What is a characteristic feature of toxic shock syndrome (TSS) in children with burns?

Leukopenia is a Characteristic Feature of Toxic Shock Syndrome in Children with Burns

Leukopenia is a characteristic feature of toxic shock syndrome (TSS) in children with burns. 1

Clinical Features of Toxic Shock Syndrome in Pediatric Burns

Toxic shock syndrome is a potentially life-threatening condition that can occur in children with burns, even those with minor thermal injuries. Understanding its characteristic features is crucial for early diagnosis and management:

Key Clinical Features

• Leukopenia: A hallmark laboratory finding in TSS, distinguishing it from other infectious complications of burns 1, 2
• Fever: Typically presents within 2-3 days of thermal injury 3, 4
• Erythematous rash: Often diffuse and resembling sunburn 1
• Hypotension: Can progress rapidly to shock 1
• Multiorgan involvement: Including gastrointestinal symptoms (diarrhea, vomiting) 4, 2
• Desquamation: Occurs later in the course of illness 1

Timing and Presentation

• TSS typically develops within 1-7 days after the burn injury (median 2.5 days) 4
• Can occur even with very small burns (as little as 2% total body surface area) 5, 2
• Most commonly affects children under 2 years of age 3

Distinguishing Features from Other Options

Why Leukopenia is Correct

• Leukopenia is a distinctive laboratory finding in TSS that helps differentiate it from other infectious complications of burns 1
• It reflects the superantigen-mediated nature of the disease rather than a typical bacterial infection 1

Why Other Options are Incorrect

• Purulent wound drainage: Not characteristic of TSS; in fact, TSS often occurs with wounds that appear relatively clean 3, 2
• Hypothermia: TSS typically presents with high fever, not hypothermia 1, 4
• Bradycardia: Tachycardia, not bradycardia, is the typical cardiovascular finding in TSS due to the hyperdynamic state and compensatory response to hypotension 1

Management Considerations

Early recognition and prompt management are crucial for improving outcomes:

• Aggressive fluid resuscitation is the cornerstone of initial management 1
• Appropriate antimicrobial therapy should target S. aureus (most common cause in burn-related TSS) 1, 3
• Clindamycin should be included in the regimen to reduce toxin production 6
• Intravenous immunoglobulin may be considered in severe cases to neutralize superantigens 1, 4
• Transfer to a specialized pediatric intensive care unit or burn center may be necessary 3, 2

Important Clinical Pearls

• TSS can occur after discharge from the hospital, highlighting the importance of parent education about warning signs 5
• The cessation of prophylactic antibiotics can sometimes be followed by the development of TSS 5
• Mortality in pediatric TSS (5-10%) is lower than in adults but still significant 1
• Children with comorbidities or immunodeficiencies may be at higher risk for severe presentations 4