Burns and TSS
By Dr. Colin Michie MA FRCPCH FLS who qualified from Oxford in 1983 and trained as a paediatrician with a special interest in infectious diseases. Dr Michie has also been involved in investigations into the effects of bacterial toxins and has treated a number of patients with TSS.
Burns and scalds often damage normal skin defences, allowing bacteria to grow and synthesise toxins. For many years it has been known that children in particular following burns are prone to develop confusion, fever, low blood pressure, diarrhoea and a rash – in other words, Toxic Shock Syndrome.
This condition may be seen following very small areas of skin damage; it may be fatal with a similar mortality rate to the tampon-related disease. As menstrually related TSS has become less common, this paediatric problem has become more evident.
The early use of antibiotics by mouth may prevent the development of TSS following a burn, but at present it is difficult to identify those most at risk. Various dressings and topical treatments have little effect on the incidence of the illness. Any sick child with a burn or scald must have a blood pressure measurement in order to exclude TSS.
TSS and MRSA
By Dr. Colin Michie MA FRCPCH FLS
Treatment of TSS includes the administration of antibiotics that kill S. aureus and decrease production of the toxin or toxins that are causing the illness. As the incidence of community-acquired infection with MRSA increases, it will become important to consider the possibility that MRSA is responsible for a case of TSS, especially if a patient does not respond to treatment as expected.
Physicians caring for patients with TSS, especially severe cases or in geographic areas where there is a high rate of infection with MRSA, should consider antibiotics that are effective against MSRA.
