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Toxic shock syndrome in burns: diagnosis and management
  1. Amber E Young,
  2. Katharine L Thornton
  1. Department of Anaesthesia, South West Paediatric Burns Service, Frenchay Hospital, Bristol, UK
  1. For correspondence:
    Dr A E Young
    Department of Anaesthesia, South West Paediatric Burns Service, Frenchay Hospital, Beckspool Road, Frenchay, Bristol BS16 1LE, UK; Amber.Young{at}

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Toxic shock syndrome (TSS), a toxin-mediated disease, is the most common cause of unexpected mortality in children with small burns. It is a diagnosis that is often missed because of non-specific signs and an ability to mimic other childhood illnesses. Any child with a pyrexia greater than 38.9°C, a rash, or a sudden change in clinical condition within a few days of a burn injury should be monitored closely for TSS. If there is co-incident hyponatraemia or lymphopaenia, or if there is any deterioration in clinical condition, the child should be managed with anti-staphylococcal and streptococcal antibiotics and passive immunity for toxins provided by fresh frozen plasma (FFP) or intravenous immunoglobulin (IVIG). It is essential that all paediatric and emergency departments accepting children with burns are aware of the symptoms, signs and early management of TSS.


Toxic shock syndrome is a severe systemic illness characterised by shock, pyrexia, an erythematous rash, gastrointestinal disturbance and central nervous system signs including lethargy or irritability. It is mediated by toxins produced by some strains of bacteria, most commonly Staphylococcus aureus or Group A Streptococcus. It has a high associated mortality of up to 50% if untreated.1–3 Children under 4 years of age with skin loss are particularly at risk, having not developed antibodies to the toxins produced by the bacteria.

Recent years have seen doctors found guilty of manslaughter for missing a diagnosis of TSS that resulted in the death of an adult patient, and their hospital heavily fined for lack of adequate supervision.4 With the high mortality associated with full-blown TSS in children with burns, it is essential that all doctors involved in the care of these children are aware of how to diagnose and manage TSS.5,6


Toxic shock syndrome first appeared in the medical press in …

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  • Competing interests: None declared.

  • The tragic death of Ahil Islam led to the commissioning of this paper.