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Streptococcus associated toxic shock
C Torres-Martínez1, D Mehta, A Butt
1Academic Department of Paediatrics, St Mary's Hospital Medical School, London.
Insights
Group A beta-haemolytic streptococcus (GABHS) can cause a severe toxic shock-like syndrome in children. Early recognition and aggressive treatment are crucial for managing this serious condition.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Group A beta-haemolytic streptococcus (GABHS) infections have shown a changing spectrum of disease.
- Toxic shock-like syndrome has been recently described in adults caused by GABHS.
Observation:
- Four children presented with acute illness characterized by rapid shock, rash, and multisystem organ involvement.
- Three children had extensive cutaneous/soft tissue infections; one had peritonitis.
- All four children developed bacteremia and fulfilled diagnostic criteria for toxic shock syndrome.
Findings:
- The children experienced severe complications including electrolyte imbalances and desquamation.
- Treatment involved aggressive cardiovascular resuscitation and antibiotics.
- All patients survived but required prolonged hospitalization and treatment for complications.
Implications:
- Streptococcal toxic shock syndrome (STSS) is a distinct clinical entity in previously healthy children.
- This syndrome necessitates prompt diagnosis and intensive management.
- Understanding STSS is vital for pediatric infectious disease specialists and critical care providers.
Abstract:
In the past few years, there appears to have been a change in the spectrum of disease caused by group A beta-haemolytic streptococcus (GABHS), and a toxic shock-like syndrome caused by this organism has recently been described in adults. We report four children with an acute illness characterised by rapid progression of shock, erythematous rash, multisystem organ involvement, electrolyte derangements, and desquamation who fulfil the previously established diagnostic criteria for toxic shock syndrome. Three of the children had extensive cutaneous and soft tissue infection and the fourth had peritonitis. All four developed bacteraemia. Treatment included aggressive cardiovascular resuscitation and antibiotic therapy. Although no patient died, they suffered multiple and severe complications requiring prolonged treatment and hospitalisation. Streptococcal toxic shock syndrome is a separate and clearly defined entity occurring in previously healthy children.