Infections with Rhodococcus equi in children

Three cases of serious infection in children, including the first two reports of bacteremia, due to Rhodococcus equi are described. Only seven pediatric cases have been reported to date. In the laboratory, R. equi can easily be misidentified as a nonpathogenic Corynebacterium spp. (diphtheroid) or a Mycobacterium spp. Despite an overall mortality rate of 25% in adults, no pediatric deaths have occurred due to R. equi. The organism is generally susceptible to vancomycin, aminoglycosides, chloramphenicol, and erythromycin, but, optimal duration of antibiotic therapy is unknown. Treatment with multiple antibiotics was successful in all three cases reported here. Although only a small number of cases have been reported in children, R. equi appears to be an important pediatric pathogen.