Volume 1, Number 3—July 1995
Synopsis
Streptococcal Toxic-Shock Syndrome: Spectrum of Disease, Pathogenesis, and New Concepts in Treatment
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.
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