Toxic Shock Syndrome Associated with Staphylococcus aureus Sinusitis in Children

Toxic shock syndrome (TSS) is a severe, acute, multisystem illness associated with rash and shock. It is usually associated with a focal infection (e.g., during menstruation associated with tampon use, abscess, surgical wound infection) caused by certain Staphylococcus aureusstrains. Identification and drainage of the focus of infection may be important in therapy. Occasionally, a focus of infection is not obvious, requiring additional diagnostic procedures. Three cases of children with TSS associated with sinusitis and no other focus ofS. aureusinfection are presented, demonstrating the important consideration of the perinasal sinuses as a cryptic focus of S. aureus infection causing TSS. Since its first description and association with Staphylococ-cus aureus infection in 1978 [1], toxic shock syndrome (TSS) has been associated with various high-risk groups. Several studies have clearly correlated TSS with the use of tampons during menstruation [2-5] and, more recently, with the use of barrier contraceptives. An increased risk has also been sug-gested in nonmenstruating individuals including postpartu