TSS & Children

Children can get Toxic Shock Syndrome too – do you know the symptoms?

If your child showed flu like symptoms coupled with vomiting and diarrhoea would you be unduly worried? Most parents would simply resolve to stay at home with their son or daughter and tend to their needs until the condition subsides, with perhaps a trip to the local G.P. or a call to NHS Direct if things did not improve.

However on rare occasions these symptoms, when associated localised infections such as burns, scalds, boils or insect bites (particularly if accompanied by a high fever, drowsiness and sunburn-like rash) can be early signs of a very serious illness indeed: toxic shock syndrome (TSS).

TSS can affect anyone or any age. Most women will be aware of the form of TSS associated with menstruation and tampon use, but may not realize it can occur in any member of the family. At present, as cases of menstrual TSS are becoming less common, the incidence of TSS in children looks as if it may be increasing, particularly following burns. The risk of TSS is greater in younger people as they are less likely to have developed sufficient protective antibodies to the toxin which causes the illness.

In July 1999, seven year old Christopher Withey was accidentally splashed with hot water while melting chocolate with his mother, brothers and sister. He was taken to the local community hospital where the minor scald on his back – less than a one per cent burn – was treated. A few days later Christopher became very unwell with a high fever, sickness and diarrhoea. Mrs Withey returned with Christopher to the hospital ten times in ten days, partly to have the scald checked but also because she was increasingly concerned about his health. On all but the last visit, she was assured Christopher simply had a ‘stomach bug’. Finally, doctors recognised Christopher was indeed severely unwell, and he was rushed to a children’s hospital. Tragically, Christopher died soon after. He was diagnosed as suffering from Toxic Shock Syndrome which had occurred as a result of the burn.

Consultant paediatrician Dr Colin Michie, MA FRCPCH FLS , is familiar with TSS in children. He explains, “Burns and scalds often damage normal skin defences, allowing bacteria to grow and make potentially dangerous toxins. For many years it has been known that children with burns may develop confusion, fever, low blood pressure, diarrhoea and a rash – in other words, toxic shock syndrome. This condition may be seen following very small areas of skin damage and tragically, can be fatal. Of the various cases I have seen – and it is rare – the diagnosis has been made quite late, when the child was already very unwell. This can be avoided. Such children were thought to have gastroenteritis, or a viral infection of some type. A useful message would be for any sick child with a burn or scald to have a blood pressure check, in order to exclude shock.”

So while TSS is a rare illness indeed, it is important to be aware of its potential causes and symptoms. If caught early, it can be successfully treated with antibiotics and fluids. This results in an excellent outcome with no long-term complications. The onset of TSS is like a very severe ‘flu with symptoms including some or all of the following:

• Sudden high fever
• Vomiting
• Diarrhoea
• Fainting or feeling faint
• Muscle aches
• Dizziness
• Confusion
• Sunburn-like rash

Medical attention should be sought early for anyone who may be at risk, either by calling the local G.P. or visiting the nearest Accident and Emergency department. An accurate blood-pressure measurement must be performed in order exclude shock, or low blood pressure.

TSS: Anyone can get it

TSS – Did you know anyone can get it?

If you or a family member showed severe ‘flu’ like symptoms coupled with vomiting and diarrhoea would you be unduly worried? Probably not. However these symptoms can be early signs of toxic shock syndrome (TSS,) which is a very rare but serious illness for which urgent medical help should be sought.
Toxic shock syndrome is a form of blood poisoning which is caused by the common bacterium Staphylococcus aureus, which normally live harmlessly on the skin and in the nose, armpit, groin or vagina of one in every three people. In rare cases certain strains of these bacteria can produce the toxin TSST-1 which causes TSS.

TSS can occur in any member of the population, regardless of age or sex. It is usually seen as a consequence of localised infections following scalds, burns, wounds, surgery, piercings, chicken pox spots, childbirth etc. Menstrual TSS can occur during or following menstruation and has been linked to the use of tampons, although the actual reason for this association is not clear.

The condition will rapidly make a person become very unwell indeed where in addition to aches, pains, diarrhoea and vomiting, they may develop a high fever, low blood pressure, confusion and dizziness, and often sporadic patches of a sunburn like rash. With early diagnosis TSS can be easily treated, but unfortunately the initial symptoms are often mistaken for less serious conditions such as gastroenteritis. This may lead to a patient becoming critically ill before being correctly diagnosed and treated. Without medical help TSS rapidly becomes very serious and sadly a small number of people die each year from TSS. People who receive treatment in good time will usually make a full recovery.

Blood pressure measurement is one of the keys to the diagnosis of TSS as low blood pressure denotes shock, and this coupled with the other visible signs will give a clear indication that TSS may be present. Special equipment required to monitor children’s blood pressure is not always readily available. It is vital that anyone who suspects TSS in a child – or for that matter any individual – insists that this measurement is taken.

TSS is more likely to affect children and young people as they will have yet to develop the necessary levels of antibodies to protect them from the illness. Most women will have heard of menstrual TSS which has been linked to tampon use. However, very few people are aware that any member of the family can be affected by TSS. There are no official up to date figures available for cases in the UK, though it is commonly acknowledged that today there are fewer menstrual cases than a number of years back, while the incidence of TSS in children particularly following burns and scalds is more frequently seen.

While TSS is very rare, cases such as these where the diagnosis has been missed appear all too often in newspapers. If you or anyone you know suspects TSS, it is important to get medical advice without delay, in order to rule out the possibility or to commence appropriate treatment. If a tampon is in use it should be removed immediately and the doctor should be told the patient was menstruating and using a tampon.

TSS: Research News

Research News – Toxic Shock Syndrome – a rare but dangerous illness.

By Dr Colin Michie for Children’s Heart Federation’s Update, Summer 2007

It you have heard of toxic shock syndrome (TSS), you probably associate it with women using tampons. However, tampon-related cases account for only half of the TSS cases in the UK each year. The other 50% of cases result from localised infections, for example following burns, cuts or surgery. Men, women and children can all get TSS but young people tend to be more at risk because they may not yet have the necessary antibodies to protect them from the toxin that causes TSS.

TSS is caused by the common bacteria – Staphylococcus aureus – which normally live on the skin and in the nose, armpit, groin or vagina of one in every three people. Very rarely certain strains of these bacteria produce toxins (poisons) that cause TSS.

If a child contracts TSS, then they will develop severe ‘flu-like’ symptoms such as a high fever, vomiting, a sun-burn like rash, muscle-aches and general weakness. An early diagnosis is really important as TSS can then be successfully treated with fluids, antibiotics and more specifically immunoglobulins.

If you think your child is displaying symptoms of TSS, then it is a good idea to consult your doctor at once. Do not worry about being alarmist – it is important to rule out the possibility of TSS, especially if your child is recovering from an operation.

Parents can be reassured however that TSS is a very rare illness. From a population of around 60 million there are only about 40 cases reported each year. Children are monitored carefully after any heart operation and TSS has only been reported in a handful of post-operative cardiac patients.

As previously mentioned, this is an illness that a few parents are aware of and although cases are thankfully still rare, it is very important to spread this awareness to as many parents as possible. Vigilance by parents will always help prevent serious illness from conditions such as TSS.