Surveillance study of Toxic Shock Syndrome in under – 16s highlights significant morbidity and mortality; but very few due to tampon use
Toxic shock syndrome (TSS) caused by the streptococcus bacteria may have higher incidence than previously thought and is associated with higher mortality than staphylococcal infections, according to a new report launched recently.
The first comprehensive population based surveillance study of the rate of cases of toxic shock syndrome presenting in children under sixteen years of age in the UK and Republic of Ireland, has been published in Archives of Disease in Childhood.
TSS is a severe acute condition ,caused by toxin- producing strains of the bacteria Staphylococcus aureus and Streptococcus pyogenes It is characterized by hypotension, fever, rash, and organ dysfunction.
The study confirms the incidence of TSS is low – less than 4 per million children – but the majority of these are likely to be a result of streptococcal infection rather than staphylococcal infection (the type more commonly associated with Toxic Shock Syndrome).
It also reveals that only 10% of cases are associated with tampon use.
The paper finds:
- 49 cases of Toxic Shock Syndrome (TSS) in under-16s were reported over 13 months
- 29 cases were attributed to streptococcal infection and 20 cases from staphylococcal causation
- Almost 80% were admitted to an intensive care unit and 68% required invasive ventilation support.
- Children with streptococcal TSS had a higher mortality (28%) than those with staphylococcal disease where there were no deaths.
Dr Shazia Adalat, who carried out the research with the British Paediatric Surveillance Unit (BPSU), says that toxic shock syndrome in children, although rare, needs to be promptly and appropriately managed, to avoid adverse morbidity and mortality:
“Toxic Shock syndrome in children is a very uncommon but very serious condition when it occurs. The condition often requires rapid treatment and intensive care, sometimes with additional procedures tailored to the individual cases. Clinicians need to identify and aggressively manage this disease, which can often rapidly progress to mortality as shown by our study.
“This study also demonstrated long term consequences on children’s health in those who survive, with 38% affected by residual morbidity at discharge from hospital and 14% 4-10 weeks later”
Dr Tom Dawson, another researcher on the study said:
“Although TSS first came to prominence in the 1980s after it was associated with tampon use, this affected only 10% of cases in our surveillance study. Another well documented association with TSS is in cases of burns, which in our study only contributed 8% of cases. In fact other skin disorders were the most common cause (29%), with chickenpox and cuts/abrasions making up the majority of these.”
The study recognised the lack of current standardised guidance on the management of toxic shock syndrome in children and the need to maintain a high index of suspicion for the diagnosis and prompt action in suspected cases. It represents the largest set of clinical data in children reported using well established clinical definitions and should be useful for paediatricians in diagnosing and managing the condition.
The research team from London, Birmingham and Newcastle led a study in the four countries of the UK and the Republic of Ireland which was run through the British Paediatric Surveillance Unit (BPSU). Public Health England (PHE) provided surveillance data to the study.
The research team comprised: Dr Shazia Adalat, Dr Tom Dawson, Dr Scott Hackett and Dr Julia Clark
The BPSU surveys rare childhood disorders by monthly surveys of all paediatricians in the UK and Republic of Ireland. It has run many studies of national importance including those that monitor vCJD in children, HIV/AIDS, and congenital rubella infection. It is affiliated to Rare Disease UK. The BPSU is run as a collaboration between the RCPCH, University College London, the Institute of Child Health and Public Health England.