New football boots and toxic shock syndromeBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7554.1376 (Published 08 June 2006) Cite this as: BMJ 2006;332:1376
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EDITOR-We read with interest the account by Taylor et al of 2
children getting toxic shock syndrome after blisters from football boots.
We agree strongly that children who present with rash, pyrexia, shock,
gastrointestinal, and central nervous system disturbance as described by
Cole and Shakespeare(1) should be managed as toxic shock syndrome.
However we would like to add two points we consider vital to the
diagnosis and management of toxic shock syndrome:
1. We have published a prospective audit of 37 patients with toxic
shock syndrome out of 1288 cases of paediatric burns admitted to the South
West paediatric burn service(2). In this we found that lymphopaenia was
present in 70% of the children, despite an often normal white cell count,
and hyponatraemia present in 77% prior to fluid administration.
2. We would add that the addition of Fresh Frozen Plasma (FFP) or
Immunoglobulin into the treatment regimen at an early stage to provide
pooled antibodies to the actual toxins involved, in addition to antibiotic
treatment for the organisms, halts further deterioration almost on
Since following a protocol of administration of fluids, antibiotics
and FFP to all children fulfilling Cole and Shakespeares’ criteria, no
patients have deteriorated enough to require ventilation or organ support
and are fully resolved in less than 48 hrs. We attribute our successful
outcomes to early diagnosis of toxic shock syndrome through an effective
integrated care pathway and pooled antibody use.
It is crucial that early, effective diagnosis and management of toxic
shock syndrome occurs to prevent possible multi-organ failure or death and
our audit data suggests that FFP is a key component of this management.
1. R.P. Cole and P.G. Shakespeare, Toxic shock syndrome in scalded
children. Burns 1990;16;221-224
2. White MC, Thornton K, Young AE. Early diagnosis and treatment of
toxic shoch syndrome in paediatric burns. Burns 2005;31:193-7.
Competing interests: No competing interests