From the Guidelines
The correct answer is (b) leukopenia. Toxic shock syndrome (TSS) in children with burns is characterized by a significant decrease in white blood cell count, known as leukopenia, as the toxins produced by bacteria trigger an overwhelming immune response that depletes white blood cells 1. Other hallmark features of TSS include high fever, tachycardia, hypotension, and a diffuse rash that resembles sunburn. The wound drainage in TSS is not necessarily purulent, as the condition is toxin-mediated rather than caused by direct tissue invasion.
Key Features of TSS
- High fever
- Tachycardia
- Hypotension
- Diffuse rash
- Leukopenia Leukopenia in this context serves as an important diagnostic indicator and reflects the severity of the systemic inflammatory response to bacterial toxins. Early recognition of this feature, along with other symptoms, is crucial for prompt intervention with appropriate antibiotics, fluid resuscitation, and supportive care to prevent potentially fatal outcomes in pediatric burn patients. The management of severe thermal burns in the acute phase involves early fluid resuscitation, with experts proposing the administration of 20 mL/kg of crystalloid within the first hour to address the early hypovolaemic phase 1.
From the Research
Characteristic Features of Toxic Shock Syndrome
- The characteristic features of toxic shock syndrome (TSS) in children with burns are not explicitly listed in the provided options, but based on the studies, common symptoms include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension 2, 3, 4, 5, 6.
- Diffuse erythema and desquamation may occur later in the disease course 2.
- Laboratory assessment may demonstrate anemia, thrombocytopenia, elevated liver enzymes, and abnormal coagulation studies 2.
Options Analysis
- Option (a) purulent wound drainage is not a characteristic feature of TSS, but rather a sign of infection 4.
- Option (b) leukopenia is not typically associated with TSS, although laboratory abnormalities may include anemia and thrombocytopenia 2.
- Option (c) hypothermia is not a characteristic feature of TSS, but rather hypotension 2, 3.
- Option (d) bradycardia is not typically associated with TSS, although the disease can cause multiple organ failure syndrome and death 3.
Burn-Related TSS
- TSS is a rare, but potentially life-threatening complication of thermal injuries in children 4.
- The injured total body surface area in burn-related TSS cases can range from less than 1% to 41% 4.
- Diagnosis of TSS in children with burns can be challenging, and awareness among treating clinicians is crucial for a favourable outcome 4, 5.