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Toxic Shock Syndrome (Other Than Streptococcal) (TSS)
1990 Case Definition

Clinical Criteria

An illness with the following clinical manifestations:

  • Fever: temperature greater than or equal to 38.9°C (102.0°F)
  • Rash: diffuse macular erythroderma
  • Desquamation: 1-2 weeks after onset of illness, particularly on the palms and soles
  • Hypotension: systolic blood pressure less than or equal to 90 mm Hg for adults or less than fifth percentile by age for children aged less than 16 years; orthostatic drop in diastolic blood pressure greater than or equal to 15 mm Hg from lying to sitting, orthostatic syncope, or orthostatic dizziness
  • Multisystem involvement (three or more of the following):
    • Gastrointestinal: vomiting or diarrhea at onset of illness
    • Muscular: severe myalgia or creatine phosphokinase level at least twice the upper limit of normal
    • Mucous membrane: vaginal, oropharyngeal, or conjunctival hyperemia
    • Renal: blood urea nitrogen or creatinine at least twice the upper limit of normal for laboratory or urinary sediment with pyuria (greater than or equal to 5 leukocytes per high-power field) in the absence of urinary tract infection
    • Hepatic: total bilirubin, serum glutamic-oxaloacetic transaminase (SGOT), or serum glutamic-pyruvic transaminase (SGPT) at least twice the upper limit of normal for laboratory
    • Hematologic: platelets less than 100,000/mm3
    • Central nervous system: disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent
  • Negative results on the following tests, if obtained:
    • Blood, throat, or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus)
    • Rise in titer to Rocky Mountain spotted fever, leptospirosis, or measles

Case Classification

Probable

A case with five of the six clinical findings described above

Confirmed

A case with all six of the clinical findings described above, including desquamation, unless the patient dies before desquamation could occur



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