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

Toxic Shock Syndrome (Other Than Streptococcal) (TSS)
2011 Case Definition
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NOTE: A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. Surveillance case definitions are not intended to be used by healthcare providers for making a clinical diagnosis or determining how to meet an individual patient’s health needs.

CSTE Position Statement(s)

  • 10-ID-14

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 rash
  • 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
  • Multisystem involvement (three or more of the following organ systems):
    • 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 or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus)
  • Negative serologies for Rocky Mountain spotted fever, leptospirosis, or measles

Case Classification

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

Related Case Definition(s)

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Last Reviewed: April 16, 2021
Source: Office of Public Health Data, Surveillance, and Technology