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Volume 9, Number 3—March 2003

Dispatch

Early and Definitive Diagnosis of Toxic Shock Syndrome by Detection of Marked Expansion of T-Cell-Receptor Vβ2-Positive T Cells

Yoshio Matsuda*Comments to Author , Hidehito Kato*, Ritsuko Yamada*, Hiroya Okano*, Hiroaki Ohta*, Ken’ichi Imanishi*, Ken Kikuchi*, Kyouichi Totsuka*, and Takehiko Uchiyama*
Author affiliations: *Tokyo Women’s Medical University School of Medicine, Tokyo, Japan

Main Article

Table

Laboratory data on admission of case-patients

Case-patient 1 
Day 2 postpartum Case-patient 2
Day 7 postpartum
Laboratory findings (normal range)


Leukocytes (µL) (5,000–8,500)
2,800
17,500
Platelets (x104/µL) (13–40)
12.2
19.8
C-reactive protein (mg/dL) (0–0.4)
46.4
22
Total protein (g/dL) (6.5–8.2)
3.8
5.9
Albumin (g/dL (3.8–5.1)
1.6
3
Aspartate aminotransgerase (IU/L) (0–35)
30
51
Alanine aminotransgerase (IU/L) (0–35)
10
53
Lactic dehydrogenase (IU/L) (200–450)
712
698
Blood urea nitrogen (mg/dL) (5–12)
29.5
12.4
Creatine (mg/dL) (<0.8)
2.58
0.72
Uric acid (mg/dL) (1.2–4.5)
9.2
2.5
Natrium (mEq/L) (136–145)
135
133
Potassium (mEq/L) (3.5–5)
4.6
3.3
Chloride (mEq/L) (98–108)
104
99
Creatine kinase (IU/L) (10–70)
244

Prothrombin time (sec) (12–14)
11.7
13.7
Activated partial thrombospilastin time (sec) (24–36)
36.7
43.2
Fibrinogen (mg/dL) (400–650)
674
668
Antithrombin-III (%) (70–120)
60
82
Fibrinogen degeneration product (µg/mL) (<10)
8.8
11.7
D-dimer (µg/mL) (<0.2)
5.22
3.93
Thrombin/antithrombin complex (ng/mL) (<3.0)
40
20.4
Criteria for definite TSS (all criteria must be present)
No
Yes
>38.9°C
Yes
Yes
Rash with desquamation

Yes
Hypotension <90mmHg
Yes
Yes
Clinical or laboratory abnormalities (>3 organs)


Gastrointestinal


Hepatic
Yes
Yes
Muscular


Mucous membrane

Yes
Renal
Yes
Yes
Cardiovascular


CNS


Criteria for probable TSS
No
Yes
>3 criteria and desquamation or >5 criteria without desquamation


>38.9°C
Yes
Yes
Rash

Yes
Hypotension
Yes
Yes
Myalgia


Vomiting and/or diarrhea


Mucous membrane inflammation

Yes
Clinical or laboratory abnormalities


>2 organs


Gastrointestinal


Hepatic
Yes
Yes
Muscular


Mucous membrane

Yes
Renal
Yes
Yes
Cardiovascular


Central nervous system

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