Toxic shock syndrome

The authors present two children who had fever ≥38.9°C, diffuse rash, hypotension, deranged renal and hepatic functions, disseminated intravascular coagulation, altered sensorium and inflamed oral mucosa. They responded to fluids, inotropes, antibiotics and intravenous immunoglobulin (2 g/kg). Desquamation particularly of palms and soles and periungal region was noted 1 to 2 weeks after onset of illness. These features were consistent with the diagnosis of staphylococcal toxic shock syndrome (TSS). The cases highlight that TSS is very much with us and can mimic a variety of other diseases. Early recognition, and aggressive antimicrobial supportive and IVIG therapy cover can ensure complete recovery     

Toxic shock syndrome

We report about a one year old girl with toxic shock syndrome (TSS), which was confirmed by a significant rise of TSST-1 titers. In addition to known manifestations of TSS, to our knowledge this is the first report about development of polyserositis in this disease. Tumor necrosis factor (TNF) was elevated at initial evaluation and fell under treatment with cortisone. This finding is in contrast to in-vitro observations. We believe that the use of cortisone in TSS warrants further investigation.     

Toxic shock syndrome in a neonate

We report an unusual case of toxic shock syndrome in a 4-day-old baby, with mucosal isolates of Staphylococcus aureus (SEC, G, and I) and group G streptococcus. Treatment involved intravenous immunoglobulin and antibiotics. This case highlights the difficulties associated with the diagnosis and treatment of this condition in neonates.     

Toxic shock syndrome due to osteomyelitis

An 11 3/4 year old girl contracted Toxic-Shock-Syndrome following osteomyelitis. The symptoms comprised a severe fall in blood-pressure with centralisation, petechiae and haematoma particularly in the lower extremities, hyperaemia of the oral mucosa and of the throat with profuse and unstaunchable bleeding in this area within in a short period of time. In order to stabilise the blood-pressure the patient had be given approx. 15 l colloidal solution (350 ml/kg) intravenously, mainly frozen-plasma. The risk of aggravation of a pulmonary failure along the lines of ARDS particularly due to the backward flow of the interstitial deposited fluid was avoided by the use of continuous veno-venous haemofiltration (CVVH).     

Toxic shock syndrome in children. Report of four cases

We report four children with toxic shock syndrome admitted in the pediatric intensive care unit of our hospital during the past year. All the children had the five criteria established by the Centers for Disease Control for the diagnosis of this syndrome. In all four there was a probable point of entry of the infection: maxillar sinusitis in one, pneumonia in two and surgical wound in the other. No bacteria that could have caused the infection were isolated in any of the children, which suggests a staphylococcal origin for this syndrome. Evolution was good in all of the children due to aggressive treatment that included inotropic support, volemic expansion and antibiotics. Two of the children, who suffered adult respiratory distress syndrome, required prolonged respiratory support.     

Toxic shock syndrome: diagnosis and management

Staphylococcal and streptococcal toxic shock syndrome (TSS) is a type of shock that is mediated by superantigens. It is associated with significant morbidity and mortality. Early recognition of this disease is important because the clinical course is fulminant and the outcome depends on the prompt institution of therapy. Management of a child with TSS includes hemodynamic stabilization and appropriate antimicrobial therapy to eradicate the bacteria. The use of immunoglobulin is advised to block the superantigens. The authors describe the definitions of TSS, the clinical presentation, the role of superantigens, and the initial management.     

Toxic shock syndrome in a 6-year-old male

Toxic shock syndrome, caused by an exotoxin of staphylococcus aureus is very rare in children. On admission, beside the shock, abdominal problems as vomiting, diarrhoea and a developing adynamic ileus were outstanding in our patient. Not before additional symptoms as staphylococcal pneumonia with bacteriemia occurred and later desquamation of palms and feet, diagnosis of toxic shock syndrome could be confirmed.     

Toxic shock syndrome associated with poison oak dermatitis

Toxic shock syndrome commonly occurs in menstruating women, but it is known to be associated with a variety of staphylococcal infections. We report a case of nonmenstrual toxic shock syndrome in an 11-year-old male who presented with altered consciousness and infected poison oak dermatitis of the feet. This is the first reported case of toxic shock syndrome associated with poison oak dermatitis. The signs and symptoms, laboratory findings, and treatment of toxic shock syndrome are reviewed.     

Toxic shock syndrome in a 14-year-old girl

The toxic shock syndrome in a 14-year old girl is described. This syndrome occurs most frequently - but not exclusively - in the teens and young women during the first days of menstruation, if tampons are used. The patients are acutely ill with high fever, diarrhea and/or vomiting, with a rash, with loss of consciousness, and signs of shock (occasionally shock lung syndrome and renal insufficiency). During convalescence desquamation of hands and feet shows up. Patients with much less severe symptoms have been seen. The primary lesion is a local infection (e.g. vaginitis) with staphylococcus aureus, the symptoms being caused by staphylococcal toxins. Early recognition and immediate therapy are important for a better prognosis. The therapy consists of removal of the tampon, i.v. fluids including albumin, and the administration of a beta-lactamase-resistant antibiotic.     

Toxic shock syndrome in burns: diagnosis and management

Toxic shock syndrome (TSS), a toxin-mediated disease, is the most common cause of unexpected mortality in children with small burns. It is a diagnosis that is often missed because of non-specific signs and an ability to mimic other childhood illnesses. Any child with a pyrexia greater than 38.9 degrees C, a rash, or a sudden change in clinical condition within a few days of a burn injury should be monitored closely for TSS. If there is co-incident hyponatraemia or lymphopaenia, or if there is any deterioration in clinical condition, the child should be managed with anti-staphylococcal and streptococcal antibiotics and passive immunity for toxins provided by fresh frozen plasma (FFP) or intravenous immunoglobulin (IVIG). It is essential that all paediatric and emergency departments accepting children with burns are aware of the symptoms, signs and early management of TSS.     

Toxic shock syndrome and streptococcal myositis: three case reports

Group A streptococcal (GAS) infection is the most common cause of bacterial pharyngitis and has an important role in the pathogenesis of post-infective phenomena including rheumatic fever and glomerulonephritis. Mortality from GAS is uncommon, particularly in the paediatric population. Toxic shock syndrome reflects the most severe form of GAS-related disease and is often associated with fasciitis or myositis. CONCLUSION: We present three cases of toxic shock syndrome secondary to (GAS) myositis demonstrating the importance of early recognition and provision of intensive care management.     

Toxic shock syndrome associated with newly diagnosed type I diabetes

Studies of two post-mortem pancreata of children at the onset of type I diabetes have suggested activation and expansion of islet infiltrating T cells by a superantigen. We present the first reported case of a superantigen mediated disease, toxic shock syndrome (TSS), occurring at the diagnosis of type I diabetes. A 12-year-old girl presented with TSS and newly diagnosed diabetes with ketoacidosis. At presentation she was unconscious, febrile and hypotensive, with a desquamating erythematous rash and Kussmaul breathing. During resuscitation, her renal impairment, diarrhoea, thrombocytopaenia and ketoacidosis resolved. Vaginal discharge and blood cultures grew Staphylococcus aureus. T cell studies at 2 weeks after diagnosis detected a high level of spontaneous and islet antigen-specific proliferation with associated interleukin-10 production compared to human leucocyte antigen DR matched controls.