Acute bacterial infection in kwashiorkor and marasmus.

" God cast down on them great tribulation, famine, and pestilence: the people perished." So Hesiod (c. 700 B.c.) described the association between famine and pestilence, and they have been firmly coupled in men's minds at least since that time. McCance (1951) has reviewed the historical association. Children with kwashiorkor or nutritional marasmus often have acute bacterial infections. This has been established mainly by post-mortem surveys. Campbell (1956) found at necropsy microscopical evidence of pyaemic abscesses or bronchopneumonia in the lungs of 31 out of 40 malnourished children in Cape Town, and another six had evidence of renal infection. Renal lesions, many of them infective, were also found in two-thirds of a Jamaican series (Stirling, 1962), and Brown (1965) found a 45% incidence of, bronchopneumonia among malnourished infants in a survey of all paediatric necropsies performed over a 12-year period in Mulago Hqspital, Kampala. In Cape Town two clinical studies with bacteriological support attributed many of the deaths to infection of