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April 1989

Polymicrobial Bacteremia and Child Abuse

Author Affiliations

Department of Pediatrics St Louis Children's Hospital 400 S Kingshighway Blvd St Louis, MO 63110

Am J Dis Child. 1989;143(4):444. doi:10.1001/archpedi.1989.02150160066011

Sir.—We read with interest Bonadio's recent article1 about polymicrobial bacteremia in children. The author presents an extensive list of underlying conditions associated with this unusual condition. We wish to add child abuse as another important cause of polymicrobial bacteremia.

Adult-induced sepsis in children has been described in several reports2-6 as a manifestation of Munchausen syndrome by proxy. This syndrome described by Meadow2 is a variant of child abuse in which parents, usually mothers, fabricate signs and symptoms of illness in their children. In some cases, fabrication is done by deliberate injection of bacteriologically contaminated material. The special features that should suggest exogenously induced bacteremia are the following: (1) recovery of unusual organisms that are not commonly pathogens, (2) development of frequent skin infections at the site of intravenous infusions, (3) absence of an underlying condition or source of infection that would explain the development of polymicrobial

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