Toxic shock in paediatric burns

Mrs Kristen Storey1, Dr Browyn Griffin2, Professor Roy Kimble1,2

1Lady Cilento Children’s Hospital, South Brisbane, Australia, 2Centre for Children’s Burns and Trauma Research, South Brisbane, Australia

Toxic Shock Syndrome (TSS) is an endotoxin mediated disease usually caused by Staphylococcus aureus. While difficult to diagnose, due to symptoms mimicking those of other childhood diseases, mortality rate in those diagnosed are approximately 28%. Children under the age of 4 are yet to develop the antibodies for the exotoxin called toxic shock syndrome toxin-1(TSST-1), therefore are more susceptible.

In our unit, we had not had a diagnosed case of TSS in over 30 years, however two cases have been identified in the past year. Child 1, a 5mth old who sustained  a 9% scald burn. Diagnosis of Staphylococcus aureus TSS, was diagnosed through punch biopsy. This child required admission to PICU and was intubated for a period of 3 days. Overall admission to PICU being 5 days and discharged home day 20. Child 2, a 2yo girl admitted with 5% scald burn. She required admission to PICU however not intubated. Her total length of stay in PICU being 4 days with an overall stay of 14 days. Treatment included a combination of IV Ab’s and IVIg in child 2. Time to reepithelialisation being 40 days and 38 days.

Toxic shock is an uncommon complication of a burn injury however it should still be considered for those presenting with common childhood symptoms. With the high mortality rate, it is important to have accurate diagnosis. Even though specialised units may not have had much exposure, they need to have awareness of the condition.

I am the Clinical Nurse Consultant at the Lady Cilento Children’s Hospital

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