![]() ![]() 1, 10 Streptococcus pneumoniae and Streptococcus pyogenes have also been reported as potential causes of TSS, 3 cases of which were described in patients with rhinosinusitis. In a large proportion of TSS cases, the pathogenesis involves Staphylococcus aureus infection. Also, a diverse set of multisystem derangements may be present. The 3 hallmark clinical signs include fever, erythrodermatoid rash, and hypotension. Reingold and colleagues' algorithm for diagnosis stipulates that 4 of 4 diagnostic criteria must be present for proven TSS and that 3 of 4 diagnostic criteria must be present for probable TSS ( Table 1). The criteria for the diagnosis of TSS were originally established by the Centers for Disease Control and Prevention and were subsequently revised by Reingold et al 9 in 1982. The association between TSS and rhinosinusitis has been less well characterized in the literature, with only a few case reports having been published to date. 2 Although not as publicized, numerous other risk factors have been established for TSS in association with focal infections, such as surgical wound infections (notably after rhinologic surgery and nasal packing), postpartum and postabortion infections, and a wide variety of connective tissue lesions. Several years later, the syndrome gained widespread recognition as a disease associated with menstruation and tampon use. Toxic-shock syndrome (TSS) was first described in pediatric patients by Todd et al 1 in 1978. Once the link is made, prompt otolaryngology consultation and sinus lavage should be considered. Rhinosinusitis should be considered the primary cause of TSS when another site of infection has not been identified. Results Correlation of the data revealed 4 patients who met the criteria for proven TSS and proven rhinosinusitis, 2 patients who met the criteria for probable TSS and proven rhinosinusitis, 7 patients who met the criteria for proven TSS and possible rhinosinusitis, and 3 patients who met the criteria for probable TSS and possible rhinosinusitis.Ĭonclusions Rhinosinusitis was found to be the primary cause of TSS 21% of the time in this series. Main Outcome Measures Patients with TSS and rhinosinusitis were identified using a rigorous set of definitions and detailed data pertaining to history, imaging studies, microbiologic studies, and hospital course. Surgical intervention for sinus disease included bilateral antral lavage in 5 patients and bilateral maxillary antrostomy and ethmoidectomy in 1 patient. Interventions Of the 23 patients with TSS and rhinosinusitis, 10 were admitted to the intensive care unit, 4 required pressors, and 6 received surgical intervention. Twenty-three of them were also diagnosed as having either acute or chronic rhinosinusitis, with no other source of infection in 17 cases. Patients A total of 76 patients were identified as having TSS. Objective To determine the association between toxic shock syndrome (TSS) and rhinosinusitis in children.ĭesign Eighteen-year retrospective review of medical records. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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