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Toxic shock syndrome and rhinosinusitis in children
Kenny H Chan1, Tania L Kraai, Gresham T Richter
1Department of Pediatric Otolaryngology, The Children's Hospital, 13123 E 16th Ave., Aurora, CO 80045, USA. chan.kennyh@tchden.org
Insights
Rhinosinusitis is a significant cause of pediatric toxic shock syndrome (TSS), identified in 21% of cases. Prompt otolaryngology consultation and sinus lavage are recommended when rhinosinusitis is suspected as the primary source of TSS.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Critical Care Medicine
Background:
- Toxic shock syndrome (TSS) is a severe, multi-system illness.
- Rhinosinusitis, an inflammation of the nasal passages and sinuses, can be a source of infection.
- The association between rhinosinusitis and TSS in children requires further investigation.
Observation:
- A retrospective review identified 76 patients with TSS.
- Of these, 23 also had acute or chronic rhinosinusitis, with no other infection source identified in 17 cases.
- This suggests rhinosinusitis as a potential primary driver of TSS in pediatric patients.
Findings:
- Rhinosinusitis was identified as the primary cause of TSS in 21% of the studied cases.
- Among patients with TSS and rhinosinusitis, several required intensive care, pressor support, or surgical intervention for sinus disease.
- Rigorous definitions and data analysis confirmed the link between these conditions.
Implications:
- Rhinosinusitis should be considered a primary cause of TSS, especially when no other infection source is apparent.
- Early otolaryngology consultation is crucial for diagnosing and managing suspected cases.
- Consideration of sinus lavage may be beneficial in treating TSS originating from rhinosinusitis.
Objective:
To determine the association between toxic shock syndrome (TSS) and rhinosinusitis in children.
Design:
Eighteen-year retrospective review of medical records.
Setting:
Tertiary children's hospital.
Patients:
A total of 76 patients were identified as having TSS. Twenty-three of them were also diagnosed as having either acute or chronic rhinosinusitis, with no other source of infection in 17 cases.
Interventions:
Of the 23 patients with TSS and rhinosinusitis, 10 were admitted to the intensive care unit, 4 required pressors, and 6 received surgical intervention. Surgical intervention for sinus disease included bilateral antral lavage in 5 patients and bilateral maxillary antrostomy and ethmoidectomy in 1 patient.
Main Outcome Measures:
Patients with TSS and rhinosinusitis were identified using a rigorous set of definitions and detailed data pertaining to history, imaging studies, microbiologic studies, and hospital course.
Results:
Correlation of the data revealed 4 patients who met the criteria for proven TSS and proven rhinosinusitis, 2 patients who met the criteria for probable TSS and proven rhinosinusitis, 7 patients who met the criteria for proven TSS and possible rhinosinusitis, and 3 patients who met the criteria for probable TSS and possible rhinosinusitis.
Conclusions:
Rhinosinusitis was found to be the primary cause of TSS 21% of the time in this series. Rhinosinusitis should be considered the primary cause of TSS when another site of infection has not been identified. Once the link is made, prompt otolaryngology consultation and sinus lavage should be considered.
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