Observations on the epidemiology of pemphigus neonatorum. (Impetigo contagiosa bullosum?)

Abstract

On account of recrudescences of this condition in obstetric wards following long periods of quiescence the presumption obtains that the infection has never been completely eradicated from the institution. In order to verify this conjecture, attention has been concentrated on the sporadic case, especially that one occurring after months of freedom from the disease.

Careful study of such a case reveals the interesting fact that the origin of the disease in the infant was apparently by way of the mother's milk, which was heavily infected with pure hemolytic staphylococcus aureus and albus, the former predominating. The lesion on the infant's skin followed forty-eight hours after a rather generalized rash on the mother. It was of note that aside from this macular type of rash the mother was quite normal. The rash itself resembled that often caused by drugs. Cultures of the cervix blood and stool were negative for the infecting organisms, but the urine contained a few colonies. The first and last portions obtained by completely emptying the breasts with a sterile breast pump contained approximately equal numbers of the organisms, which were quite abundant, although no evidence of mastitis was present, either clinical or from examination of the milk.

Although ingesting large numbers of the organism in the milk, the infant's stools were negative for the specific germ, which ruled out the possibility of the initial thigh lesions being the result of direct contamination from the stool. Many lesions appeared on the baby's face and head about seventy-two hours after those on the thighs. All this evidence points to a mild systemic infection via the upper respiratory or intestinal tracts.

Successful feeding experiments of young guinea pigs rather confirms this idea. A certain per cent. of these animals fed with cultures of the organism in milk developed a pneumonia, the lungs yielding pure cultures of the organisms fed. One of the adult pigs that suckled the young pigs also died of this type of pneunmnia.