Toxic shock syndrome in a scald burn child treated with an occlusive wound dressing

Toxic shock syndrome (TSS) is a rare complication of a Staphylococcus aureus infection and was first described in seven children by Todd [1]. Twenty per cent of the strains of S. aureus are capable of producing toxic shock syndrome toxin (TSST)-1, a superantigen (SAg), which causes the classic picture seen in TSS due to the over stimulation of T-cells [2]. Before the early 1980s, most cases occurred in young women with menstruation (MTSS) and tampon use. Non-menstrual (NMTSS) cases occur in cutaneous and subcutaneous infections, pharyngitis, vaginitis unrelated to menstruation and after surgical procedures (e.g. otolaryngologic). Frame et al. [3] first described TSS in children with burns in 1985. Children, who develop TSS during the first few days after the thermal injury usually only have small burns, which should be expected to heal uneventfully. The staphylococcal exotoxin-1 (TSST-1), which is implicated in the development of this disease, and the low levels or absence of anti TSST-1 antibodies may indicate susceptibility to this illness [4]. The majority of burn victims at our children’s burns unit, and elsewhere, are younger than four years. Most of them present with relatively small scalds.