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
