Reingold et al listed criteria for the diagnosis of toxic shock syndrome (TSS) associated with Staphylococcus aureus.

Patient selection: evidence of Staphylococcus aureus


Diagnostic features:

(1) fever with temperature > 38.9°C

(2) hypotension with systolic blood pressure < 90 mm Hg

(3) diffuse macular rash followed by desquamation

(4) involvement of 3 or more of the following:

(4a) blood (thrombocytopenia)

(4b) liver (hepatitis with elevated liver function tests)

(4c) renal dysfunction

(4d) gastrointestinal tract (vomiting, diarrhea)

(4e) hyperemia of mucous membranes

(4f) central nervous system (CNS)

(4g) muscular (including myalgias, rhabdomyolysis)

(5) exclusion of alternative diagnosis that can explain the findings better



• Desquamation typically involves the palms of the hands and soles of the feet. It occurs 1-2 weeks after the onset of illness.

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