BRIEF COMMUNICATION Intracellular Bacteria in the Peripheral Blood

THE PARAMOUNT IMPORTANCE of Staphylococ-cus aureus as a cause of hospital-acquired infections is well recognized. Despite extensive investigation, the pathogenesis and the na tu re a n d importance of host defenses in staphy-lococcal infections have not been clearly de-fined. I n fact there is exper imental evidence that the usually protective mechanism of phagocytosis may actually perpe tua te staphy-lococcal bacteremia (1, 2). Studies of bacteremia in rabbits suggest that a l though pathogenic staphylococci are readily ingested by phagocytic leukocytes, some cont inue to reside undamaged in this intracellular location and are provided a protective envi ronment which hinders their destruction by other host defenses (3). T h i s repor t demonstrates that a similar pat-tern may be observed in humans. T h e extreme degree of bacteremia and the fact that the correct diagnosis was first suggested by the demonstra t ion of phagocytosed bacteria in the per iphera l blood were also unusual. C A S E R E P O R T A 74-year-old male sustained a 40 % burn in-volving the head, face, back, hands, lower legs, and feet on October 19, 1960. He was promptly hos-pitalized, and the burns were debrided, washed with soap and water, and dressed. A tracheostomy was performed because of respiratory distress. Two thousand milliliters of 5 % dextrose in water, 2,000 ml of physiological saline solution, 600 ml of plasma, and 600 ml of 6 % dextran were admin-istered during the first 48 hours of hospitalization. Other therapy consisted of 600,000 units of procaine penicillin and 1 g of streptomycin daily. The patient was transferred to the West Side Veterans Administration Hospital, Chicago, Illinois, on October 22, 1960. At this time his temperature was 102 F, pulse was 116/min, and blood pressure was 120/70 mm Hg. The face was edematous and charred; the tongue, pharynx, and nasal mucosa were hyperemic and edematous. There was purulent drainage from the burns on the extremities and back. The lungs were clear to percussion and aus-cultation. A soft apical systolic murmur was audible, but the remainder of the physical ex-amination was unremarkable. LABORATORY FINDING