Toxic shock syndrome surveillance in UK children.
BACKGROUND
Toxic shock syndrome (TSS) is an acute toxin-mediated illness caused by toxin-producing strains of Staphylococcus aureus and Streptococcus pyogenes. There is no recent data regarding incidence, management and mortality of TSS in UK children.


METHODS
Consultants from paediatric and burns units in the UK and Ireland, reported cases of TSS seen between November 2008 and December 2009, via the British Paediatric Surveillance Unit. Respondents were sent questionnaires requesting detailed information about TSS cases. Established criteria were used to divide cases into staphylococcal or streptococcal TSS.


RESULTS
Forty-nine cases were identified overall; 29 cases of streptococcal TSS (18 confirmed and 11 probable) and 20 cases of staphylococcal TSS (15 confirmed and 5 probable). The incidence of TSS children in the UK & the Republic of Ireland was calculated to be 0.38 per 100 000 children. Children with staphylococcal TSS were older than those with streptococcal TSS (9.5 vs 3.8 years; p<0.003). Paediatric intensive care facilities were used for 78% of cases (invasive ventilatory support 69%; inotropic support 67%; haemofiltration 12%). Agents with antitoxin effects were underused; clindamycin 67%, intravenous immunoglobulin (IVIG) 20%, fresh frozen plasma 40%. There were eight deaths, all in the streptococcal group (28% of streptococcal cases)-none were given IVIG.


CONCLUSIONS
Streptococcal TSS was as frequent as staphylococcal TSS, contrasting with previous literature. Children with streptococcal TSS had a higher mortality than those with staphylococcal TSS (28% vs 0%; p<0.05). Recommended immunomodulatory agents (IVIG and clindamycin) were underused. This study highlights the need for a guideline to improve management of TSS in children.
Evelina Children's Hospital, London, UK.
S
S
Adalat
Department of Paediatrics, Alexandra Hospital, Redditch, UK.
T
T
Dawson
Department of Paediatrics, Heartlands Hospital, Birmingham, UK.
S J
SJ
Hackett
Great North Childrens Hospital, Newcastle upon Tyne, UK.
J E
JE
Clark
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007494:Ireland / Q000453:epidemiology; D008297:Male; D012772:Shock, Septic / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006113:United Kingdom / Q000453:epidemiology
Data Collection; Infectious Diseases; Outcomes research; Paediatric Practice