Toxic shock syndrome in Australian children

Chen, Katherine Y H; Cheung, Michael; Burgner, David; Curtis, Nigel

doi:10.1136/archdischild-2015-310121

Cited by 27 publications

(43 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Str-TSS cases had a more severe prognosis than the Sta-TSS cases, including longer PICU stay, higher PIM2 scores, higher number of organ failure with more frequent acute respiratory distress syndrome, and required mechanical ventilation more often and for a longer time, in accordance to UK and Australian studies ( 5 , 6 , 40 ). Although not significant, the case-fatality rate for Str-TSS (20%) was higher than Sta-TSS (7%), that is consistent with the meta-analysis of Chuang et al, who analyzed 27 and 30 studies focused on Sta- and Str-TSS, respectively.…”

Section: Discussionsupporting

confidence: 80%

“…Toxic Shock Syndrome (TSS) is a severe acute illness characterized by high fever, hypotension, rash, multi-organ system dysfunction, and desquamation during convalescence. TSS is caused by toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes and occurs in both adult and pediatric patients ( 1 – 5 ). TSS remains a rare but severe disease, with a mortality rate that varies from 4 to 27% for streptococcal (Str) TSS ( 2 – 4 ) and from 0 to 22% for menstrual and non-menstrual staphylococcal (Sta) TSS ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Similarities and Differences Between Staphylococcal and Streptococcal Toxic Shock Syndromes in Children: Results From a 30-Case Cohort

et al. 2018

View full text Add to dashboard Cite

Introduction: Toxic shock syndromes (TSS) are severe shocks due to staphylococcal or streptococcal infection that require specific treatments. The early recognition of these shocks is crucial to improve their outcomes.Objectives: The primary objective of this study was to compare characteristics and outcomes of staphylococcal and streptococcal TSS in children, in order to identify putative early clinical diagnostic criteria. Secondary objectives were to determine the toxin gene profiles of associated isolated strains and the relevance of measuring Vβ T-cell signatures to confirm the diagnosis.Study design: We performed a multicenter retrospective evaluation of clinical data, biological results, and treatment outcomes of children with a confirmed or probable case of staphylococcal or streptococcal TSS. Children were consecutively included if they were admitted to the pediatric intensive care units of Lyon (France), between January 2005 and July 2011.Results: Among the 30 analyzed children, 15 presented staphylococcal TSS and 15 streptococcal TSS. The most frequent origin of staphylococcal and streptococcal TSS was the lower respiratory tract (53%) and the genital tract (47%) respectively. Non-menstrual TSS syndrome cases presented more frequently with neurological alterations, and digestive signs were predominant in menstrual forms. Compared to Staphylococcal TSS, Streptococcal TSS presented with higher organ dysfunction scores (median Pediatric Index of Mortality 2 score 20.9 (4.1–100) vs. 1.7 (1.3–2.3), p = 0.001), required respiratory support more frequently (80 vs. 33%, p = 0.02), were intubated for a longer time (3 days (0.75–5) vs. 1 day (0–1.5), p = 0.006) and had a non-significant trend of higher, case-fatality rate (20 vs. 7%, p = 0.60). The lack of antitoxin therapy was associated with higher case-fatality rate (50 vs. 4%, p = 0.04). The Vβ repertoire measurements exhibited toxin dependent-alterations in accordance with the toxin gene profiles of isolated strains in both types of toxic shock syndromes. Regarding toxin gene profiles of isolated strains, 10/15 Staphylococcus aureus belonged to clonal complex (CC) 30 and 6/12 Streptococcus pyogenes were emm1 type suggesting clonal etiologies for both staphylococcal and streptococcal TSS.Conclusion: Despite the involvement of functionally similar toxins, staphylococcal and streptococcal TSS differed by their clinical signs, origin of infection and prognosis. The detection of Vβ profiles was useful to confirm the diagnosis of staphylococcal and streptococcal TSS and for the identification of involved toxins.

show abstract

Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Similarities and Differences Between Staphylococcal and Streptococcal Toxic Shock Syndromes in Children: Results From a 30-Case Cohort

et al. 2018

View full text Add to dashboard Cite

show abstract

“…It is important to underline that unlike other streptococcal invasive infections that can lead to shock, SSTS is due to toxins that act as superantigens triggering an uncontrolled inflammatory response causing endothelial lesion and evolving to shock with multiple organ failure. 6,7 Thus, treatment with clindamycin leads to better survival in cases of STSS, due to the antitoxin effect of clindamycin compared with B-lactam agents, so its use is recommended 11 ; in this sample, it was administered in more than half of the cases. Although all the patients in our study made a good recovery, the death rate in the literature has been shown to be as high as 28%.…”

