1174 HOST DETERMINANTS OF TOXIC SHOCK SYNDROME AND SCALDED SKIN SYNDROME IN CHILDREN AND ADOLESCENTS

Abstract

Staphylococcal scalded skin syndrome (SSSS) and toxic shock syndrome (TSS) appear to be toxin mediated diseases caused by different strains of S. aureus. We reviewed all cases of TSS (defined by the collaborative strict case definition) and SSSS (acute fever, painful erythroderma, positive Nikolsky sign) at The Children's Hospital of Denver for the years 1979-84. Of the 16 TSS cases, 13 (81%) were female compared to a balanced distribution of 5 (50%) of 10 hospitalized SSSS cases (p=0.22). The mean age was significantly greater (p=0.0007) for TSS compared to SSSS females (13.8±5.8 vs 2.4±2.5 years) but not males (7.1±0.8 vs 3.6±4.2 years). The likelihood of a potential focus of sequestered infection (vagina, abscess) was significantly greater (p=0.0003) in the TSS group. All 10 postmenarchal females with TSS were menstruating, grew S. aureus from vaginal cultures, and were using tampons at the time of clinical onset. Of the remaining 6 TSS patients (3 female), 4 had distinct loci of infection (bacteremia, cervical abscess, wound abscess, cervical adenitis) compared to only 1 (bacteremia) of 10 SSSS patients (p=0.07). These clinical differences suggest that S. aureus strains capable of causing TSS may require different host potentiating conditions than SSSS strains (focal infection vs nasopharyngeal colonization) to cause disease.

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