June 16, 2009

Sinus Infections May Be Linked To Toxic Shock In Children

U.S. researchers recently reported surprising information suggesting that sinus infections might be responsible for more than 20% of all cases of toxic shock syndrome in children.

They said doctors treating children for toxic shock syndrome should take this into account when providing treatment.

Rhinosinusitis is inflammation of the nose as well as the sinuses surrounding the nose often caused by some sort of infection resulting from bacteria, viral, allergic or autoimmune issues. General symptoms include facial pain, ear pressure, nasal blockage, fatigue, fever, headaches and even halitosis (bad breath).

In a statement, Dr. Kenny Chan of the University of Colorado and the Children's Hospital of Denver said, "Prompt imaging studies of the sinuses is mandatory when no apparent cause of toxic shock syndrome is found."

Toxic shock syndrome (TSS) is a very rare but potentially fatal illness caused by a bacterial toxin.  Different bacterial toxins may cause toxic shock syndrome, depending on the situation. The causative bacteria include Staphylococcus aureus and Streptococcus pyogenes.

While approximately half the cases of TSS reported today are associated with tampon use during menstruation, Chan says that TSS can also occur in children, men, and non-menstruating women. TSS typically manifests as a fever, rash, drop in blood pressure, malaise, confusion and can lead to coma, multi-organ failure and even death.

The number of reported TSS incidence after nasal surgery is 16 cases out of 100,000 patients. There have been five unusual cases of delayed TSS reported that occurred after functional endonasal sinus surgery in which no packing was used. TSS developed in three children and two adults between 5 days and 5 weeks postoperatively. All of the patients were successfully treated without further complications.

Chan and colleagues analyzed the medical records of 76 children who had toxic shock syndrome between 1983 and 2000.

They found 23 were experiencing either acute or chronic sinus infections. Sinus infections were named the prime causative factor of toxic shock in 21% of the cases, many of which were serious. Ten of the children were admitted to the intensive care unit, four required medication to raise their blood pressure and six needed surgery.

"This study illustrates several salient points concerning toxic shock syndrome and rhinosinusitis in children," the authors write. "First, rhinosinusitis as the primary culprit in the pathogenesis of toxic shock syndrome is not a sporadic phenomenon."

"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," they conclude. "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."


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