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Streptococcal Toxic-Shock Syndrome (STSS)
1995 Case Definition
Clinical description
The streptococcal toxic-shock syndrome 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 less than 16 years of
age.
- Multiorgan involvement characterized by two
or more of the following:
- Renal impairment: Creatinine greater than or
equal to 2mg/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 pre-existing
renal disease, a greater than or equal to 2-fold 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 pre-existing liver disease,
a greater than or equal to 2-fold increase over the baseline
level.
- Adult respiratory distress syndrome: 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.
- A generalized erythematous macular rash that may desquamate.
- Soft-tissue necrosis, including necrotizing fascitis
or myositis, or gangrene.
Laboratory criteria for diagnosis
Diagnosis is based on laboratory isolation of group
A Streptococcus.
Case classification
-
Probable: Isolation
of group A Streptococcus from a nonsterile site
in a patient with illness that meets the clinical case definition
in the absence of another identified etiology for the illness.
-
Confirmed: Isolation of group A Streptococcus from
a normally sterile site in a patient with an illness that
meets the clinical case definition.
Comment
See also Toxic-Shock
Syndrome.
See also:
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