Severe Staphylococcal Infections in Children

Abstract

<P>More than 30 years ago, Shulman and Ayoub described a group of children with severe life-threatening infections caused by methicillin-susceptible <i>Staphylococcus aureus</i> (MSSA) in the absence of predisposing factors. Multifocal osteomyelitis and septic pulmonary emboli were among the predominant features of this sepsis syndrome. A paucity of similar cases was reported until 1999 when four healthy children died of sepsis caused by methicillin-resistant <i>S. aureus</i> associated with the community (CA-MRSA). Since the establishment of MRSA in the community, severe infections similar to those described by Shulman and Ayoub, as well as other newer presentations of severe <i>S. aureus</i> infections such as necrotizing fasciitis, necrotizing pneumonia, and purpura fulminans, have been seen with increasing frequency in offices and emergency departments around the country.</P> <H4>ABOUT THE AUTHORS</H4> <P>Blanca E. Gonzalez, MD, is Pediatric Infectious Diseases Staff Clinician, Department of Pediatrics, The Children’s Hospital of SW Florida, Lee Memorial Health System. Sheldon L. Kaplan, MD, is Professor and Vice-Chairman for Clinical Affairs, and Head, Section of Pediatric Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, and Chief, Infectious Disease Service, Texas Children’s Hospital.</P> <P>Blanca E. Gonzalez, 9981 S. HealthPark Drive, Suite 279, Fort Myers, FL 33908; e-mail <a href="mailto:blanca.gonzalez@leememorial.org">blanca.gonzalez@leememorial.org</a>; fax: 239-343-9715.</P> <P>Dr. Gonzalez and Dr. Kaplan have disclosed no relevant financial relationships.</P> <H4>EDUCATIONAL OBJECTIVES</H4> <OL> <LI>Recognize the epidemiology and clinical manifestations of the staphylococcal severe sepsis syndrome.</LI> <LI>Review the role of virulence factors in the pathogenesis of <i>Staphyloccocus aureus</i> infections.</LI> <LI>Describe the different therapeutic alternatives for the severe staphylococcal sepsis syndrome.</LI> </OL>