Clinical Efficacy of Intravenous Immunoglobulins in Management of Toxic Shock Syndrome: An Updated Literature Review

Amreen, Sana; Brar, Simrandeep K; Perveen, Sumera; Chaudhry, Muhammad Reza; Albabtain, Sarah; Khan, Safeera

doi:10.7759/cureus.12836

Cited by 7 publications

(8 citation statements)

References 30 publications

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“…Clindamycin is a frequent choice given its action of ribosome and the consequent ability to inhibit protein synthesis, therefore limiting the production of GAS toxins [ 22 ]. Similarly, IVIG can neutralize toxin activity [ 23 ]. However, none of the studies that used clindamycin or IVIG were randomized or randomized controlled trials.…”

Section: Discussionmentioning

confidence: 99%

State of the Art of Invasive Group A Streptococcus Infection in Children: A Scoping Review of the Literature with a Focus on Predictors of Invasive Infection

Mariani,

Gentili,

Pulcinelli

et al. 2023

Children

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Currently, it remains unclear why some children develop invasive group A Streptococcus (iGAS) and how to manage this condition. Therefore, to explore available works in the literature, we performed a scoping review aiming to analyze the current literature on clinical presentation of different illnesses outcomes of iGAS, with a specific focus on predictors of invasive infection, including an assessment of the prodromal stages of the disease and the possible presence of previous non-invasive GAS infections in children that later developed iGAS. Methods: We conducted a systematic search on PubMed and SCOPUS of all pediatric studies reporting iGAS cases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. For those studies in which multivariable analysis investigating iGAS risk factors was performed, a second review was performed and reported in detail. Results: A total of 209 studies were included. Five studies investigated risk factors for iGAS, the most relevant being varicella infection, chronic underlying illness, presence of the speC gene in GAS strains, acetaminophen and ibuprofen use, children nonwhite, living in low-income households, exposure to varicella at home, persistent high fever, having more than one other child in the home, and new use of NSAIDs. Although we observed a progressive increase in the number of papers published on this topic, no trials investigating the benefits of clindamycin or intravenous immunoglobulins were found and low-to-middle-income countries were found to be poorly represented in the current literature. Conclusions: Our scoping review highlights important gaps regarding several aspects of iGAS in children, including prodromic presentation and optimal treatment strategies. There is also little representation of low–middle-income countries. The current literature does not allow the performance of systematic reviews or meta-analyses, but this work should inform healthcare professionals, policy makers, and funding agencies on which studies to prioritize on this topic.

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Section: Discussionmentioning

confidence: 99%

State of the Art of Invasive Group A Streptococcus Infection in Children: A Scoping Review of the Literature with a Focus on Predictors of Invasive Infection

Mariani,

Gentili,

Pulcinelli

et al. 2023

Children

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“…Some antibiotics (clindamycin, rifampicin, or linezolid) possess antitoxin effects by reducing exotoxin synthesis which may result in reduction in inflammation and cytokine storm [ 15 ]. IVIG neutralize the superantigens [ 25 , 26 ] and has been shown to reduce mortality in TSS, especially in streptococcal TSS in adults [ 27 , 28 ]. Although definitive evidence for beneficial effects of either IVIG or clindamycin in children with TSS is lacking, they are relatively safe treatments and suggested as adjunctive treatment in children with TSS [ 5 , 15 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Profile, Intensive Care Needs, and Short-Term Outcome of Toxic Shock Syndrome Among Children: A 10-Year Single-Centre Experience from North India

