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Table 2 Diagnostic categories of toxic shock syndrome (TSS)

From: Clinically mild encephalitis/encephalopathy with a reversible splenial lesion caused by methicillin-sensitive Staphylococcus aureus bacteremia with toxic shock syndrome: a case report

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