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Toxic Shock Syndrome (Other Than Streptococcal) (TSS)
1997 Case Definition

Clinical Criteria

An illness with the following clinical manifestations:

  • Fever: temperature greater than or equal to 102.0°F (greater than or equal to 38.9°C)
  • 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, alanine aminotransferase enzyme, or asparate aminotransferase enzyme levels 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

Laboratory Criteria for Diagnosis

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 which meets the laboratory criteria and in which four of the five clinical criteria described above are present

Confirmed

A case which meets the laboratory criteria and in which all five of the clinical criteria described above are present, including desquamation, unless the patient dies before desquamation occurs



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