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Table 86-1

Case Definition of S. Aureus Toxic Shock Syndrome

  1. Fever: temperature of ≥38.9°C (≥102°F)
  2. Hypotension: systolic blood pressure of ≤90 mmHg or orthostatic hypotension (orthostatic drop in diastolic blood pressure by ≥15 mmHg, orthostatic syncope, or orthostatic dizziness)
  3. Diffuse macular rash, with desquamation 1-2 weeks after onset (including the palms and soles)
  4. Multisystem involvement
    1. Hepatic: bilirubin or aminotransferase levels ≥2 times normal
    2. Hematologic: platelet count ≤100,000/µL
    3. Renal: blood urea nitrogen or serum creatinine level ≥2 times the normal upper limit
    4. Mucous membranes: vaginal, oropharyngeal, or conjunctival hyperemia
    5. Gastrointestinal: vomiting or diarrhea at onset of illness
    6. Muscular: severe myalgias or serum creatine phosphokinase level ≥2 times the normal upper limit
    7. Central nervous system: disorientation or alteration in consciousness without focal neurologic signs and in the absence of fever and hypotension
  5. Negative serologic or other tests for measles, leptospirosis, and Rocky Mountain spotted fever, as well as negative blood or cerebrospinal fluid cultures for organisms other than S. aureus

Source: M Wharton et al: Case definitions for public health surveillance. MMWR 39:1, 1990; with permission.