title: Streptococcal toxic shock syndrome in children without skin and soft tissue infection: report of four cases.
abstract: Streptococcal toxic shock syndrome is a fulminant, highly fatal disease characterized by evidence of group A beta-haemolytic streptococcus infection and early shock with consecutive organ failure. In adults, affected individuals usually have preceding skin or soft tissue infection. However, in paediatric patients, except for varicella, the background focus is usually respiratory tract infection, and early diagnosis of streptococcal toxic shock syndrome in such patients is difficult. We report four previously healthy children with streptococcal toxic shock syndrome. Pharyngitis was identified in three cases. All of them had constitutional symptoms such as fever, vomiting, diarrhoea, abdominal pain and physical findings of tachycardia and diffuse abdominal tenderness, but no concomitant skin infection.
  
  
  CONCLUSIONS
  Streptococcal toxic shock syndrome should be considered in paediatric patients with fever, vomiting, diarrhoea, abdominal pain and early shock. Early diagnosis, prompt initiation of antibiotics and aggressive fluid therapy are lifesaving for such patients.
authors.affiliation: Department of Paediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
authors.forename: Ming-Chou
authors.initials: MC
authors.lastname: Chiang
authors.forename: Tang-Her
authors.initials: TH
authors.lastname: Jaing
authors.forename: Chang-Teng
authors.initials: CT
authors.lastname: Wu
authors.forename: Shao-Hsuan
authors.initials: SH
authors.lastname: Hsia
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D008297:Male; D012772:Shock, Septic / Q000175:diagnosis* / Q000628:therapy; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000628:therapy; D013297:Streptococcus pyogenes