TABLE 1.
Clinical case definition of TSS
| Symptom or criterion | Description |
|---|---|
| Fever | Temperature of ≥38.9°C (102.0°F) |
| Rash | Diffuse macular erythroderma |
| Desquamation | 1–2 wk after onset of illness, particularly on the palms and soles |
| Hypotension | Systolic blood pressure of ≤90 mm Hg for adults or less than 5th percentile by age for children younger than 16 yr; orthostatic drop in diastolic pressure of ≥15 mm Hg from lying to sitting, orthostatic syncope or orthostatic dizziness |
| Multisystem involvementa | |
| Gastrointestinal: vomiting or diarrhea at onset of illness | |
| Muscular: severe myalgia, or creatinine phosphokinase level at least twice the upper limit of normal | |
| Mucous membrane: vaginal, oropharyngeal, or conjuctival hyperemia | |
| Renal: blood urea nitrogen or creatinine at least twice the upper limit of normal for laboratory or urinary sediment with pyuria (≥5 leukocytes per high-power field) in the absence of urinary tract infection | |
| Hepatic: total bilirubin, alanine aminotransferase, or aspartate aminotransferase levels at least twice the upper limit of normal for laboratory | |
| Hematologic: platelet count 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 | Negative results on the following tests, if performed: |
| Blood, throat, or cerebrospinal fluid cultures (blood culture may be positive for S. aureus) | |
| Rocky Mountain spotted fever, leptospirosis, or measles | |
| Case classification | |
| Confirmed: a case in which all six of the clinical findings described above are present | |
| Probable: a case with five of the six clinical findings described above are present | |
| Additional laboratory findings pathognomic for TSS,b but presently not included in the case definition | |
| Isolation of S. aureus from a mucosal or normally sterile body site | |
| Production by an incriminated staphylococcal isolate of TSST-1 or an alternative toxin known to cause TSS | |
| Serologic susceptibility to the relevant toxin at the time of acute illness | |
| Development of antibody to the relevant toxin during convalescence |
a
Three or more of these systems must be involved.
b
Proposed by Parsonnet (124) as additional criteria to be included in the case definition.