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Table 87-2

Proposed Case Definition for the Streptococcal Toxic Shock Syndromea

  1. Isolation of group A streptococci (Streptococcus pyogenes)
    1. From a normally sterile site
    2. From a nonsterile site
  2. Clinical signs of severity
    1. Hypotension and
    2. ≥2 of the following signs
      1. Renal impairment
      2. Coagulopathy
      3. Liver function impairment
      4. Adult respiratory distress syndrome
      5. A generalized erythematous macular rash that may desquamate
      6. Soft tissue necrosis, including necrotizing fasciitis or myositis; or gangrene

aAn illness fulfilling criteria IA, IIA, and IIB is defined as a definite case. An illness fulfilling criteria IB, IIA, and IIB is defined as a probable case if no other etiology for the illness is identified.

Source: Modified from Working Group on Severe Streptococcal Infections: JAMA 269:390, 1993.