Infections in children with severe protein-energy malnutrition.

The infections occurring in 68 black children admitted to hospital with kwashiorkor, marasmus or marasmic-kwashiorkor were studied prospectively. Fifteen episodes of bacteraemia, most commonly due to Gram-negative enteric bacilli, occurred in 13 children (19%), six of these episodes being nosocomial. Urinary tract infection, diagnosed on suprapubic urine specimens and all due to Escherichia coli, occurred in five out of 16 cases (31%). In the 48 cases admitted with gastro-enteritis and 18 with pneumonia, a causative organism was found in the minority. Fifteen episodes of nosocomial infection occurred in 14 children (20.6%), of whom four died. Of the 14 deaths, eight were associated with bacteraemia. Skin infections were due mainly to staphylococci and streptococci. Infections in severely malnourished children appear to be due largely to the same microorganisms as cause infection in well-nourished children of the same community. Nosocomial infections pose a major threat to these children.