Streptococcal Toxic Shock Syndrome in the Emergency Department

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 - pediatrics

Authors' 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;

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