Katherine Y H Chen1, Michael Cheung2, David P Burgner3, Nigel Curtis1. 1. Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, The University of Melbourne, Parkville, Australia Infectious Diseases Unit and Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia. 2. Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, The University of Melbourne, Parkville, Australia Department of Cardiology, The Royal Children's Hospital Melbourne, Parkville, Australia. 3. Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, The University of Melbourne, Parkville, Australia Department of Paediatrics, Monash University, Clayton, Australia.
Abstract
BACKGROUND: There are limited data describing the epidemiology, management and outcomes of children with toxic shock syndrome (TSS), a potentially life-threatening illness. Here, we describe the incidence, clinical features, treatment and outcome of children with staphylococcal and streptococcal TSS in Victoria, Australia. METHODS: Retrospective chart review of children admitted between 2003 and 2014 to two tertiary paediatric referral centres who fulfilled the Centers for Disease Control and Prevention case definition of TSS. RESULTS: There were 62 cases over the 11-year period; 43 staphylococcal TSS and 19 streptococcal TSS. The majority (46 (74%)) of cases were admitted to an intensive care unit and 44 (71%) required inotropic support. Compared with those with staphylococcal TSS, patients with streptococcal TSS were younger, more unwell and more likely to have residual morbidity. Adjunctive therapy with intravenous immunoglobulin or clindamycin was used in 58 (94%) of cases and fresh frozen plasma was used in 15 (24%). Seven patients received extracorporeal membrane oxygenation. All patients survived. CONCLUSIONS: 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: There are limited data describing the epidemiology, management and outcomes of children with toxic shock syndrome (TSS), a potentially life-threatening illness. Here, we describe the incidence, clinical features, treatment and outcome of children with staphylococcal and streptococcal TSS in Victoria, Australia. METHODS: Retrospective chart review of children admitted between 2003 and 2014 to two tertiary paediatric referral centres who fulfilled the Centers for Disease Control and Prevention case definition of TSS. RESULTS: There were 62 cases over the 11-year period; 43 staphylococcal TSS and 19 streptococcal TSS. The majority (46 (74%)) of cases were admitted to an intensive care unit and 44 (71%) required inotropic support. Compared with those with staphylococcal TSS, patients with streptococcal TSS were younger, more unwell and more likely to have residual morbidity. Adjunctive therapy with intravenous immunoglobulin or clindamycin was used in 58 (94%) of cases and fresh frozen plasma was used in 15 (24%). Seven patients received extracorporeal membrane oxygenation. All patients survived. CONCLUSIONS: 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Entities:
Keywords:
General Paediatrics; Infectious Diseases
Authors: Jessica Leung; Joseph Y Abrams; Ryan A Maddox; Shana Godfred-Cato; Lawrence B Schonberger; Ermias D Belay Journal: Pediatr Infect Dis J Date: 2021-03-01 Impact factor: 3.806
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