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Volume 1, Number 3—July 1995
Synopsis

Streptococcal Toxic-Shock Syndrome: Spectrum of Disease, Pathogenesis, and New Concepts in Treatment

Dennis L. Stevens
Author affiliation: Professor of Medicine, University of Washington School of Medicine, Seattle,Washington
Chief, Infectious Disease Section, Veterans Affairs Medical Center, Boise, Idaho, USA

Main Article

Table 1

Case definition of streptococcal toxic-shock syndrome (streptococcal TSS) and necrotizing fasciitis*

I. Streptococcal TSS
A. Isolation of group A Streptococcus
1. From a sterile site
2. From a nonsterile body site
B. Clinical signs of severity
1. Hypotension
2. Clinical and laboratory abnormalities (requires two or more of the following):
a)Renal impairment
b)Coagulopathy
c)Liver abnormalities
d)Acute respiratory distress syndrome
e)Extensive tissue necrosis, i.e., necrotizing fasciitis
f)Erythematous rash
Definite Case = A1 + B(1+2)
Probable Case = A2 + B(1+2
II. Necrotizing fasciitis
A. Definite case
1. Necrosis of soft tissues with involvement of the fascia PLUS
2.Serious systemic disease, including one or more of the following:
a)Death
b)Shock (systolic blood pressure <90 mm of Hg).
c)Disseminated intravascular coagulopathy
d)Failure of organ systems
a.respiratory failure
b.liver failure
c.renal failure
3.Isolation of group A Streptococcus from a normally sterile body site
B.Suspected case
1.1+2 and serologic confirmation of group A streptococcal infection by a 4-fold rise against:
a)streptolysin O
b)DNase B
2.1+2 and histologic confirmation:
Gram-positive cocci in a necrotic soft tissue infection

*Streptococcal toxic-shock syndrome (streptococcal TSS) is defined as any group A streptococcal infection associated with the early onset of shock and organ failure. Definitions describing criteria for shock, organ failure, definite cases,and probable cases are included below. Source: reference 61.

Main Article

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