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Clinical criteria for staphylococcal toxic shock syndrome (issued by the United States Centers for Disease Control and Prevention)

Clinical criteria for staphylococcal toxic shock syndrome (issued by the United States Centers for Disease Control and Prevention)
Clinical criteria
Fever: Temperature ≥38.9°C (102.0°F)
Rash: Diffuse macular erythroderma
Desquamation: 1 to 2 weeks after onset of rash
Hypotension: For adults: systolic blood pressure ≤90 mmHg; for children <16 years of age: systolic blood pressure less than 5th percentile by age
Multisystem involvement (3 or more of the following organ systems):
  • Gastrointestinal: Vomiting or diarrhea at onset of illness
  • Muscular: Severe myalgia or creatine phosphokinase elevation >2 times the upper limit of normal
  • Mucous membranes: Vaginal, oropharyngeal, or conjunctival hyperemia
  • Renal: Blood urea nitrogen or serum creatinine >2 times the upper limit of normal or pyuria (>5 leukocytes/high-power field) in the absence of urinary tract infection
  • Hepatic: Bilirubin or transaminases >2 times the upper limit of normal
  • Hematologic: Platelets <100,000/microL
  • Central nervous system: Disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent
Laboratory criteria
Cultures (blood or cerebrospinal fluid) negative for alternative pathogens (blood cultures may be positive for Staphylococcus aureus)
Serologic tests negative (if obtained) for Rocky Mountain spotted fever, leptospirosis, or measles
Case classification
Probable case: A case which meets the laboratory criteria and four of the five clinical criteria
Confirmed case: A case which meets the laboratory criteria and all five of the clinical criteria, including desquamation (unless the patient dies before desquamation occurs)
The above criteria were established for epidemiologic surveillance; they should be not be used to exclude a case that is highly suspicious for toxic shock syndrome, even if all criteria are not met.
Reproduced from: Centers for Disease Control and Prevention. Toxic shock syndrome (other than streptococcal) (TSS) 2011 case definition. Available at: http://wwwn.cdc.gov/nndss/conditions/toxic-shock-syndrome-other-than-streptococcal/case-definition/2011/ (Accessed on September 11, 2018).
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