without this complication, but no other significant risk factors were identified. A literature survey indicated that symptomatic pericarditis occurs in fewer than 1% of patients with meningitis. Conversely, in series of cases of purulent pericarditis, associated meningitis was reported in 12% of patients. We concluded that pericardial infection is common in patients with meningitis but that it is usually of no clinical significance and resolves with antibiotic therapy.