Subscribe to RSS
DOI: 10.1055/s-0039-3401983
Streptococcal Toxic Shock Syndrome in the Emergency Department
Publication History
17 June 2019
13 November 2019
Publication Date:
02 January 2020 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00029028/202002/lookinside/thumbnails/10-1055-s-0039-3401983_1900064-1.jpg)
Abstract
Objective Streptococcal toxic shock syndrome (STSS) is a very rare and severe entity from among the invasive diseases caused by Streptococcus pyogenes, whose characteristics, treatment, morbidity, and mortality are little known in pediatrics. The aim of this study was to determine its prevalence and the characteristics of its presentation in the emergency department (ED) in Spain.
Methods This is a descriptive and observational study. Patients from 1 month to 18 years of age, admitted to the ED with a final diagnosis of STSS between 2009 and 2014, were included. Patients whose parents or guardians did not allow informed consent were excluded.
Results Nine cases were diagnosed (1/100,000 consultations); the median average age was 2 years, and five were girls. No patient had a significant medical history. The most frequent reason for consultation was fever (9/9), followed by respiratory symptoms (6/9). Six presented in the ED with shock. Seven were diagnosed with pleuropneumonia, one with meningitis, and one with necrotizing fasciitis. All patients required admission at the pediatric intensive care unit, mechanical ventilation, and inotropic support. All had a complete recovery.
Conclusion STSS is a rare entity in the ED affecting healthy patients who presented respiratory or otorhinolaryngology disease. In our patients, nonspecific clinical manifestations and its rapid progression to shock are shown, meaning the importance of bearing this entity in mind in the emergency room. Understanding the epidemiology and clinical manifestations of this syndrome in our work area helps pediatricians to recognize it and to initiate the appropriate treatment at an early stage, which helps engender a quick and effective approach, essential for a favorable prognosis.
Keywords
streptococcal toxic shock syndrome - Streptococcus pyogenes - invasive disease - pediatricsAuthors' Contribution
C.G.P.: Conception and design of the work, drafting the manuscript, final approval of the version to be published;
V.A.C.: Data analysis and interpretation, critical revision of the manuscript;
V.T.S.: Data analysis and interpretation, critical revision of the manuscript;
N.E.S.M.: Conception and design of the work;
I.J.G.: Conception and design of the work, critical revision of the manuscript;
C.L.C.: Conception and design of the work, critical revision of the manuscript;
-
References
- 1 Rodríguez-Nuñez A, Dosil-Gallardo S, Jordan I. ; ad hoc Streptococcal Toxic Shock Syndrome collaborative group of Spanish Society of Pediatric Intensive Care. Clinical characteristics of children with group A streptococcal toxic shock syndrome admitted to pediatric intensive care units. Eur J Pediatr 2011; 170 (05) 639-644
- 2 Butragueño Laiseca L, García Morín M, Barredo Valderrama E, Alcaraz Romero AJ. Toxic shock syndrome in a paediatric intensive care unit over the last 15 years. An Pediatr (Barc) 2017; 87 (02) 111-113
- 3 Arias-Constanti V, Trench-Sainz de la Maza V, Elvira Sanz-Marcos N, Guitart-Pardellans C, Gené-Giralt A, Luaces-Cubells C. Enfermedad invasiva por Streptococcus pyogenes: ingresos durante 6 años. Infect Dis Clin Microbiol 2018; 36 (06) 352-356
- 4 Dosil Gallardo S, Jordan Garcia I, Morteruel Arizcuren E, Rodríguez Nuñez A. Streptococcal toxic shock syndrome: an emerging pathology?. An Pediatr (Barc) 2009; 70: 310-311
- 5 Lamagni TL, Darenberg J, Luca-Harari B. , et al. Strep-EURO Study Group. Epidemiology of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol 2008; 46 (07) 2359-2367
- 6 Adalat S, Dawson T, Hackett SJ, Clark JE. ; In association with the British Paediatric Surveillance Unit. Toxic shock syndrome surveillance in UK children. Arch Dis Child 2014; 99 (12) 1078-1082
- 7 Chen KY, Cheung M, Burgner DP, Curtis N. Toxic shock syndrome in Australian children. Arch Dis Child 2016; 101 (08) 736-740
- 8 Curtis N. Toxic shock syndrome: under-recognised and under-treated?. Arch Dis Child 2014; 99 (12) 1062-1064
- 9 Hoge CW, Schwartz B, Talkington DF, Breiman RF, MacNeill EM, Englender SJ. The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome. A retrospective population-based study. JAMA 1993; 269 (03) 384-389
- 10 Baxter F, McChesney J. Severe group A streptococcal infection and streptococcal toxic shock syndrome. Can J Anaesth 2000; 47 (11) 1129-1140
- 11 Costa-Orvay JA, Caritg Bosch J, Morillo Palomo A, Noguera Julián T, Esteban Torne E, Palomeque Rico A. Síndrome de shock tóxico: experiencia en una UCIP. An Pediatr (Barc) 2007; 66 (06) 566-572
- 12 Timmis A, Parkins K, Kustos I, Riordan FA, Efstratiou A, Carrol ED. Invasive group A streptococcal infections in children presenting to a paediatric intensive care unit in the North West of England. J Infect 2010; 60 (02) 183-186