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Table 3 Diagnostic categories of toxic shock syndrome (TSS)

From: RS3PE syndrome developing during the course of probable toxic shock syndrome: a case report

Definite TSS (all criteria must be present) [6]  
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: 1–2 weeks 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):  
Gastrointestinal: vomiting or diarrhea at onset of illness  
Muscular: severe myalgia or creatine phosphokinase level at least twice the upper limit of normal  
Mucous membrane: vaginal, oropharyngeal, or conjunctival hyperemia  
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  
Hepatic: total bilirubin, alanine aminotransferase enzyme, or aspartate aminotransferase enzyme levels at least twice the upper limit of normal for laboratory  
Hematologic: platelets less than 100,000/mm3  
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) [7]  
・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