Treatment of Staphylococcal Septicaem1a in Childhood

The complications of staphylococcal septicaemia are many and varied, according to the age group affected. In the adult, acute bacterial endocarditis, pneumonia (which may be further complicated by acute pyogenic pericarditis), osteomyelitis and focal abscess formation in the liver, spleen, kidney and brain may all occur. In childhood, staphylococcal pneumonia with its attendant danger of pyopneumothorax is the commonest complication in the first i8 months of life. Osteomyelitis may also occur. In infancy, it may occur as a benign condition, or it may be a severe illness endangering life (Thomson and Lewis, I950). Pericarditis and focal abscess formation are much less common complications in childhood. Multiple complications of staphylococcal septicaemia are unusual. Impink et al. (I943) described a case of staphylococcal septicaemia with secondary osteomyelitis, acute purulent pericarditis, pneumonia and pleural effusion in a four-year-old girl. Treatment with sulphadiazine, bacteriophage, blood transfusions and pericardial aspiration resulted in recovery. Rohmer et al. (1946) successfully treated an i8month-old child who had staphylococcal septicaemia, osteomyelitis and pericarditis with large doses of iodine and sulphonamides. The only untoward effects were transient haematuria and occasional vomiting. Zimmerman et al. (1946), Bret et al. (1946) and Coffey (I948) described cases of pericarditis complicating staphylococcal septicaemia in adults in which recovery followed treatment with penicillin. In Coffey's case staphylococcal pneumonia preceded the onset of pericarditis. Terrasse et al. (1945) successfully treated a boy of io years who developed osteomyelitis of the tibia, pneumonia and pericarditis complicating staphylococcal septicaemia. Penicillin and sulphonamides, together with pericardial aspiration, were necessary. Jones-Davies et al. (I950) also described a case of suppurative pericarditis complicating osteomyelitis of the femur on the tenth day. The case, a boy of io years, was successfully treated with streptomycin systemically and intrapericardially. The present case illustrates some of the complications that may occur in a child.