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Surveillance of toxic shock syndrome in the paediatric population in the UK
  1. S Adalat1,
  2. T Dawson2,
  3. S Hackett3,
  4. J Clark4
  1. 1Institute of Child Health, University College London, London, UK
  2. 2Paediatrics, Redditch Hospital, Redditch, UK
  3. 3Paediatrics, Birmingham Heartlands Hospital, Birmingham, UK
  4. 4Paediatrics, Newcastle General Hospital, Newcastle, UK


Background and aims A UK-wide study of Toxic Shock Syndrome (TSS) cases in UK children under 16 years of age was undertaken beginning November 2008 until the end of November 2009. Little data regarding incidence, management and outcomes has been published about children with TSS. Previous literature suggested staphylococcal TSS to have a significantly greater incidence than streptococcal TSS.

Methods Consultants from paediatric and burns units notified the British Paediatric Surveillance Unit of cases. Questionnaires requesting detailed information on case presentation and progression were sent to notifying consultants. TSS cases were identified as staphylococcal or streptococcal if they met the established criteria used by the US Centre for Disease Control and American Academy of Paediatrics respectively.

Results 50 confirmed and probable cases were identified. 15 were confirmed and 5 probable staphylococcal cases; 18 were confirmed and 12 probable streptococcal cases. There were nine deaths, all from the confirmed or probable streptococcal groups. Mortality was 18% overall but 30% of the streptococcal cases. Four were reported to have residual morbidity. 78% (n=39) received treatment in paediatric intensive care facilities. 70% (n=35) required invasive ventilatory support, 68% (n=34) inotropic support and12% (n=6) haemofiltration. All patients received antibiotics, with two thirds (n=33) receiving clindamycin and only two receiving linezolid. 20% (n=10) received immunoglobulin and 40% (n=20) fresh frozen plasma.

Conclusions This study demonstrates streptococcal TSS to have a higher incidence than staphylococcal TSS, in contrast to previous literature. This finding is in keeping with the increasing incidence of other types of invasive streptococcal disease. A significantly higher mortality was seen with streptococcal TSS indicating it may be a more virulent disease than staphylococcal TSS. Intensive care support facilities were required in three-fourth of patients. It was noted that proven antitoxin therapies which have been shown to reduce toxin production, such as clindamycin and linezolid, appeared to be underused. This study highlights the need for education on patho-aetiology and management of TSS.

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