Toxic Shock Syndrome From Sinus Infection?

Children's Sinusitis Can Lead to Toxic Shock Syndrome, Study Shows

Reviewed by Louise Chang, MD on June 15, 2009
From the WebMD Archives

June 15, 2009 -- Sinus infections in children can sometimes lead to toxic shock syndrome, according to a new study. Toxic shock syndrome, a potentially fatal condition typically known for its association with tampon use, is also known to be linked with numerous infections.

The link between sinus infection and toxic shock syndrome in children has been largely overlooked until now, says study lead author Kenny Chan, MD, chief of pediatric otolaryngology at The Children's Hospital and professor of otolaryngology at the University of Colorado, Denver.

About one-fifth of the 76 patients identified with toxic shock syndrome over an 18-year period in Chan's study also had sinusitis -- and no other source of infection for the toxic shock could be found, he says.

"It came as a surprise to me in terms of not realizing it was that high," Chan tells WebMD. But, he says, to put it in perspective, "sinus infections sometimes have rare complications, one of which is toxic shock syndrome." His study is published in the Archives of Otolaryngology -- Head & Neck Surgery.

Toxic Shock Syndrome and Sinusitis

Toxic shock syndrome, caused by toxins released by bacteria that have infected a body part, was first described in children more than 30 years ago, Chan notes, and in later years was found in menstruating women using tampons.

"The medical community and the community in general latched onto tampon use because it is a more frequent phenomenon than any other cause," Chan says.

While the public perception of the disease is often linked just with tampon use, Chan says many other risk factors are known, including surgical wound infections, postpartum infections, and many types of connective tissue lesions.

Symptoms of toxic shock syndrome include fever, rash, vomiting, diarrhea, and severe muscle pain. Blood pressure drops to an abnormally low level and multiple organ failures can occur. Bacteria known as Staphylococcus aureus can cause toxic shock, as can other bacteria.

Sinus Infection and Toxic Shock Syndrome: Study Details

Chan and his colleagues evaluated the medical records of 76 children, average age 10, who were found to have toxic shock syndrome between 1983 and 2000.


Of the 76, 23 were diagnosed as also having acute or chronic rhinosinusitis, with no other infection source identified in 17 cases. In rhinosinusitis, the sinus membranes are inflamed, which can be triggered by a bacterial or viral infection. Nasal congestion, coughing, postnasal drip, and discomfort in the cheeks are common symptoms.

Next, Chan's team divided the patients into those who met the criteria for proven toxic shock syndrome and proven rhinosinusitis. Four patients had proven toxic shock and proven rhinosinusitis.

All groups fared about the same once diagnosed, although those with both conditions were more likely to need to be admitted to the intensive care unit and to need more intensive treatment.

Second Opinion

The study findings should not alarm parents, says Frank Virant, MD, a Seattle allergist and clinical professor of pediatrics at the University of Washington, Seattle.

"Sinusitis infection is exceedingly common in kids," he tells WebMD, especially children who have asthma.

While the researchers couldn't find any other source of infection besides the sinus infection in about 20% of the patients, Virant points out that a much smaller percent -- only 4 patients, or about 5% -- had proven rhinosinusitis and proven toxic shock syndrome.

Advice to Parents

Parents can keep a watchful eye on children with sinusitis or suspected sinusitis, Chan says.

"If things don't add up, and if the symptoms are unusual in terms of severity and duration, don't just blow it off as a cold," he says. Seek medical care.

WebMD Health News



Kenny Chan, MD, chief of pediatric otolaryngology, The Children's Hospital; professor of otolaryngology, University of Colorado School of Medicine, Denver.

Frank Virant, MD, clinical professor of pediatrics, University of Washington, Seattle.

Chan, K. Archives of Otolaryngology -- Head and Neck Surgery, June 2009; vol 135: pp 538-542.

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