section name header

Table 90-2

Proposed Case Definition for the Streptococcal Toxic Shock Syndromea

  • Isolation of group A streptococci (Streptococcus pyogenes)
    • From a normally sterile site
    • From a nonsterile site
  • Clinical signs of severity
    • Hypotension and
    • ≥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

a An 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.