Short-Term Outcome and Management of TSS in Children

A study aimed to describe the clinical and laboratory profile, management, intensive care needs, and outcomes of children with toxic shock syndrome (TSS) – from the pediatric intensive care unit (PICU) of a tertiary care center in North India.

This retrospective study was conducted in the PICU of a tertiary care hospital in North India between 2011–2020. The participants were 63 children <12 years of age with TSS. 

Participants’ median age was 5 years; the Pediatric Risk of Mortality III (PRISM-III) score was 15 (range: 12-17). The associated infection was identified among 60.3% of children. Overall, 44.5% of children had skin and soft tissue infections and 17.5% harbored Staphylococcus aureus growth.

Almost all patients presented with shock and rash. Other common signs were – thrombocytopenia in 79.4%; transaminitis in 66.7%; coagulopathy in 58.7%; and acute kidney injury (AKI) in 52.4%. Further, involvement of the gastrointestinal, mucus membrane, respiratory system, musculoskeletal system, and central nervous system (CNS) was also noted. 

Management strategies involved – fluid resuscitation; vasoactive drugs; antibiotics – clindamycin, intravenous immunoglobulin (IVIG), blood product infusion, mechanical ventilation, and renal replacement therapy (RRT). 

Seventeen children succumbed to the infection; the fatality rate was 27%. The PICU and hospital stay duration was 5 (range: 4-10) and 7 (range: 4-11) days, respectively. 

It was observed that the majority of the non-survivors had CNS involvement, thrombocytopenia, coagulopathy, transaminitis, and AKI. They necessitated mechanical ventilation and blood product infusions and had higher vasoactive–inotropic score.

TSS management includes early diagnosis, supportive therapy, intensive care, antibiotics, source control, and adjunctive therapy. The predictors of mortality were multiorgan dysfunction and the need for organ supportive therapies.

Source: Indian Journal of Pediatrics. 90, 334–340 (2023). Doi: 10.1007/s12098-022-04271-4