et al. 2022

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Objective To describe the clinical and laboratory profile, management, intensive care needs, and outcome of children with toxic shock syndrome (TSS) admitted to the pediatric intensive care unit (PICU) of a tertiary care center in North India. Methods This retrospective study was conducted in the PICU of a tertiary care hospital in North India over a period of 10 y ( January 2011–December 2020) including children < 12 y with TSS ( n = 63). Results The median (interquartile range, IQR) age was 5 (2–9) y, 58.7% were boys, and Pediatric Risk of Mortality III (PRISM-III) score was 15 (12–17). The primary focus of infection was identified in 60.3% children, 44.5% had skin and soft tissue infections, and 17.5% ( n = 11) had growth of Staphylococcus aureus . Common manifestations were shock (100%), rash (95.2%), thrombocytopenia (79.4%), transaminitis (66.7%), coagulopathy (58.7%), and acute kidney injury (AKI) (52.4%); and involvement of gastrointestinal (61.9%), mucus membrane (55.5%), respiratory (47.6%), musculoskeletal (41.3%), and central nervous system (CNS) (31.7%). The treatment included fluid resuscitation (100%), vasoactive drugs (92.1%), clindamycin (96.8%), intravenous immunoglobulin (IVIG) (92.1%), blood products (74.6%), mechanical ventilation (58.7%), and renal replacement therapy (31.7%). The mortality was 27% ( n = 17). The duration of PICU and hopsital stay was 5 (4–10) and 7 (4–11) d, respectively. Higher proportion of nonsurvivors had CNS involvement, transaminitis, thrombocytopenia, coagulopathy, and AKI; required mechanical ventilation and blood products; and had higher vasoactive–inotropic score. Conclusion TSS is not uncommon in children in Indian setup. The management includes early recognition, intensive care, antibiotics, source control, and adjunctive therapy (IVIG and clindamycin). Multiorgan dysfunction and need for organ supportive therapies predicted mortality.

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“…16 A recent literature review, however, mixing adult and paediatric data, suggested intravenous IG efficacy. 17 Ig M-enriched immunoglobulin (IgGAM) could be an alternative to intravenous IG as it has been reported to improve survival in adult septic shock. 16 18 19 Data on the use of IgGAM in children with TSS are scarce.…”

Section: Original Researchmentioning

confidence: 99%

“…A second RCT that enrolled less than 50% TSS patients reported inconclusive results on mortality or organ failure and physical functioning 16. A recent literature review, however, mixing adult and paediatric data, suggested intravenous IG efficacy 17. Ig M-enriched immunoglobulin (IgGAM) could be an alternative to intravenous IG as it has been reported to improve survival in adult septic shock 16 18 19.…”

Section: Introductionmentioning

confidence: 99%

High-dose intravenous immunoglobulin versus albumin 4% in paediatric toxic shock syndrome: a randomised controlled feasibility study

Portefaix,

Dhelens,

Recher

et al. 2024

Arch Dis Child

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PurposeToxic shock syndrome (TSS) is a rare disease responsible for significant morbidity and mortality. Intravenous immunoglobulin (IG) therapy in paediatric TSS could improve shock and organ failure, but more consistent efficacy and safety data are needed. Our objective was to determine whether a randomised clinical trial (RCT) assessing intravenous IG in TSS in children is feasible.MethodsWe performed a multicentre, feasibility, double-blind RCT assessing efficacy of high-dose intravenous IG versus albumin 4% (control group) within the first 12 hours of shock onset. Included patients were aged above 1 month and below 18 years with suspected TSS and septic shock. Feasibility was assessed by measuring inclusion rate, protocol compliance and missing data regarding death and the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) Score. Other secondary clinical outcomes were evaluated during hospital stay, at 60 day and 1 year.Results28 patients, admitted in 6 paediatric intensive care units during 36 consecutive months and followed for 1 year, received the allocated treatment: 13 in intravenous IG group, 15 in control group. The median age was 10.6 years and the sex ratio was 1. Inclusion rate was above 50%, protocol deviations were below 30% and missing data regarding death and PELOD-2 Score below 10%. No difference concerning secondary clinical outcomes between groups was observed, and more adverse events were reported in the control group.ConclusionIt seems to be feasible to conduct an RCT assessing intravenous IG efficacy and safety in paediatric TSS but must be realised internationally, with choice of a clinically relevant endpoint and a specific design in order to be realistic.Trial registration numberNCT02219165.

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Clinical Efficacy of Intravenous Immunoglobulins in Management of Toxic Shock Syndrome: An Updated Literature Review

Cited by 7 publications

References 30 publications

State of the Art of Invasive Group A Streptococcus Infection in Children: A Scoping Review of the Literature with a Focus on Predictors of Invasive Infection

State of the Art of Invasive Group A Streptococcus Infection in Children: A Scoping Review of the Literature with a Focus on Predictors of Invasive Infection

Clinical Profile, Intensive Care Needs, and Short-Term Outcome of Toxic Shock Syndrome Among Children: A 10-Year Single-Centre Experience from North India

High-dose intravenous immunoglobulin versus albumin 4% in paediatric toxic shock syndrome: a randomised controlled feasibility study

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