Staphylococcal infections in children: part 3.

Abstract

1. Anjali Jain, MD* 2. Robert S. Daum, MD* 1. 2. *The Department of Pediatrics, Section of Pediatric Infectious Diseases, The University of Chicago, Chicago IL. After completing this article, readers should be able to: 1. Describe the characteristics of toxic shock syndrome in a young child who has multiple organ failure and shock. 2. Plan therapeutic options for children who have community-acquired staphylococcal infections. 3. Describe the clinical features of a food-borne infectious outbreak that suggest the need to include staphylococcal food poisoning in the differential diagnosis. 4. Plan the antimicrobial therapy of staphylococcal infections. ### TOXIC SHOCK SYNDROME In 1978, Todd et al first described toxic shock syndrome (TSS) in seven children. At about the same time, a marked increase in the number of cases called attention to a possible association between TSS and the use of newly introduced superabsorbent tampons by menstruating women. Between 1980 and 1986, 2,960 cases of TSS were reported to the Centers for Disease Control and Prevention (CDC), 90% of which were associated with menses. In 1980, an epidemiologic link between TSS and the use of super-absorbent tampons was discovered; one brand of these tampons was removed from the market in 1980, and all tampons containing poly-acrylate fibers were removed in 1985. Published reports made it apparent that cases of TSS not associated with menses also occurred infrequently among women as well as men and children. Clinically, nonmenstrual and menstrual TSS are similar entities, but they seem to affect different populations and vary in outcome. Since its peak in the early 1980s, the incidence of TSS has decreased markedly with the institution of preventive measures. However, nonmenstrual TSS has decreased to a lesser extent and now accounts for an increased percentage of all TSS cases, currently about 50%. #### Epidemiology Overall, menstrual TSS occurs at an estimated rate of 1 per 100,000 menstruating women per year, 99% of whom use tampons. The decreased incidence of this disease probably is related to a greater awareness of its presentation, the nonuse …