Acute disseminated staphylococcal disease in childhood
J. P. Hieber, A. J. Nelson and G. H. McCracken Jr
From 1964 to 1974 we treated 15 children who had acute disseminated
staphyloccal disease. The majority were previously-well males over 5 years
of age. Thirteen of 15 patients had one or more cutaneous lesions
characteristic of staphyloccal septicemia. Fifty percent of extracutaneous
foci of staphylococcal infection were not detected on hospital admission
and one third of these lesions were noted for the first time at autopsy. An
absolute polymorphonuclear cell count of greater than 10,000/cu mm or an
absolute band-form count of greater than 500/cu mm, or both, correlated
with the presence of one or more inadequately treated sites of infection.
These foci were responsible for bacteremia continuing after the initiation
of antimicrobial therapy and for prolonged fever. The overall mortality was
27%; three of the four deaths occurred in patients with predisposing
medical conditions. In addition to prolonged antimicrobial therapy, all
patients should be evaluated carefully for the presence of occult
metastatic sites of staphyloccal infection.
