Bacterial toxicosis/toxic shock syndrome as a contributor to morbidity in children with burn injuries

When a child with a thermal injury suddenly becomes unwell, it is often difficult to obtain an accurate diagnosis in the early stages of the illness. Out of 71 children admitted to our burns unit over a 15-month period, 13 became acutely toxic. Most of the cases had relatively small burns and the exact reason for their sudden deterioration was not apparent in the immediate stages. Several children required admission to the intensive therapy unit and there was one death. The number of children experiencing this significant morbidity over a relatively short period of time prompted us to perform a detailed retrospective study to ascertain the exact cause of the deterioration and to identify any patterns in their presenting signs and symptoms. There was considerable variation in the clinical picture of the children who developed the toxicosis, however, several features were frequently observed which resembled those seen in the toxic shock syndrome (TSS). In order to be more specific, we applied the criteria for TSS as defined by the Centres for Disease Control (CDC) to each of the 13 children. All of the criteria were noted in six children and the majority in the other seven. This was a much higher incidence than we would normally have expected. The clinical features of children with TSS are not always easy to distinguish from those observed in other illnesses. We therefore explored the possibility of alternative diagnoses that may have caused the toxicosis in these children. The mortality associated with TSS can be high, especially if there is a delay in recognition and subsequent management of the disease. Clinicians should be alerted to the fact that TSS is probably more prevalent than previously thought and should practise with a high index of suspicion in any child with a burn whose clinical condition suddenly deteriorates.