Characteristic Feature of Toxic Shock Syndrome in Children with Burns
Leucopenia is the characteristic feature of toxic shock syndrome in children with burns. 1
Understanding Toxic Shock Syndrome in Pediatric Burns
Toxic shock syndrome (TSS) is a potentially life-threatening complication that can occur in children with burns, even with relatively small burn injuries. While TSS presents with multiple clinical manifestations, leucopenia stands out as the distinguishing laboratory feature in the pediatric burn population.
Key Clinical Features of TSS in Burned Children:
- Typically presents within 2-5 days post-burn injury 2, 3
- Can occur even with minor burns (as small as 2% total body surface area) 4, 5
- Most commonly affects children under 2 years of age 2
- Presents with:
Why Leucopenia is the Characteristic Feature
Among the options presented (purulent wound drainage, leucopenia, hypothermia, bradycardia), leucopenia is the defining laboratory abnormality in TSS. The Surviving Sepsis Campaign guidelines specifically identify leucopenia as a key feature in toxic shock syndromes, particularly in the pediatric population 1.
Why the Other Options are Not Characteristic:
Purulent wound drainage: While infection is the underlying cause of TSS, purulent drainage is not a consistent or characteristic finding. TSS is toxin-mediated rather than directly related to wound infection appearance.
Hypothermia: TSS typically presents with fever rather than hypothermia 5, 6.
Bradycardia: TSS is more commonly associated with tachycardia as part of the systemic inflammatory response, not bradycardia 1.
Management Implications
Early recognition of leucopenia in a burned child with sudden deterioration should prompt consideration of TSS. The guidelines recommend:
- Immediate administration of clindamycin (to reduce toxin production) and antitoxin therapies for toxic shock syndromes with refractory hypotension 1
- Early and aggressive source control 1
- Prompt fluid resuscitation and hemodynamic support 1
Important Considerations
- TSS can occur even with very small burns (as low as 2% TBSA) 4
- Children with burns should be monitored closely for signs of TSS, especially 1-7 days post-injury 3
- TSS in pediatric burns carries significant mortality risk if not promptly diagnosed and treated 6
- Parent education about warning signs is crucial, as many cases present after discharge 4, 5
Early recognition of leucopenia in the context of other clinical signs can facilitate prompt diagnosis and treatment of this potentially fatal condition in children with burns.