Clinical Studies on Pediatric Staphylococcal Infections

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  • KUBO Masakatsu
    Department of Pediatrics, Tokyo Jikei University School of Medicine
  • SEGAWA Takaaki
    Department of Pediatrics, Tokyo Jikei University School of Medicine
  • KANDACHI Susumu
    Department of Pediatrics, Tokyo Jikei University School of Medicine
  • 玉置 尚司
    東京慈恵会医科大学小児科
  • OKAZAKI Minoru
    Department of Pediatrics, Tokyo Jikei University School of Medicine
  • WAKASUGI Hiroaki
    Department of Pediatrics, Tokyo Jikei University School of Medicine
  • WADA Noriyuki
    Department of Pediatrics, Tokyo Jikei University School of Medicine
  • ITO Fumiyuki
    Department of Pediatrics, Tokyo Jikei University School of Medicine
  • MAEKAWA Kihei
    Department of Pediatrics, Tokyo Jikei University School of Medicine

Bibliographic Information

Other Title
  • 小児ブドウ球菌感染症の臨床的研究
  • 小児ブドウ球菌感染症の臨床的研究-2-最近5年間に経験したブドウ球菌感染症の5剖検例
  • ショウニ ブドウキュウキン カンセンショウ ノ リンショウテキ ケンキュウ 2
  • Clinical Experience with Five Autopsied Cases of Staphylococcal Infection Over the Last Five Years Report 2
  • 第2報最近5年間に経験したブドウ球菌感染症の5剖検例

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Abstract

To investigate the contributing factors for increasing severity of staphylococcal infections, clinicopathological studies were performed in five cases autopsied during the last five years. Autopsies revealed that three patients had been compromized with transient hypogammaglobulinemia of infancy insulin-dependent diabetes mellitus, and congenital heart disease. Their clinical courses were precipitous, and thrombocytopenia and hypoproteinemia were noted in all cases. We therefore studied serum total protein concentrations in 56 cases of severe staphylococcal infection treated in our department during the past 15 years.<BR>Hypoproteinemia was present in 30 of these 56 cases. With respect to the prognosis and clinicalfeatures in 14 cases of marked hypoproteinemia where protein concentrations were 5 g/dl or less, five patients died, four patients had phlegmon, and, in eight patients who had marked abdominal distention, symptoms were particularly of a severe degree. Meanwhile, total protein levels were normal in the remaining 26 cases, and there was no death case in the latter group. Sepsis, pneumonia, empyema, and meningitis are some examples of severe staphylococcal infections. If marked hypoproteinemia is superimposed on these cases, the grave clinical features will result. In these cases, therefore, the institution of prompt and vigorous antibiotic therapy coupled with adjunctive treatment is necessitated.<BR>Emergence of strains which highly develop multiple drug resistance is one of the contributing factors for increasing severity and intractability of staphylococcal infections. In four cases where the antibiotic sensitivity test could be performed, however, staphylococcus aureus were shown to be considerably susceptibel (+++) to cephems and aminoglycosides.<BR>One patient died of multiorgan dysfunction caused by the staphylococcal exotoxin.<BR>Pathological studies on these five autopsied cases revealed features of transtracheal lobular pneumonia in four cases and those of pneumonitis due to sepsis in one case. In all of these five cases, non-suppurative fibrin thrombosis was present in the lung, kidney, or spleen, suggesting that these patients had been complicated by DIC.<BR>In the five autopsied cases in the present study, the exotoxin produced by staphylococcus and the onset of DIC were thought to be the contributing factors for increasing severity of staphylococcal infections. Further exploration of the staphylococcal strains which cause DIC will be necessitated.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 60 (12), 1303-1310, 1986

    The Japanese Association for Infectious Diseases

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