Burns or scalds are frequently are associated with transient rashes and pyrexia and rarely associated with toxic shock syndrome. Toxic shock syndrome(TSS) is defined by a set of clinical criteria, but is thought to be caused by a bacterial superantigen (TSST-1) which activates Vβ2+ T cells. We therefore measured T cell phenotypes using standard flow cytometric techniques in a series of 6 children admitted to a paediatric unit following burns. None of the cases studied showed hypotension; 4 developed fever and diarrhoea, 2 had an erythematous rash. All 6 cases initially had a clean burn, but all were commenced on antibiotics within 48 hours of admission. Staphylococci were grown from the burn in all 6 children. All cases were discharged within 10 days. Of these cases 4 showed substantial changes in the repertoire of their circulating T lymphocytes, equivalent to that described in patients with toxic shock syndrome. Decreased total lymphocyte counts were observed in all 4(median 0.6, range 0.3-1.1×109/dl), and raised proportions of Vβ2+ T cells were observed (median 15% of CD3+ cells, range 12-26%). These changes resolved within days, and were not present at discharge. These observations suggest that superantigens activating Vβ2+ cells may be more frequently involved in children with burns than is recognised, although in the majority of cases this is a sub clinical phenomenon which will not lead to TSS. The T cell repertoire was distorted in those patients with fever, diarrhoea and low lymphocyte counts: these may therefore be investigated as proxy measures of bacterial superantigenic activity.
