[Toxic shock syndrome: experience in a pediatric intensive care unit]. / Síndrome de shock tóxico: experiencia en una UCIP.

OBJECTIVES: To review patients with toxic shock syndrome (TSS) in a pediatric intensive care unit. METHODS: We performed a retrospective study of patients with TSS admitted to the intensive care unit in the previous 15 years. The patients included were those that met the clinical and microbiological criteria for TSS proposed by the Centers for Disease Control and Prevention. RESULTS: There were nine patients (four boys). The mean age was 7 years. The most frequent findings were fever (100 %), hypotension (100 %), erythroderma (100 %), multisystem organ failure [coagulopathy (100 %), lethargy (89 %), hypertransaminasemia (89 %), increased creatine phosphokinase levels (78 %), renal failure (66 %)] and cutaneous desquamation (100 %). Laboratory studies showed changes in the leukocyte count and C-reactive protein value in all patients. The etiology was as follows: Staphylococcus was detected in six patients (S. epidermidis in three and S. aureus in three) and Streptococcus was detected in two patients (S. pyogenes in one and S. pneumoniae in one); no microorganisms were detected in only one patient. The origin of the infection was identified in seven patients (cutaneous in six patients and tonsillar in one). All patients received life support and antibiotic treatment. Six patients received corticosteroid treatment and one received intravenous immunoglobulins. Patients with TSS secondary to Streptococcus showed the greatest severity, exhibiting renal failure and requiring greater respiratory and circulatory support. All patients recovered well from the infection, without serious long-term sequelae. CONCLUSION. TSS should be included in the differential diagnosis of patients with fever, exanthema and shock, since early diagnosis has been shown to improve outcomes. S. pneumoniae should be included among the microorganisms that cause TSS. Treatment is based on life support measures and antibiotic therapy.

Síndrome de shock tóxico: experiencia en una UCIP / Toxic shock syndrome: experience in a pediatric intensive care unit

Objetivos. Revisar los casos de síndrome de shock tóxico (SST) admitidos en una unidad de cuidados intensivos pediátricos. Métodos. Estudio retrospectivo de los casos de SST ingresados en los últimos 15 años. Se incluyeron aquellos casos que cumplían los criterios clínico-microbiológicos propuestos por el Center for Disease Control and Prevention (CDC). Resultados. Revisión de un total de 9 casos (4 varones). Edad media de 7 años. Hallazgos más frecuentes: fiebre (100 %), hipotensión (100 %), eritrodermia (100 %), fallo multiorgánico (coagulopatía 100 %, depresión del sensorio 89 %, hipertransaminemia 89 %, aumento de creatinfosfocinasa (CPK) 78 %, insuficiencia renal 66 %, etc.) y descamación cutánea (100 %). En la analítica sanguínea se detectaron alteraciones en la fórmula leucocitaria y la proteína C reactiva de forma constante. Etiología: en 6 casos se aislaron Staphylococcus (tres S. epidermidis, tres S. aureus); en 2 casos Streptococcus (uno S. pyogenes, uno S. pneumoniae), tan sólo en un caso no se detectó microorganismo. El origen de la infección se evidenció en 7 casos: seis de origen cutáneo y uno amigdalar. Todos los pacientes recibieron soporte vital y antibioterapia. Recibieron corticoterapia 6 casos y uno gammaglobulina. Los casos secundarios a Streptococcus presentaron mayor gravedad: insuficiencia renal, mayor soporte ventilatorio y vasoactivo. Todos los casos evolucionaron correctamente del cuadro infeccioso, sin existir secuelas de gravedad a largo plazo. Conclusión. Es necesario incluir el SST en el diagnóstico diferencial de aquellos casos que cursan con fiebre, exantema y shock, ya que un diagnóstico precoz ha demostrado mejorar el pronóstico. S. pneumoniae debe incluirse dentro de los microorganismos causantes de SST. El tratamiento se fundamenta en medidas de soporte y antibioterapia

Objectives. To review patients with toxic shock syndrome (TSS) in a pediatric intensive care unit. Methods. We performed a retrospective study of patients with TSS admitted to the intensive care unit in the previous 15 years. The patients included were those that met the clinical and microbiological criteria for TSS proposed by the Centers for Disease Control and Prevention. Results. There were nine patients (four boys). The mean age was 7 years. The most frequent findings were fever (100 %), hypotension (100 %), erythroderma (100 %), multisystem organ failure [coagulopathy (100 %), lethargy (89 %), hypertransaminasemia (89 %), increased creatine phosphokinase levels (78 %), renal failure (66 %)] and cutaneous desquamation (100 %). Laboratory studies showed changes in the leukocyte count and C-reactive protein value in all patients. The etiology was as follows: Staphylococcus was detected in six patients (S. epidermidis in three and S. aureus in three) and Streptococcus was detected in two patients (S. pyogenes in one and S. pneumoniae in one); no microorganisms were detected in only one patient. The origin of the infection was identified in seven patients (cutaneous in six patients and tonsillar in one). All patients received life support and antibiotic treatment. Six patients received corticosteroid treatment and one received intravenous immunoglobulins. Patients with TSS secondary to Streptococcus showed the greatest severity, exhibiting renal failure and requiring greater respiratory and circulatory support. All patients recovered well from the infection, without serious long-term sequelae. Conclusion. TSS should be included in the differential diagnosis of patients with fever, exanthema and shock, since early diagnosis has been shown to improve outcomes. S. pneumoniae should be included among the microorganisms that cause TSS. Treatment is based on life support measures and antibiotic therapy