Table 1.

Clinical case definition of TSS

Symptom or criterionDescription
FeverTemperature of ≥38.9°C (102.0°F)
RashDiffuse macular erythroderma
Desquamation1–2 wk after onset of illness, particularly on the palms and soles
HypotensionSystolic blood pressure of ≤90 mm Hg for adults or less than 5th percentile by age for children younger than 16 yr; orthostatic drop in diastolic pressure of ≥15 mm Hg from lying to sitting, orthostatic syncope or orthostatic dizziness
Multisystem involvementa
Gastrointestinal: vomiting or diarrhea at onset of illness
Muscular: severe myalgia, or creatinine phosphokinase level at least twice the upper limit of normal
Mucous membrane: vaginal, oropharyngeal, or conjuctival hyperemia
Renal: blood urea nitrogen or creatinine at least twice the upper limit of normal for laboratory or urinary sediment with pyuria (≥5 leukocytes per high-power field) in the absence of urinary tract infection
Hepatic: total bilirubin, alanine aminotransferase, or aspartate aminotransferase levels at least twice the upper limit of normal for laboratory
Hematologic: platelet count less than 100,000/mm3
Central nervous system: disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent
Laboratory criteriaNegative results on the following tests, if performed:
 Blood, throat, or cerebrospinal fluid cultures (blood culture may be positive for S. aureus)
 Rocky Mountain spotted fever, leptospirosis, or measles
Case classification
Confirmed: a case in which all six of the clinical findings described above are present
Probable: a case with five of the six clinical findings described above are present
Additional laboratory findings pathognomic for TSS,b but presently not included in the case definition
Isolation of S. aureus from a mucosal or normally sterile body site
Production by an incriminated staphylococcal isolate of TSST-1 or an alternative toxin known to cause TSS
Serologic susceptibility to the relevant toxin at the time of acute illness
Development of antibody to the relevant toxin during convalescence
  • a Three or more of these systems must be involved.

  • b Proposed by Parsonnet (124) as additional criteria to be included in the case definition.