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Toxic-Shock Syndrome (TSS)
1997 Case Definition
Clinical case definition
An illness with the following clinical manifestations:
- Fever: temperature greater than or
equal to 102.0°F (greater than or equal to 38.9°C)
- 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, alanine
aminotransferase enzyme, or asparate aminotransferase
enzyme levels 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
Laboratory criteria
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 which
meets the laboratory criteria and in which four of the five clinical
findings described above are present
Confirmed: a case which meets the laboratory
criteria and in which all five of the clinical findings described
above are present, including desquamation, unless the patient
dies before desquamation occurs
See also:
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