{"id":2506,"date":"2009-03-08T12:37:51","date_gmt":"2009-03-08T12:37:51","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/inftssnf\/"},"modified":"2025-05-14T19:10:22","modified_gmt":"2025-05-14T19:10:22","slug":"inftssnf","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/inftssnf\/","title":{"rendered":"Case Definition of Streptococcal Toxic-Shock Syndrome (Streptococcal TSS) and Necrotizing Fasciitis"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p><\/p>\n<div class=\"Section1\">\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">I. Streptococcal TSS<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 12px; margin-top: 0pt; margin-bottom: 0pt;\">A. Isolation of group A <em>Streptococcus<\/em><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 24px; margin-top: 0pt; margin-bottom: 0pt;\">1. From a sterile site<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 24px; margin-top: 0pt; margin-bottom: 0pt;\">2. From a nonsterile body site<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 12px; margin-top: 0pt; margin-bottom: 0pt;\">B. Clinical signs of severity<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 24px; margin-top: 0pt; margin-bottom: 0pt;\">1. Hypotension<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 24px; margin-top: 0pt; margin-bottom: 0pt;\">2. Clinical and laboratory abnormalities (requires two or more of the following):<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36px; margin-top: 0pt; margin-bottom: 0pt;\">a) Renal impairment<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36px; margin-top: 0pt; margin-bottom: 0pt;\">b) Coagulopathy<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36px; margin-top: 0pt; margin-bottom: 0pt;\">c) Liver abnormalities<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36px; margin-top: 0pt; margin-bottom: 0pt;\">d) Acute respiratory distress syndrome<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36px; margin-top: 0pt; margin-bottom: 0pt;\">e) Extensive tissue necrosis, i.e., necrotizing fasciitis<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36px; margin-top: 0pt; margin-bottom: 0pt;\">f) Erythematous rash<\/p>\n<p><!--more--><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Definite Case = A1 + B (1+2)<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">Probable Case = A2 + B (1+2)<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">II. Necrotizing fasciitis<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 12px; margin-top: 0pt; margin-bottom: 0pt;\">A. Definite case<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 24px; margin-top: 0pt; margin-bottom: 0pt;\">1. Necrosis of soft tissues with involvement of the fascia<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 24px; margin-top: 0pt; margin-bottom: 0pt;\">PLUS<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 24px; margin-top: 0pt; margin-bottom: 0pt;\">2. Serious systemic disease, including one or more of the following:<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36px; margin-top: 0pt; margin-bottom: 0pt;\">a) Death<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36px; margin-top: 0pt; margin-bottom: 0pt;\">b) Shock (systolic blood pressure &lt;90 mmHg).<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36px; margin-top: 0pt; margin-bottom: 0pt;\">c) Disseminated intravascular coagulopathy<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36px; margin-top: 0pt; margin-bottom: 0pt;\">d) Failure of organ systems<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 48px; margin-top: 0pt; margin-bottom: 0pt;\">a. respiratory failure<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 48px; margin-top: 0pt; margin-bottom: 0pt;\">b. liver failure<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 48px; margin-top: 0pt; margin-bottom: 0pt;\">c. renal failure<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 24px; margin-top: 0pt; margin-bottom: 0pt;\">3. Isolation of group A <em>Streptococcus<\/em> from a normally sterile body site<\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 12px; margin-top: 0pt; margin-bottom: 0pt;\">B. Suspected case<\/p>\n<ul>\n<li class=\"MsoNormal\">1+2 and serologic confirmation of group A streptococcal infection by a 4-fold rise against:<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: lower-alpha;\">\n<li class=\"MsoNormal\">streptolysin O<\/li>\n<li class=\"MsoNormal\">DNase B<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<ul>\n<li class=\"MsoNormal\">1+2 and histologic confirmation:<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol style=\"list-style-type: lower-alpha;\">\n<li class=\"MsoNormal\">Gram-positive cocci in a necrotic soft tissue infection<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">*Streptococcal toxic-shock syndrome (streptococcal TSS) is defined as any group A streptococcal infection associated with the early onset of shock and organ failure.<\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\"><strong>References:<\/strong><\/p>\n<ol>\n<li>Stevens DL. Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment. Emerg Infect Dis. 1995 Jul-Sep;1(3):69-78.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/8903167\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<li>Stevens DL. The toxic shock syndromes. Infect Dis Clin North Am. 1996 Dec;10(4):727-46.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/8958166\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created: Feb 23, 2006<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[39],"tags":[316,315,314,313,1556,1555,1344,1554,1553,614,5,1552,4,1551,1550,1557],"class_list":["post-2506","post","type-post","status-publish","format-standard","hentry","category-infetious-disease","tag-case","tag-caso","tag-definicion","tag-definition","tag-estreptococico","tag-fasciitis","tag-infectious","tag-necrotizante","tag-necrotizing","tag-shock","tag-sindrome","tag-streptococcal","tag-syndrome","tag-toxic","tag-toxico","tag-tss"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2506","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2506"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2506\/revisions"}],"predecessor-version":[{"id":9144,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2506\/revisions\/9144"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2506"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2506"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2506"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}