Chapter 10 - Infections and immunizations

Abstract

This chapter discusses infections and immunizations. Staphylococcus aureus is the most common cause of recurrent boils, folliculitis and impetigo, and cultures from the nose or hairy areas usually confirm the carrier state. Outbreaks of infection are often associated with transient carriage. Recurrent abscesses in children often indicate a defect in neutrophil function much more commonly than in adults. Immunological investigation of superficial staphylococcal infections is generally unrewarding. Pneumococcal infections are common and occur mainly in the respiratory tract, or as meningitis, peritonitis or septicaemia. Noncapsulated Strep, pneumoniae are common in the nasopharynx, occurring in 38% of under 2-year-old and 6% of adults, rising to 19% if children live in the house. Sputum culture underestimates the incidence of pneumococcal pneumonia. In sputum specimens from adult patients with pneumococcal pneumonia, 86% were positive by CIE compared to sputum culture being positive in 60% and blood cultures positive in 26%. Recurrent pneumonia in the same site may have a local cause. Up to 9% of children under 2 years old with a fever >39°C have Strep, pneumonia bacteraemia and 10% of these will have a further septicaemia before the age of 2 years.