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Toxic-Shock Syndrome (TSS)
1990 Case Definition
Clinical case definition
An illness with the following clinical manifestations:
- Fever: temperature greater than or
equal to 38.9°C (102.0°F)
- Rash: diffuse macular erythroderma
- Desquamation: 1-2 weeks after onset
of illness, particularly on the palms and soles
- Hypotension: systolic blood pressure
less than or equal to 90 mm Hg for adults or less than fifth
percentile by age for children aged less than16 years; orthostatic
drop in diastolic blood pressure greater than or equal to 15
mm Hg from lying to sitting, orthostatic syncope, or orthostatic
dizziness
- Multisystem involvement (three or
more of the following):
- Gastrointestinal: vomiting or
diarrhea at onset of illness
- Muscular: severe myalgia or creatine
phosphokinase level at least twice the upper limit of
normal
- Mucous membrane: vaginal, oropharyngeal,
or conjunctival hyperemia
- Renal: blood urea nitrogen or
creatinine at least twice the upper limit of normal for
laboratory or urinary sediment with pyuria (greater than
or equal to 5 leukocytes per high-power field) in the
absence of urinary tract infection
- Hepatic:
total bilirubin, serum glutamic-oxaloacetic transaminase (SGOT),
or serum glutamic-pyruvic transaminase (SGPT) at least twice
the upper limit of normal for laboratory
- Hematologic: platelets less than
100,000/mm3
- Central nervous system: disorientation
or alterations in consciousness without focal neurologic
signs when fever and hypotension are absent
- Negative results on the following tests, if obtained:
- Blood, throat, or cerebrospinal fluid cultures
(blood culture may be positive for Staphylococcus aureus)
- Rise in titer to Rocky Mountain spotted fever,
leptospirosis, or measles
Case classification
Probable: a case with five of the six clinical
findings described above
Confirmed: a case with all six of the clinical findings described
above, including desquamation, unless the patient
dies before desquamation could occur
See also:
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