Section: Discussionmentioning

confidence: 99%

“…Proinflammatory cytokines act on the capillary endothelium, increase its permeability, and eventually lead to shock, manifesting with hypotension, fever, rash, and multiple organ failure. 6,7 Children usually have a weak antibody response against the toxins that cause the syndrome. 8 The diagnosis of STSS often involves the recognition by the clinician of a constellation of signs and symptoms not always easy to identify, as well as the microbiological determination of S. pyogenes.…”

Section: Introductionmentioning

confidence: 99%

Streptococcal Toxic Shock Syndrome in the Emergency Department

Guitart

Constantí

Maza

et al. 2020

J Pediatr Infect Dis

View full text Add to dashboard Cite

Objective Streptococcal toxic shock syndrome (STSS) is a very rare and severe entity from among the invasive diseases caused by Streptococcus pyogenes, whose characteristics, treatment, morbidity, and mortality are little known in pediatrics. The aim of this study was to determine its prevalence and the characteristics of its presentation in the emergency department (ED) in Spain. Methods This is a descriptive and observational study. Patients from 1 month to 18 years of age, admitted to the ED with a final diagnosis of STSS between 2009 and 2014, were included. Patients whose parents or guardians did not allow informed consent were excluded. Results Nine cases were diagnosed (1/100,000 consultations); the median average age was 2 years, and five were girls. No patient had a significant medical history. The most frequent reason for consultation was fever (9/9), followed by respiratory symptoms (6/9). Six presented in the ED with shock. Seven were diagnosed with pleuropneumonia, one with meningitis, and one with necrotizing fasciitis. All patients required admission at the pediatric intensive care unit, mechanical ventilation, and inotropic support. All had a complete recovery. Conclusion STSS is a rare entity in the ED affecting healthy patients who presented respiratory or otorhinolaryngology disease. In our patients, nonspecific clinical manifestations and its rapid progression to shock are shown, meaning the importance of bearing this entity in mind in the emergency room. Understanding the epidemiology and clinical manifestations of this syndrome in our work area helps pediatricians to recognize it and to initiate the appropriate treatment at an early stage, which helps engender a quick and effective approach, essential for a favorable prognosis.

show abstract

“…The production of enterotoxin was previously assessed using toxin detection kits (Denka Seiken Co. Ltd, Tokyo, Japan) for TSST-l and staphylococcal enterotoxins A-D (SEA-SED). In addition, TSST-l production was evaluated using an isoelectric focusing procedure [9, 10]. Bacteria were cultured on blood agar for 24 h, then reincubated on blood agar for another 24 h at 37°C.…”

Section: Methodsmentioning

confidence: 99%

The Immunomodulatory Effect of Trichophyton Rubrum Exoantigens in the Treatment of Experimental Septic Arthritis

et al. 2017

View full text Add to dashboard Cite

Background: Understanding the nature and function of fungal exoantigens might lead to novel approaches in the treatment and prophylaxis of some infectious diseases. Septic arthritis represents a serious problem for medicine due to the high incidence rate and severe complications.Objective: The present study aimed at assessing the immunomodulatory effects of Trichophyton rubrum culture filtrate as a novel compound in experimental septic arthritis.Method:The septic arthritis was haematogenously induced in Sprague-Dawley rats by a single intravenous injection of 109 colony forming units of the human clinical isolate Staphylococcus aureus producing toxic shock syndrome toxin-1. Trichophyton rubrum culture filtrate at two different doses 20 and 40 mg/kg was administered intraperituneally two days after bacterial inoculation in the treatment groups and concurrently with the appearance of clinical signs in the patient groups. The administration of Trichophyton rubrum solution was continued every other day for 10 injections.Results:The clinical evaluation showed that Trichophyton rubrum-treated rats were significantly protected from disease development compared with untreated controls. This finding was correlated with results of radiological evaluation of the involved joints. Although, the inflammatory cell infiltration, cartilage/bone destruction and synovial hypertrophy had been decreased in the treatment groups in comparison with arthritic controls however, the histological changes were not significant in these two groups.Conclusion:It is possible that Trichophyton rubrum antigens may play a role in modulating the immune responses and would be efficient in septic arthritis treatment.

show abstract

Toxic shock syndrome in Australian children

Abstract: This study highlights the importance of early recognition of TSS and supports rapid tertiary referral and intensive care management, which includes the use of adjunctive therapy with intravenous immunoglobulin and clindamycin.

Cited by 27 publications

References 21 publications

Similarities and Differences Between Staphylococcal and Streptococcal Toxic Shock Syndromes in Children: Results From a 30-Case Cohort

Similarities and Differences Between Staphylococcal and Streptococcal Toxic Shock Syndromes in Children: Results From a 30-Case Cohort

Streptococcal Toxic Shock Syndrome in the Emergency Department

The Immunomodulatory Effect of Trichophyton Rubrum Exoantigens in the Treatment of Experimental Septic Arthritis

Contact Info

Product

Resources

About