Pediatric Toxic Shock Syndrome After a 7% Burn

Abstract

Introduction Toxic shock syndrome (TSS) is a life-threatening condition, which occurs in children after sustaining a burn. Often diagnosed retrospectively, many patients may not receive optimal treatment. The primary objective of this study was to evaluate a severe and complex case of TSS at our unit and subsequently conduct a Preferred Reporting for Systematic Reviews and Meta-Analyses–compliant systematic literature review, to identify cases of postthermal injury TSS and evaluate their presentation and management. Case Report A 9-year-old boy with Down syndrome presented with a 7% total body surface area scald to his back and posterior head. Four days after discharge, he developed a fever. The following day, he deteriorated, becoming stridulous and unresponsive. A working diagnosis of TSS was made. The patient's intensive care stay was arduous with multiple complications, including 2 cardiac arrests. Methods A Preferred Reporting for Systematic Reviews and Meta-Analyses–compliant systematic literature review was conducted. MEDLINE, PubMed, and Web of Science were searched using key terms “burns, thermal injury, scalds, paediatric, child, infant, neonate, toxic shock syndrome” to identify cases. Two authors independently checked each study against inclusion criteria. Results The systematic literature search yielded 9 articles, identifying 40 cases. Ages ranged between 9 months and 8 years. The mean number of days' postburn patients presented with symptoms of TSS was 2.5 days (1–7 days). The most common presenting symptoms were fever (75%), rash (70%), and diarrhea, and/or vomiting (52.5%). Intravenous immunoglobulins were administered in 11 (27.5%) cases. Discussion We have highlighted a case where a possible delayed diagnosis along with the immunodeficiency seen in Down syndrome may have impacted the severity of TSS. The literature review highlighted that a significant proportion of patients do not meet diagnostic criteria. Conclusions It is fundamental that appropriate diagnostic and management guidelines are developed. Furthermore, this case highlights the importance of educating patient's carers and health professionals of key symptoms to be wary of postburn.

Efficacy of Infection Control Measures in Managing Outbreaks of Multidrug-Resistant Organisms in Burn Units

“…Burn patients are a population vulnerable to microbial colonization and infection because of loss of skin barriers and decreased immune defenses 1–4 . Despite major advances in burn care, infection remains a frequent complication after severe burns.…”

“…B urn patients are a population vulnerable to microbial colonization and infection because of loss of skin barriers and decreased immune defenses. [1][2][3][4] Despite major advances in burn care, infection remains a frequent complication after severe burns. Patients with extensive burn injures often receive multiple courses of antibiotics, undergo invasive procedures and surgical interventions, and require prolonged length of hospital stay, all of which increase the risk of infection including infection with multidrug-resistant organisms (MDROs).…”