Toxic shock syndrome

• Severe septic shock caused by certain bacterial infections

Criteria

Criteria	Staphylococcal	Streptococcal
Confirmed	hypotension + fever + rash + desquamating + 3 or more other	hypotension + 2 or more other
Hypotension	SBP ≤90 mmHg	SBP ≤90 mmHg
Fever	temp ≥38.9ºC
Skin	diffuse macular erythroderma followed by desquamation	generalized erythematous macular rash that may desquamate
GI	n/v/d at onset
Resp		ARDS
MSK	myalgia ± CK ≥2x ULN	soft-tissue necrosis (e.g. nec.fasc)
Mucosa	hyperemia of any mucosa
Nephro	Creatinine ≥2x ULN, or pyuria without UTI	Creatinine ≥177 or ≥2x ULN or ≥2x baseline
Hepatic	bili/ALT/AST ≥2x ULN	ALT/AST/bili ≥2x ULN or ≥2x baseline
Heme	thrombocytopenia <100	thrombocytopenia ≤100, or DIC (INR/fibrinogen/D-dimer)
CNS	altered LOC without focal signs

Staphylococcal Toxic Shock Syndrome

Source: CDC case definition 2011

Clinical Criteria

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 rash
• 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 than 16 years
• Multisystem involvement (three or more of the following organ systems):
  • 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 for Diagnosis

Negative results on the following tests, if obtained:

• Blood or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus)
• Negative serologies for 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 criteria described above are present
• Confirmed: A case which meets the laboratory criteria and in which all five of the clinical criteria described above are present, including desquamation, unless the patient dies before desquamation occurs