Acute Disseminated Staphylococcal Disease in Childhood

From 1964 to 1974 we treated 15 children who had acute disseminated staphylococcal disease. The majority were previously-well males over 5 years of age. Thirteen of 15 patients had one or more cutaneous lesions characteristic of staphylococcal 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 staphylococcal infection.