Table 2.

TTS criteria [12]

Clinical Criteria
Fever: temperature greater than or equal to 38.9 °C
Rash with diffuse macular erythroderma
Desquamation: 1–2 weeks after onset of rash
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
Multisystem involvement (three or more of the following organ systems): o Gastrointestinal: vomiting or diarrhea at onset of illness o Muscular: severe myalgia or creatine phosphokinase level at least twice the upper limit of normal o Mucous membrane: vaginal, oropharyngeal, or conjunctival hyperemia o 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 o Hepatic: total bilirubin, alanine aminotransferase enzyme, or asparate aminotransferase enzyme levels at least twice the upper limit of normal for laboratory o Hematologic: platelets less than 100,000/mm3 o Central nervous system: disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent
Laboratory Criteria
Negative results on the following tests, if obtained: Blood or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus) Negative serologies for 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