Table 3.

Staphylococcal and Streptococcal toxic shock syndrome clinical disease definitions

Staphylococcal toxic shock syndrome (TSS)	Streptococcal toxic shock syndrome (STSS) (Modified CDC definition 2010)
1.Fever >/ = 39.9 °C 2.Rash – diffuse blanching erythema (‘sunburn’ like) (see Figure 2) 3.Desquamation – 10–14 days after onset of illness- palms and soles (see Figure 3) 4.Hypotension – systolic BP < 90 mmHg adults	A.Isolation of GAS from: 1.Normally sterile site – blood, CSF, peritoneal fluid, tissue biopsy. 2.Non-sterile site – throat, vagina, sputum
Multisystem involvement Three or more of the following systems affected: Gastrointestinal – vomiting or diarrhoea at onset illness Muscular – severe myalgia or elevated Creatinine phosphokinase Mucous membranes – vaginal, oro-pharyngeal or conjunctival hyperaemia Renal – blood urea nitrogen or creatinine twice upper limit of normal Hepatic – total bilirubin twice upper limit normal Haematological – platelets <100 x 109/L Central nervous system -disorientation or alterations conscious level with no focal neurological signs	B. Clinical case definition Multi-organ involvement characterized by two or more of the following: 1.Hypotension 2. Two or more of the following: Renal impairment – creatinine> 2 mg/dl Coagulopathy – platelets <100 x109/L or Disseminated intravascular coagulation. Liver involvement – ALT, AST or bilirubin levels twice normal upper limit for age Acute respiratory distress syndrome. Generalized erythematous macular rash – (10% patients) may desquamate Soft tissue necrosis- NF, myositis or gangrene
Case classification: Probable – 4 of the 5 clinical findings positive Confirmed – case with all 5 clinical findings	Case classification: Probable – meets clinical case definition (above) plus isolation from non-sterile site Definite – meets clinical case definition (above) plus isolation of Group A streptococcus from a normally sterile site
Overall better prognosis – mortality < 10%	Poor prognosis especially if associated with NF- mortality >40%