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 5^th 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 4 of the 5 clinical criteria

Confirmed case – A case which meets the laboratory criteria and all 5 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.

Adapted from: Centers for Disease Control and Prevention. Toxic shock syndrome (other than streptococcal) (TSS): 2011 case definition. Available at: https://ndc.services.cdc.gov/case-definitions/toxic-shock-syndrome-2011/ (Accessed on February 11, 2022).

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