Case Definition of Streptococcal Toxic-Shock Syndrome (Streptococcal TSS) and Necrotizing Fasciitis*

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

1. Hypotension

2. Clinical and laboratory abnormalities (requires two or more of the following):

a) Renal impairment

b) Coagulopathy

c) Liver abnormalities

d) Acute respiratory distress syndrome

e) Extensive tissue necrosis, i.e., necrotizing fasciitis

f) Erythematous rash

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Case Definition of Staphylococcal Toxic Shock Syndrome (TSS)

An illness with the following clinical manifestations:

  1. Fever: temperature > 38.9º C (102º F)

  2. Rash: diffuse macular erythroderma

  3. Desquamation: 1-2 weeks after onset of illness, particularly palms and soles

  4. 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

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