Toxic shock syndrome in children

Toxic shock syndrome (TSS) is an acute, toxin-mediated illness characterized by fever, rash, rapid-onset hypotension, multi-organ failure, and desquamation. TSS represents the most fulminant form of the diseases caused by toxin-producing strains of Staphylococcus aureus and Streptococcus pyogenes (group A streptococcus) and is the best example of superantigen-mediated disease. Toxins produced by the staphylococci and streptococci act as superantigens that can activate the immune system by bypassing certain steps in the usual antigen-mediated immune response sequence, resulting in massive cytokine release. This massive cytokine release is responsible for the clinical manifestations of TSS. The host-pathogen interactions, the virulence factors, and absence or presence of immunity determines the epidemiology, clinical syndrome and outcome. Treatment of a child with TSS includes early recognition of disease, source control, and administration of antimicrobial agents, including drugs capable of suppressing toxin production. Supportive therapy, aggressive fluid resuscitation, and vasopressors remain the main elements. Adjuvant therapy with intravenous immunoglobulin containing neutralizing antibodies can block the superantigens.