Toxic Shock Syndrome Information Service

Table 1: Toxic Shock Syndrome: Case Definition1

1) Fever: temperature ≥ 38.9 oC

2) Rash: diffuse macular erythroderma ("sunburn")

3) Hypotension: systolic blood pressure ≤ 90 mm Hg (adults) or ≤ 5th percentile for age (children under 16 years of age), or orthostatic hypotension, dizziness or syncope

4) Multisystem dysfunction: at least three:

  1. a. Gastrointestinal: vomiting or diarrhoea at onset of illness
  2. b. Muscular: severe myalgias, or serum creatine phosphokinase level (CPK) ≥ twice the upper limit of normal
  3. c. Mucous membranes: vaginal, oropharyngeal, or conjunctival hyperemia
  4. d. Renal: blood urea nitrogen (BUN) or creatinine ≥ twice the upper limit of normal, or pyuria ( ≥ 5 leuckocytes per high-power field), in the absence of urinary tract infection
  5. e. Hepatic: total serum bilirubin or transaminase level ≥ twice the upper limit of normal
  6. f. Hematologic: platelets ≤ 100,000 per L
  7. g. Central nervous system: disorientation or alteration in consciousness but no focal neurological signs at a time when fever and hypotension are absent

5) Desquamation: 1 to 2 weeks after the onset of illness (typically palms and soles)

6) Evidence against an alternative diagnosis: If obtained: negative cultures of blood, throat, or cerebrospinal fluid;2 absence of a rise in antibody titres to the agents of, leptospirosis, measles or Rocky Mountain spotted fever.

Source: Reingold AL, Hargrett NT, et al. Toxic shock syndrome surveillance in the United States, 1980 to 1981. Ann Intern Med 1982; 96(Part 2): 875-880.
1"Confirmed" case meets all six criteria; "probable" case meets 5 of the 6.
2 Blood culture may be positive for S. aureus.

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