New football boots and toxic shock syndrome

• Published in: BMJ 2006-06, Vol.332 (7554), p.1376-1378
• Main Authors: Taylor, C M, Riordan, F A I, Graham, C
• Format: Article
• Language: English
• Subjects: Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibiotics; Biological and medical sciences; Blister - complications; Case studies; Child; Children; Diarrhea; Emergency and intensive care: infection, septic shock; Female; Fever; Football; Footwear; Friction; Gene expression; General aspects; Humans; Intensive care medicine; Laboratories; Male; Medical diagnosis; Medical sciences; Menstruation; Mortality; Pediatrics; Practice; Product safety; Shock, Septic - diagnosis; Shock, Septic - drug therapy; Shock, Septic - etiology; Shoes; Skin; Soccer; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy; Staphylococcal Infections - etiology; Toxic shock syndrome; Toxicity; Urine; Vomiting
• ISSN: 0959-8138; 0959-8146; 0959-535X; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.332.7554.1376

Toxic shock syndrome (TSS) was diagnosed, and she was treated with clindamycin at an initial dose of 300 mg every six hours and cefotaxime 3 g every six hours. In children, for whom this association does not apply, TSS is rare and mostly a complication of skin burns affecting less than 10% of the body surface in the very young. 1 Children seem to have a better prognosis than adults, but a paediatric mortality of up to 5% for TSS induced by S aureus is currently quoted. 2 In a series of 13 referrals to a paediatric burns unit, however, none required ventilatory support or died. 1 A perinatal, incomplete form of TSS has been described in which babies develop a systemic exanthema and thrombocytopenia but not multiorgan failure and hypotension. Findings Case 1 Case 2 Fever Yes Yes Diarrhoea and vomiting Yes Yes Hypotension Yes Yes Rash Yes Yes Myopathy Yes No Renal impairment Yes Yes Mucosal erythema Yes Yes Confusion No Yes Case 1 Case 2 Laboratory findings On admission 12 hours after admission On admission 9 hours after admission Haemoglobin (g/l) 117 121 143 116 White cell count (109/l) 10.6 16.0 13.4 17.5 Neutrophil (106/l) 9600 13 100 12 900 16 500 Lymphocytes (106/l) 300 1700 100 200 Platelets (109/l) 180 169 180 149 Serum sodium (mmol/l) 134 137 126 133 Serum urea (mmol/l) 19.6 16.1 7.9 6.7 Serum creatinine (μmol/l) 188 136 88 71 Serum bilirubin (μmol/l) 56 62 NA 21 Creatine kinase (IU/l) NA 5536 NA 270 Aspartate aminotransferase (IU/l) NA 145 NA 37 C reactive protein (mg/l) 353 494 4 104 NA=not available.