A case study on early recognition and comprehensive nursing management on toxic shock syndrome in a paediatric patient

Shwetha1*, Shalini H S2, Vijayakumari. D3

1Nursing In charge, Kauvery Hospital, Electronic City, Bangalore

2CNO, Kauvery Hospital, Electronic City, Bangalore

3Nursing Educator, Kauvery Hospital, Electronic City, Bangalore

*Correspondence

Abstract

Toxic Shock Syndrome (TSS) is a serious toxin-mediated systemic illness that can progress rapidly and requires early recognition, prompt treatment, supportive management and close monitoring. This report presents a 3-year-old female child weighing 13.3 kg who was admitted with complaints of high-grade fever for two days and generalized rashes for two days, associated with cough and cold for one day. On assessment, the child had a heart rate of 120/min, respiratory rate of 20/min, temperature of 99°F and SpO₂ of 97% on room air. Rashes were present over the face, abdomen and back. Investigations showed an elevated total leukocyte count of 14,850 cells/cumm and CRP of 5.1 mg/dL, while the dengue profile and influenza panel were negative. The child was treated with intravenous fluids, antibiotics, antipyretics and supportive measures. With appropriate medical and nursing management, the child showed symptomatic improvement from the second day of admission, remained afebrile for the preceding 24 hours and showed a reduction in rashes. The child was discharged in a stable condition with medications and follow-up advice.

Key words: Toxic Shock Syndrome (TSS); Abdominal pain

Introduction

Toxic Shock Syndrome is an acute and potentially life-threatening condition caused by bacterial toxin-mediated systemic inflammation. It is commonly associated with Staphylococcus Aureus and Group A Streptococcus. The condition may present with fever, rash, tachycardia and other systemic manifestations and can progress rapidly if not recognized and treated promptly. In pediatric patients, early identification of changes in vital signs, hydration status, skin manifestations and general condition is particularly important. Nursing care plays a significant role in continuous assessment, administration of prescribed treatment, maintaining hydration, monitoring for complications, providing comfort and educating the parents. This report highlights the importance of comprehensive nursing care in a child diagnosed with Toxic Shock Syndrome.

Case presentation

A 3-year-old female child weighing 13.3 kg was brought to the hospital with complaints of high-grade fever and rashes for two days. The child also had cough and cold for one day. There were no complaints of abdominal pain or loose stools. The child was admitted for further evaluation and management.

On clinical examination

Heart rate120 Beats/min
Respiratory rate20 Breaths/ min
Temperature99°F
SpO₂97% on room air
Respiratory ExaminationBilateral air entry present
Cardiovascular ExaminationS1 and S2 +
Abdomen ExaminationSoft with bowel sounds present
Neurological ExaminationNo focal neurological abnormality
General AppearanceRashes were noted over the face, abdomen and back

Laboratory investigations

Total leukocyte count14,850 cells/cumm
Platelet count2.98 lakh
CRP5.1 mg/dL
Dengue profileNegative
Influenza panelNegative
2D echocardiographyNormal Findings

The child was treated with IV fluids, antibiotics and supportive measures as prescribed. Documented medications included ceftriaxone, linezolid, pantoprazole, paracetamol and hydroxyzine, along with Calosoft lotion for skin care.

Comprehensive Nursing Management

Nursing management focused on continuous assessment and early identification of any deterioration. Vital signs including temperature, heart rate, respiratory rate and oxygen saturation were monitored regularly. The child’s skin was assessed for the distribution and progression of the rash, and changes were documented. Hydration was maintained through prescribed IV fluids and oral fluids as tolerated, with monitoring of intake and output and urine output. Medications were administered as prescribed, and the child was observed for therapeutic response and possible adverse reactions. The nursing team also monitored for signs of systemic complications such as hypotension, respiratory distress, altered sensorium, reduced urine output, persistent fever and worsening skin manifestations. Appropriate infection-prevention practices were followed, and comfort measures were provided to promote rest and reduce discomfort. Parents were involved in the child’s care and were regularly informed about the child’s progress.

Course in the Hospital

The child was admitted and evaluated with the necessary investigations. IV fluids, antibiotics and supportive measures were initiated as prescribed. The child showed symptomatic improvement from the second day of admission. There were no fever spikes for the preceding 24 hours, and the rashes had decreased. The child’s general condition improved with continued treatment and nursing care. After clinical stabilization, the child was discharged in a stable condition with prescribed medications and follow-up advice.

Discussion

This case demonstrates the importance of early recognition and close monitoring in a pediatric patient with Toxic Shock Syndrome. The combination of fever, generalized rash, tachycardia and elevated inflammatory markers required careful assessment and timely management. Although the child’s temperature was 99°F at the time of documented examination, the history of high-grade fever was significant and required continued monitoring. The generalized rash was assessed regularly to identify progression or improvement. IV fluid therapy supported hydration, while prescribed antimicrobial and supportive medications were administered with close observation for response and adverse effects. From a nursing perspective, continuous monitoring was essential because TSS can progress rapidly and may result in systemic complications. Regular assessment of vital signs, urine output, skin condition, respiratory status, neurological status and overall behaviour helped in identifying changes early. Parent education was also an important component of care, particularly regarding medication compliance, adequate hydration, skin care, follow-up and warning signs requiring immediate medical attention.

Conclusion

This case of Toxic Shock Syndrome in a 3-year-old child emphasizes the importance of early recognition, timely treatment, supportive care and vigilant nursing observation. The child responded well to treatment, with improvement from the second day, no fever spikes for 24 hours and reduction in rashes. Comprehensive nursing care, including regular assessment of vital signs, skin condition and hydration status, safe medication administration, monitoring for complications, infection prevention and parental education, supported the child’s recovery and safe discharge. The case reinforces that early recognition; continuous monitoring and prompt intervention are essential components of effective nursing care in Toxic Shock Syndrome.

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