Sinus Infections

Can Cause Toxic Shock in Kids:

Sinus infections may be a primary factor in about 20 percent of toxic shock syndrome cases in children, a new study has found.

Fever, rash and low blood pressure are among the signs of toxic shock syndrome, widely regarded as a disease associated with tampon use and menstruation, according to background information in the study.

"Although not as publicized, numerous other risk factors have been established for toxic shock syndrome 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," Dr. Kenny H. Chan, of the University of Colorado School of Medicine and The Children's Hospital of Denver, and colleagues, reported in the study.

The researchers analyzed the medical records of 76 children, average age 10, identified as having toxic shock syndrome. Of those children, 23 were also diagnosed with either acute or chronic rhinosinusitis -- infection and inflammation in the sinus passages surrounding the nose.

Ten of the 23 children with toxic shock syndrome and rhinosinusitis were admitted to the intensive care unit, four required medications to increase blood pressure and six underwent surgery, according to the study published in the June issue of the Archives of Otolaryngology--Head & Neck Surgery.

"This study illustrates several salient points concerning toxic shock syndrome and rhinosinusitis in children," Chan and colleagues wrote. "First, rhinosinusitis as the primary culprit in the pathogenesis of toxic shock syndrome is not a sporadic phenomenon. In fact, the frequency of this combination…[in the study] is an impressive 21 percent."

The researchers concluded that "it is imperative that physicians, particularly those who are providing intensive care to children, recognize that rhinosinusitis can be the sole cause of toxic shock syndrome in children. Prompt imaging studies of the sinuses is mandatory when no apparent cause of toxic shock syndrome is found. Once rhinosinusitis is diagnosed, timely otolaryngology referral should be obtained, and sinus culture and lavage should be considered if the clinical condition warrants it."