Systemic and Other System Disorders

Abstract

Pathophysiology

TOXIC SHOCK SYNDROME ASSOCIATED WITH STAPHYLOCOCCUS AUREUS SINUSITIS

Ferguson MA, Todd JK. J Infect Dis. 1990;161:953-955.

Purpose of the Study

This study was performed to highlight, through case reviews, the potential for toxic shock syndrome to occur in pediatric patients as a result of Staphylococcus aureus sinusitis.

Study Population

The case studies involved 3 patients between 8 and 14 years of age.

Methods

The study was carried out by case review of medical records.

Findings

Three cases of toxic shock syndrome with sinusitis as their sole focal site of infection were reviewed. Two of the cases had culture documentation of S aureus with a positive nasal culture and good response to antistaphylococcal therapy. Blood and other cultures were negative. All three cases manifested fever, rash, desquamation, and hypotention or orthostatic dizziness, as well as three or more minor criteria demonstrating involvement of other organ systems. The third case, without sinus culture, represented recurrent sinusitis associated with recurrent toxic shock syndrome. All three cases responded to usual therapy for toxic shock syndrome including fluid volume, support, and antistaphylococcal antibiotics.

Conclusions

The authors concluded that sinusitis can be a nonmenstrual site of S aureus infection underlying toxic shock syndrome in pediatric patients. They noted other similar situations such as nasal surgery or nasal packing which had been associated with toxic shock syndrome perhaps due to similar focal growth conditions promoting optimal toxin production. The authors recommended aspiration of sinuses in such cases, not only for diagnosis but as an important therapeutic procedure.