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Streptococcal Toxic-Shock Syndrome (STSS)
1996 Case Definition
Clinical description
Streptococcal toxic-shock syndrome (STSS) is a
severe illness associated with invasive or noninvasive group
A streptococcal (Streptococcus pyogenes) infection.
STSS may occur with infection at any site but most often occurs
in association with infection of a cutaneous lesion. Signs of
toxicity and a rapidly progressive clinical course are characteristic,
and the case-fatality rate may exceed 50%.
Clinical case definition
An illness with the following clinical manifestations
occurring within the first 48 hours of hospitalization or, for
a nosocomial case, within the first 48 hours of illness:
- Hypotension defined by a systolic blood pressure
less than or equal to 90 mm Hg for adults or less than the
fifth percentile by age for children aged less than 16 years.
- Multi-organ involvement characterized by two
or more of the following:
- Renal impairment: Creatinine greater than or
equal to 2 mg/dL (greater than or equal to 177 µmol/L)
for adults or greater than or equal to twice the upper
limit of normal for age. In patients with preexisting renal
disease, a greater than twofold elevation over the baseline
level.
- Coagulopathy: Platelets less than or equal
to 100,000/mm3 (less than or equal to 100 x
106/L) or disseminated intravascular coagulation,
defined by prolonged clotting times, low fibrinogen level,
and the presence of fibrin degradation products.
- Liver involvement: Alanine aminotransferase,
aspartate aminotransferase, or total bilirubin levels greater
than or equal to twice the upper limit of normal for the
patient's age. In patients with preexisting liver disease,
a greater than twofold increase over the baseline level.
- Acute respiratory distress syndrome: defined
by acute onset of diffuse pulmonary infiltrates and hypoxemia
in the absence of cardiac failure or by evidence of diffuse
capillary leak manifested by acute onset of generalized
edema, or pleural or peritoneal effusions with hypoalbuminemia.
- A generalized erythematous macular rash that may desquamate.
- Soft-tissue necrosis, including necrotizing fasciitis
or myositis, or gangrene.
Laboratory criteria for diagnosis
Case classification
Probable: a case
that meets the clinical case definition in the absence of another
identified etiology for the illness and with isolation of group
A Streptococcus from a nonsterile site.
Confirmed: a case that meets the clinical
case definition and with isolation of group A Streptococcus from
a normally sterile site (e.g., blood or cerebrospinal fluid or,
less commonly, joint, pleural, or pericardial fluid).
Comment
See also Streptococcal Disease,
Invasive, Group A and Toxic-Shock
Syndrome.
See also:
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