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

Toxic shock syndrome in Australian children

“…The benefits of clindamycin and IVIG as adjunctive therapy in TSS remain inconclusive 9. In vitro and animal data suggest that IVIG neutralises superantigens and has an immunomodulatory effect 20.…”

“…Clinical studies of IVIG efficacy to date are mainly limited to streptococcal TSS, observational studies (one randomised controlled trial terminated prematurely due to slow recruitment21) and have predominantly involved adults 22. In general, studies support the use of IVIG 9 21 23 24. The optimal dose, timing of administration and whether IVIG is also effective in staphylococcal TSS are unknown 9.…”

“…In general, studies support the use of IVIG 9 21 23 24. The optimal dose, timing of administration and whether IVIG is also effective in staphylococcal TSS are unknown 9. Clindamycin inhibits bacterial superantigen production, potentially reducing stimulation of the inflammatory cascade in vitro 25.…”

“…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. Aside from this study, data on TSS in children are limited to small series included within studies of invasive group A streptococcal infections 4 10–12.…”

Toxic shock and mortality in a dialysis patient

“…Two retrospective studies are worth mentioning in support of the use of adjunctive therapies in TSS. One is from United Kingdom (UK) and other from Australia British Pediatric Surveillance Unit reported 77% cases required intensive care and mortality incidence of 16% in streptococcal TSS due to the observation that only 20% received immunoglobulin 28 . An Australian study showed a higher incidence of staph-related TSS but 100% survival which is attributed to the use of clindamycin or immunoglobulin.…”