Acute bacterial sinusitis in children is diagnosed on the basis of the history, with the use of the criteria. Imaging studies (plain-film radiography, computed tomography [CT], magnetic resonance imaging [MRI], and ultrasonography) show signs of sinus inflammation but are not recommended in patients with uncomplicated infection, given the low specificity of these studies.
Cierny and Mader classified osteomyelitis based on the affected portion of the bone, the physiologic status of the host and the local environment. This classification lends itself to the treatment and prognosis of osteomyelitis; stage 1 (medullary osteomyelitis) can usually be treated with antibiotics alone, while stages 2, 3 and 4 (superficial, localized and diffuse osteomyelitis) usually require aggressive debridement, antimicrobial therapy and subsequent orthopedic reconstruction.
1996 Case Definition
Hemolytic uremic syndrome (HUS) is characterized by the acute onset of microangiopathic hemolytic anemia, renal injury, and a low platelet count. Thrombotic thrombocytopenic purpura (TTP) also is characterized by these features but can include central nervous system (CNS) involvement and fever and may have a more gradual onset. Most cases of HUS (but few cases of TTP) occur after an acute gastrointestinal illness (usually diarrheal).
Acute nosocomial pneumonia is broadly defined as pneumonia characterized by a new and persistent infiltrate (radiographically present for greater than 48 hours) PLUS one of the following:
After identification of novel influenza A (H1N1) virus infection in Mexico, a case definition was developed. The initial definition of suspected novel influenza A (H1N1) virus infection included any hospitalized patient with severe acute respiratory illness. On May 1, 2009, this definition was expanded to include any person with acute respiratory illness defined as fever and either sore throat or cough. On May 11, 2009, the definition of suspected case was changed again to include any person with:
Clinical picture consistent with tuberculosis; bacteriologic confirmation (culture, gene probe/NAA + AFB smear); histologic findings
Syphilis is a complex sexually transmitted disease that has a highly variable clinical course. Classification by a clinician with expertise in syphilis may take precedence over the following case definitions developed for surveillance purposes.
I. Streptococcal TSS
A. Isolation of group A Streptococcus
1. From a sterile site
2. From a nonsterile body site
B. Clinical signs of severity
2. Clinical and laboratory abnormalities (requires two or more of the following):
a) Renal impairment
c) Liver abnormalities
d) Acute respiratory distress syndrome
e) Extensive tissue necrosis, i.e., necrotizing fasciitis
f) Erythematous rash
An illness with the following clinical manifestations:
Fever: temperature > 38.9º C (102º F)
Rash: diffuse macular erythroderma
Desquamation: 1-2 weeks after onset of illness, particularly palms and soles
Hypotension: systolic blood pressure < 90 mm Hg for adults or less than fifth percentile by age for children <16 years of age; orthostatic drop in diastolic blood pressure greater than or equal to 15 mm Hg from lying to sitting, orthostatic syncope, or orthostatic dizziness
A 1992 American College of Chest Physicians/Society of Critical Care Medicine consensus panel defined the following terms which are relevant to the discussion of septic shock:
Infection: Infection is a microbial phenomenon characterized by an inflammatory response to the presence of microorganisms or the invasion of normally sterile host tissue by those organisms.
Bacteremia: Bacteremia refers to the presence of viable bacteria in the blood.
Systemic inflammatory response syndrome: Systemic inflammatory response syndrome (SIRS) is a widespread inflammatory response to a variety of severe clinical insults. This syndrome is clinically recognized by the presence of two or more of the following: