Table 2 Diagnostic categories of toxic shock syndrome (TSS)

Definite TSS (all criteria must be present) [11]

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: 1–2weeks after onset of rash

 • Hypotension: systolic blood pressure less than or equal to 90 mmHg for adults or less than the fifth percentile by age for children aged less than 16 years

 • Multisystem involvement (three or more of the following organ systems):

  º Gastrointestinal: vomiting or diarrhea at onset of illness

  º Muscular: severe myalgia or creatine phosphokinase level at least twice the upper limit of normal

  º Mucous membrane: vaginal, oropharyngeal, or conjunctival hyperemia

  º 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

  º Hepatic: total bilirubin, alanine aminotransferase enzyme, or aspartate aminotransferase enzyme levels at least twice the upper limit of normal for laboratory

  º Hematologic: platelets less than 100,000/mm³

  º 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

Probable TSS (≥3 criteria and desquamation or ≥5 criteria without desquamation) [12]

 • Temperature ≥38.9 °C

 • Rash

 • Hypotension, orthostatic dizziness, or syncope

 • Myalgia

 • Vomiting, diarrhea, or both

 • Mucous membrane inflammation (conjunctivitis, pharyngitis, vaginitis)

 • Clinical or laboratory abnormalities of ≥2 organ systems

 • Reasonable evidence for absence of other etiologies