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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