Volume 26, Number 6—June 2020
CME ACTIVITY - Synopsis
Manifestations of Toxic Shock Syndrome in Children, Columbus, Ohio, USA, 2010–20171
Table 1
Characteristics of patients with STSS and NSTSS, Nationwide Children’s Hospital, Columbus, Ohio, USA, 2010–2017*
| Characteristic† | STSS, n = 27 | NSTSS, n = 31 | Total, N = 58 | p value |
|---|---|---|---|---|
| Demographic | ||||
| Sex, no. (%) | ||||
| F | 15 (55.6) | 21 (67.7) | 36 (62.1) | 0.42 |
| M | 12 (44.4) | 10 (32.3) | ||
| Mean age, y (SD) | 9.4 (5.9) | 13.2 (4.1) | 11.4 (5.3) | <0.05 |
| Mean BMI (SD) |
18.9 (4.9) |
22.7 (7.9) |
20.9 (6.9) |
<0.05 |
| Clinical findings | ||||
| Vomiting | 18 (66.7) | 26 (83.9) | 44 (75.9) | 0.22 |
| Diarrhea | 9 (33.3) | 14 (45.2) | 23 (39.7) | 0.43 |
| Myalgia | 9 (37.5) | 12 (44.4) | 21 (41.2) | 0.78 |
| Fever at presentation, mean (SD) | 39.5 (0.8) | 39.6 (0.6) | 39.5 (0.7) | 0.65 |
| Generalized erythematous rash | 14 (51.9) | 30 (96.8) | 44 (75.9) | <0.05 |
| Desquamation | 6 (22.2) | 14 (45.2) | 20 (34.5) | 0.1 |
| Altered mental status | 10 (41.7) | 11 (36.7) | 21 (38.9) | 0.83 |
| Fasciitis/tissue necrosis | 5 (20.0) | 1 (3.3) | 6 (10.9) | 0.08 |
| Pharyngeal hyperemia | 6 (22.2) | 23 (74.2) | 29 (50.0) | <0.05 |
| Pulmonary Infiltrates | 22 (88.0) | 19 (61.3) | 41 (73.2) | <0.05 |
| PPV and inotropic support | 25 (92.6) | 29 (93.5) | 54 (93.1) | 1.0 |
| Capillary leak‡ |
21 (84.0) |
18 (58.1) |
39 (69.6) |
<0.05 |
| Admission laboratory findings§ | ||||
| Thrombocyte count, × 103/μL, mean (SD) | 120.1 (81.6) | 119.2 (76.9) | 119.6 (78.4) | 0.97 |
| Abnormal coagulation tests, PT, PTT, INR, s, n = 49 | 24 (100) | 23 (92.0) | 47 (95.9) | 0.49 |
| Pyuria, n = 24 | 12 (50.0) | 12 (50.0) | 24 (50.0) | 1.00 |
| BUN, mg/dL, median (IQR), n = 57 | 14 (8–26) | 13 (11–41) | 14 (11–27) | 0.73 |
| Creatinine, g/day median (IQR) | 0.8 (0.5–1.2) | 0.9 (0.7–2.0) | 0.8 (0.5–1.6) | 0.12 |
| eGFR, mL/min/m², mean (SD) | 72.8 (34.2) | 71.9 (39.8) | 72.3 (37.0) | 0.93 |
| ALT, U/L, median (IQR) | 49 (28–129) | 40 (29–95) | 47 (29–95) | 0.55 |
| AST, U/L, median (IQR) | 52 (28–132) | 52 (25–84) | 52 (28–102) | 0.62 |
| Total bilirubin, md/dL, median (IQR), n = 57 | 0.9 (0.5–1.6) | 0.9 (0.4–1.8) | 0.9 (0.4–1.6) | 0.79 |
| CPK, U/L, median (IQR), n = 17 |
154 (73–674) |
130 (67–304) |
137 (69–304) |
0.67 |
| Treatment | ||||
| IVIg and clindamycin | 14 (51.9%) | 14 (45.2) | 28 (48.3) | <0.05 |
| Clindamycin only | 8 (29.6%) | 16 (51.6) | 24 (41.4) | |
| IVIg only | 0 (0.0%) | 1 (3.2) | 1 (1.7) | |
| Neither IVIg nor clindamycin | 5 (18.5%) | 0 | 5 (8.6) | |
*ALT, alanine transaminase; AST, aspartate transaminase; BMI, body mass index; BUN, blood urea nitrogen; CPK, creatinine phosphokinase; eGFR, estimated glomerular filtration rate; INR, international normalized ratio; IQR, interquartile range; IVIg, intravenous immunoglobulin; NSTSS, nonstreptococcal TSS; PPV, positive pressure ventilation; PT, prothrombin time; PTT, partial thromboplastin time; STSS, streptococcal TSS; TSS, toxic shock syndrome.
†Continuous variables are presented as means with SDs; categorical variables are presented as counts with percentages. If data were not available for all patients, the number of patients is indicated.
‡Capillary leak indicates hypotension, hypoalbuminemia, and hemoconcentration.
§Reference values: thrombocyte count, 140–440 × 103/μL; PT, 12.4–14.7 s; PTT, 24–36 s; INR, <1.1; BUN, 5–18 mg/dL; creatinine, varies by patient age and sex; eGFR, >60 mL/min/1.73 m²; ALT, <40 U/L); AST, 15–50 U/L); bilirubin, 0.1–1.0 mg/dL; CPK, 37–430 U/L.
1Preliminary results from this study were presented at the Pediatric Academic Societies Meeting, May 6–9, 2017, San Diego, California, USA; and at IDWeek 2018, October 3–7, 2018, San Francisco, California, USA.
2Current affiliation: Yale New Haven Hospital, New Haven, Connecticut, USA.