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Rhinosinusitis Appears to Be a Primary Factor in Toxic Shock Syndrome in Children CHICAGO -- June 15, 2009 -- Rhinosinusitis appears to be a primary factor in about one-fifth of toxic shock syndrome cases in children, according to a study published in the June issue of Archives of Otolaryngology-Head & Neck Surgery. “Although not as publicised, numerous other risk factors have been established for toxic shock syndrome in association with focal infections, such as surgical wound infections, postpartum and postabortion infections, and a wide variety of connective tissue lesions,” the authors wrote. Kenny H. Chan, MD, University of Colorado School of Medicine and The Children’s Hospital of Denver, Denver, Colorado, and colleagues analysed the medical records of 76 children (mean age, 10 years) who were identified as having toxic shock syndrome between 1983 and 2000. Of these, 23 were also diagnosed as having either acute or chronic rhinosinusitis. No other source of infection was identified in 17 cases. “Correlation of the data revealed 4 patients who met the criteria for proven toxic shock syndrome and proven rhinosinusitis, 2 patients who met the criteria for probable toxic shock syndrome and proven rhinosinusitis, 7 patients who met the criteria for proven toxic shock syndrome and possible rhinosinusitis, and 3 patients who met the criteria for probable toxic shock syndrome and possible rhinosinusitis,” the authors wrote. Of the 23 patients with toxic shock syndrome and rhinosinusitis, 10 were admitted to the intensive care unit (ICU), 4 required pressors, and 6 received surgical interventions. There was little difference in the average number of hospital days following toxic shock syndrome between children with rhinosinusitis and those without, although those with rhinosinusitis had a higher incidence of ICU admission, pressor administration, and intubation. “This study illustrates several salient points concerning toxic shock syndrome and rhinosinusitis in children,” the authors wrote. “First, rhinosinusitis as the primary culprit in the pathogenesis of toxic shock syndrome is not a sporadic phenomenon. In fact, the frequency of this combination for this 18-year series is an impressive 21%.” “It is imperative that physicians, particularly those who are providing intensive care to children, recognise that rhinosinusitis can be the sole cause of toxic shock syndrome in children,” they concluded. “Prompt imaging studies of the sinuses is mandatory when no apparent cause of toxic shock syndrome is found. Once rhinosinusitis is diagnosed, timely otolaryngology referral should be obtained, and sinus culture and lavage should be considered if the clinical condition warrants it.” SOURCE: Archives of Otolaryngology-Head & Neck Surgery E-mail this page to a friend or colleague! To print, use this version