Toxic shock syndrome surveillance in UK children

Abstract

Streptococcal TSS was as frequent as staphylococcal TSS, contrasting with previous literature. Children with streptococcal TSS had a higher mortality than those with staphylococcal TSS (28% vs 0%; p<0.05). Recommended immunomodulatory agents (IVIG and clindamycin) were underused. This study highlights the need for a guideline to improve management of TSS in children.

Toxic shock syndrome in Australian children

“…The most striking feature of our study is the absence of any deaths that contrasts with the reported 28% mortality (eight streptococcal cases) in the BPSU study, which had similar rates of intensive care admission, inotropic and ventilator support 8. Compared with the BPSU study, in addition to the use of ECMO, adjunctive treatment was used more frequently in the patients in our study (clindamycin 56/62 (90%) vs 33/49 (67%), p=0.004; IVIG 30/62 (48%) vs 10/49 (20%), p=0.003) 8.…”

“…Compared with the BPSU study, in addition to the use of ECMO, adjunctive treatment was used more frequently in the patients in our study (clindamycin 56/62 (90%) vs 33/49 (67%), p=0.004; IVIG 30/62 (48%) vs 10/49 (20%), p=0.003) 8. Conversely, compared with our study, FFP was used more frequently in the patients in the BPSU study (15/62 (24%) vs 20/49 (40%), p=0.07) 8. FFP has substantially lower concentrations of antibodies compared with IVIG and has no proven anti-inflammatory effect.…”

“…A recent series describing 49 cases identified by the British Paediatric Surveillance Unit (BPSU) reported a combined incidence of 0.3 per 100 000 children with a 28% mortality rate in the streptococcal TSS group, but no mortality in the staphylococcal TSS group 8. This series highlights the need for early diagnosis and improved management, in particular, consideration of the early use of adjunctive treatment with intravenous immunoglobulin (IVIG) and clindamycin 9.…”

Infectious Diseases and the Kidney in Children

“…Group A Streptococcus causes a severe illness with similarities to the staphylococcal toxic shock syndrome, occurring in both children and adults, associated with invasive group A streptococcal disease [33]. Patients with this syndrome present acutely with high fever, erythematous rash, mucous membrane involvement, hypotension, and multiorgan failure [34,35].…”

Toxic shock syndrome: under-recognised and under-treated?

“…In this month's edition, Adalat and colleagues1 report the results from a British Paediatric Surveillance Unit study of TSS in the UK and RI.…”