A case series of toxic shock syndrome in a low-middle-income country burn service: creating awareness about the lesser known and potentially lethal complication

Abstract

Introduction: Toxic shock syndrome (TSS) is a bacterial exotoxin-mediated disease that can be a complication of thermal injury in paediatric patients. This disease is acute in onset, occurring mostly within the first 48 hours after thermal injury, and it progresses rapidly to shock and death if appropriate management is not instituted. This case series describes the clinical diagnosis, course of management and outcome of TSS in a single institution in KwaZulu-Natal to highlight the condition in our setting and create awareness.

Methods: The burn admission database was retrospectively searched for patients with a diagnosis of TSS between January and December 2022. Demographic, injury, laboratory and outcome data were collected.

Results: Four out of 106 paediatric admissions were managed for TSS. The average age was 23 months, with 3 out of 4 children being female. The mechanism was hot water scald in all cases, with percentage total surface area burns between 15% and 30%. All patients survived, with one admission to intensive care and one patient developed acute kidney injury, which resolved by the time of discharge.

Conclusion: Our series demonstrates the typical presentation and laboratory features described in the literature. TSS is a lesser-known complication of burn injuries in young children with a high mortality rate if the diagnosis is missed. Awareness of toxic shock as a diagnosis in a child whose condition deteriorates within the first 48 hours of injury, combined with a treatment protocol, can effectively reduce morbidity and mortality.