Table 2.

Case Definition for Streptococcal Toxic Shock Syndrome, as First Defined by the Working Group on Severe Streptococcal Infections

I. Isolation of group A streptococci (Streptococcus pyogenes)

A. From a normally sterile site (eg, blood, cerebrospinal fluid, pleural or peritoneal fluid, tissue biopsy, surgical wound)

B. From a nonsterile site (eg, throat, sputum, vagina, superficial skin lesion)

II. Clinical signs of severity

A. Hypotension: systolic BP ≤ 90 mm Hg in adults or less than the fifth percentile for age in children and

B. Two or more of the following signs: 1.Renal impairment: creatinine = ≥ 2 × upper limit of normal for age, or twofold or more elevation over the baseline level 2.Coagulopathy: platelets ≤ 100,000/mm3 or disseminated intravascular coagulation 3.Liver involvement: transaminases or total bilirubin ≥ 2 × upper limit of normal for age, or twofold or more elevation over the baseline level 4.ARDS (defined by acute onset of diffuse pulmonary infiltrates and hypoxemia in the absence of cardiac failure) or evidence of diffuse capillary leak (manifested by acute onset of generalized edema, or pleural or peritoneal effusions with hypoalbuminemia) 5.Generalized erythematous macular rash that may desquamate 6.Soft tissue necrosis, including necrotizing fasciitis or myositis, or gangrene

Definite case: an illness fulfilling criteria IA and II (A and B)

Probable case: an illness fulfilling criteria IB and II (A and B), if no other etiology for the illness can be defined