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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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TOXIC SHOCK SYNDROME IN A PAEDIATRIC INTENSIVE CARE UNIT

Filipa Furtado1, Anaxore Casimiro1, Vera Brites1, João Estrada1, Maria João Brito2, Margarida Santos1

1- Unidade de Cuidados Intensivos Pediátricos;Área da Mulher, Criança e Adolescente; Hospital Dona Estefânia; Centro Hospitalar de Lisboa Central, Lisboa
2- Unidade de Infecciologia Pediátrica; Área da Mulher, Criança e Adolescente; Hospital Dona Estefânia; Centro Hospitalar de Lisboa Central, Lisboa

-28th Annual Meeting of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC), Lisboa (poster com discussão).

Background:Toxic shock syndrome(TSS) is an acute life-threatening illness, mediated by toxins produced by some strains of bacteria, most commonly Staphylococcus aureus and Streptococcus pyogenes. It´s a relatively rare but severe disease, which is more common in children than in adults.
Objectives: To describe and analyze clinical features, treatment and outcome of children with TSS.
Methods: Retrospective chart review, between 2005 and 2016, of children admitted in a pediatric intensive care unit with TSS (Centers for Disease Control case definition).
Results: In 3943 admitted patients, 11 fulfilled TSS criteria’s. Seven were male and the median age was two years (nine months to 18 years). Eight cases of streptococcal TSS (six confirmed) and three cases of staphylococcal TSS (two confirmed). Predisposing factors were identified in eight children [varicella(1), burn(1), postoperative(2), acute lower respiratory infection(1), influenza(2) and immunocompromised(1)].In all cases, intensive treatments were required: invasive ventilatory support(n=4; mean 7,3 days), inotropic support(n=10; mean 10 days), a child needed extracorporeal membrane oxygenation. All patients did clindamycin and other antitoxin therapies were performed [intravenous immunoglobulin(3), steroids(3) and fresh frozen plasma(3)]. At admission, Pediatric Risk of Mortality Score II(PRISM) presented an average of 11,7. In seven cases there were several complications due to TSS, despite this, all patients survived.
Conclusions: This study emphasizes the importance of early recognition of TSS. The high PRISM II value at admission supports the severity of these cases and the need for early treatment. A national prospective study is essential to understand the reality of TSS in Portugal.

Palavras Chave: pediatric intensive care; toxic shock syndrome.