Table 7.

Clinical Criteria for the Diagnosis of Streptococcal Toxic Shock Syndrome

Major criteria	Minor criteria (two of more of the following)
Hypotension (SBP <90 mm Hg)	Renal impairment (urea or creatinine twice upper limit of normal). In patients with pre-existing renal disease.
	Coagulopathy: Platelets less than or equal to 100,000/mm3 (less than or equal to 100 × 106/L) or disseminated intravascular coagulation, defined by prolonged clotting times, low fibrinogen level, and the presence of fibrin degradation products.
	Liver involvement: Alanine aminotransferase, aspartate aminotransferase, or total bilirubin levels greater than or equal to twice the upper limit of normal for the patient's age. In patients with pre-existing liver disease, a greater than twofold increase over the baseline level.
	Acute respiratory distress syndrome: Defined by acute onset of diffuse pulmonary infiltrates and hypoxemia in the absence of cardiac failure or by evidence of diffuse capillary leak manifested by acute onset of generalized edema, or pleural or peritoneal effusions with hypoalbuminemia.
	A generalized erythematous macular rash that may desquamate.
	Soft-tissue necrosis, including necrotizing fasciitis or myositis, or gangrene.

A “probable” case meets the clinical case definition in the absence of another identified etiology for illness and with isolation of group A Streptococcus from a non-sterile site.

A “confirmed” case meets the clinical case definition and with isolation of group A Streptococcus from a normal sterile site (e.g., blood or cerebrospinal fluid or joint, pleural or pericardial fluid.

SBP = systolic blood pressure.