Diagnostic Criteria for Streptococcal Toxic Shock Syndrome

 

Isolation of group A streptococcus (Streptococcus pyogenes):

(1) from a normally sterile site (blood, CSF, peritoneal fluid, pleural fluid, tissue biopsy, surgical wound, etc.)

(2) from a nonsterile site (throat, sputum, vagina, superficial skin lesion, etc.)

 

Clinical signs of severity - both of the following::

(1) hypotension - one of the following:

(1a) systolic blood pressure <= 90 mm Hg in adults

(1b) systolic blood pressure <= 5th percentile for age in children (Geigy Scientific Tables page 553; = (mean) - (2*s))

(2) 2 or more of the following signs:

(2a) renal impairment:

(2a1) creatinine >= 2mg/dL in adults

(2a2) creatinine >= 2-times the upper limit of normal for age

(2a3) with pre-existing renal disease: a creatinine >= 2-fold increase from baseline level

(2b) coagulopathy:

(2b1) platelet count <= 100,000/µL

(2b2) DIC (prolonged PT and PTT, decreased fibrinogen, presence of fibrin degradation products)

(2c) liver involvement:

(2c1) ALT, AST or total bilirubin greater than 2-times the upper limit of normal for age

(2c2) with pre-existing liver disease: a >= 2-fold increase over baseline levels

(2d) adult respiratory distress syndrome (ARDS): acute onset of diffuse pulmonary infiltrate and hypoxemia in the absence of cardiac failure

(2e) evidence of diffuse capillary leak with acute onset of generalized edema, or pleural or peritoneal effusions with hypoalbuminemia

(2f) generalized erythematous macular rash that may desquamate

(2g) soft tissue necrosis (necrotizing fasciitis, myositis, gangrene)

 

Criteria for diagnosis

 

Definite case: both of the following

(1) isolation from normally sterile site

(2) both clinical signs of severity

 

Probable case: all of the following

(1) isolation from nonsterile site

(2) both clinical signs of severity

(3) no other etiology for the illness identified