Infection is invasion of the body by organisms (pathogens) that have the potential to cause disease. The pathogen may be bacterial, fungal, or viral.
Circumcision is a surgical operation and amputation that creates an open surgical wound on the penis. The open wound does not heal immediately. For a period of time during and after the surgery it is subject to invasion by a wide variety of bacterial, viral, or fungal pathogens.
Maternity hospitals gather together newborn infants into a hospital nursery where they are cared for, which increases the risk of passing infection from one to the others. If an infant is compromised by an open surgical wound, then that infant is at greater risk of becoming infected. Male infants in America, where non-therapeutic infant circumcision remains popular, are more likely to become infected than female infants. Staphylococcus aureus is a common infection and is worse when a methicillin resistant strain (MRSA) is involved. Thompson et al. (1966) reported a higher risk of staphylococcus infection in newborn circumcised males. Nelson et al. (1976) reported a prolonged case of hospital nursery infection in which the pathogen was streptococcus.
Van Howe & Robson (2007) examined reports of three outbreaks of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in American maternity hospital nurseries. They found that boys, with 73 percent of the cases, are at greater risk due to the prevalence of non-therapeutic circumcision. The authors, observed that CA-MRSA can progress to bacteremia, osteomyelitis, pyelonephritis, perinephric abscess, lung abscess, empyema, shock, and death. They suggested minimizing newborn circumcisions to reduce the risk of infection.
Infant non-therapeutic circumcisions do not cure disease and do not contribute to health. When infection occurs after a circumcision performed by a physician, then it may be considered to be iatrogenic as the infection would not have occurred if the circumcision had not been performed.
Kirkpatrick & Eitzman (1974) reported two cases of septicemia (infection in the blood) after non-therapeutic neonatal circumcision in which the patients almost died.
Meningitis is a serious inflammation of the meninges, the thin, membranous covering of the brain and the spinal cord. Meningitis is most commonly caused by infection (by bacteria, viruses, or fungi). Scurlock & Pemberton (1977) reported on four cases of meningitis which started with an infected circumcision wound that proceeded to septicemia and meningitis. One of the four patients died.
Ritter's disease is now called Staphylococcal scalded skin syndrome' (SSSS). It is caused by infection with Staphylococcus aureus bacteria. The infection causes large sections of skin to peel away as occurs after burns. Annuziato & Goldblum (1978) reported three cases of SSSS, which started with infected circumcision wounds. Death occurred with one case but the other two recovered.
Cleary & Kohl (1979) reported the case of a six-week old infant boy who was circumcised in his mother's physician's office. Infection with streptococcus developed. The boy was hospitalized, but even with the best of antibiotic and other treatment, death resulted. The authors stated:
Significant infection is rarely solely attributed to circumcision because a clear-cut cause and effect relationship is difficult to establish. There have been reports of newborns5-7 who have been circumcised and then developed life threatening infection within several days of this procedure. However, the fact that in these infants infection has occurred at an age when the incidence of infection is high due to other factors complicates interpretation of these reports.
Woodside (1980) reported the case of an infant boy who was circumcised with the Plastibell device. He developed necrotizing fasciitis after his non-therapeutic circumcision. His treatment required extensive debridement of tissue. The boy apparently survived.
Curran & Al-Salihi (1980) reported an outbreak of staphylococcal scalded skin syndrome (SSSS) at the Margaret Hague Maternity Hospital in Jersey City, New Jersey. The outbreak affected 68 newborns over a 115 day period. The male to female ratio was 5.5 to one, which clearly indicated that the circumcision wound in boys was the entry point for the infection in most cases. The infants had generalized exfoliative disease with loses of large patches of skin. No deaths were reported.
Necrotizing fasciitis is a life-threatening skin infection. Bliss et al. (1997) reported two cases of necrotizing fasciitis after non-therapeutic infant circumcision with the Plastibell device. Extensive aggressive debridement of infected necrotic tissue was required.
More recently, cases of infection of baby boys with herpes simplex have been reported. One death and brain damage in another has occurred.
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