DIPHTHERITIC OR STAPHYLOCOCCIC CROUP AND SIMULTANEOUS PNEUMOCOCCIC PNEUMONIA

It is usually considered desirable to explain associated clinical phenomena as due to a single cause. Consequently when a bacteriologic excitant furnishes a satisfactory explanation for an inflammatory reaction, search for additional bacterial invaders usually ceases. Roentgenographic and physical signs of consolidated lung in the presence of laryngotracheal diphtheria are usually attributed to atelectasis produced by extension of the membrane into terminal bronchioles; further bacteriologic examination is accordingly neglected. The 2 cases reported here exemplify the presence of two separate etiologic agents in a case of infection of the respiratory tract, one causing inflammation of the larynx and trachea and the other inflammation of the lung.

Our first patient had a tonsillar, uvular, laryngotracheal and bronchial diphtheritic membrane, which was removed by suction. In spite of large doses of diphtheria antitoxin, elevation of temperature and rapidity of pulse and respirations persisted. The constitutional reactions and the radio-opacity of the lower