Toxic Shock Syndrome (Other Than Streptococcal) (TSS)
1997 Case Definition

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 illness, particularly on the palms and soles
• 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; orthostatic drop in diastolic blood pressure greater than or equal to 15 mm Hg from lying to sitting, orthostatic syncope, or orthostatic dizziness
• Multisystem involvement (three or more of the following):
  • 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, throat, or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus)
• Rise in titer to Rocky Mountain spotted fever, leptospirosis, or measles

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

• Toxic Shock Syndrome (Other Than Streptococcal) (TSS) | 2011 Case Definition
• Toxic Shock Syndrome (Other Than Streptococcal) (TSS) | 1990 Case Definition