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Volume 15, Number 5—May 2009
Dispatch

Evaluation of Surveillance Methods for Staphylococcal Toxic Shock Syndrome

Lindsey LesherComments to Author , Aaron DeVries, Richard Danila, and Ruth Lynfield
Author affiliations: Minnesota Department of Health, St. Paul, Minnesota, USA (L. Lesher, A. DeVries, R. Danila, R. Lynfield); University of Minnesota, Minneapolis, Minnesota, USA (A. DeVries)

Main Article

Table 1

Staphylococcal toxic shock syndrome case definitions*

Criteria Definition
Clinical
Fever Temperature >38.9°C (102.0°F)
Rash Diffuse macular erythroderma
Desquamation 1–2 weeks after onset of illness, particularly on the palms and soles
Hypotension Systolic blood pressure <90 mm Hg for adults or <5th percentile by age for children <16 years of age; orthostatic decrease in diastloc blood pressure >5 mm Hg from lying to sitting, orthostatic syncope, or orthostatic dizziness
Multisystem organ involvement†
Gastrointestinal Vomiting or diarrhea at onset of illness
Muscular Severe myalgia or creatine phosphokinase level at least twice the upper limit of normal
Mucous membrane Vaginal, oropharyngeal, or conjunctival hyperemia
Renal Blood urea nitrogen or creatinine at least twice the upper limit of normal for laboratory or urinary sediment with pyuria (>5 leukocytes by high-power field) in the absence of urinary tract infection
Hepatic Total bilirubin, alanine aminotransferase, or aspartate aminotransferase levels at least twice the upper limit of normal
Hematologic Platelet counts <100 × 109/L
Central nervous system
 Disorientation or alterations in consciousness with focal neurologic signs when fever and hypotension are absent
Laboratory
Culture If obtained, negative results on blood, throat, or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus)
Titer
 If obtained, no increase in titer for Rocky Mountain spotted fever, leptospirosis, or measles
Case classification
Probable Meets laboratory criteria and in which 4 of 5 clinical findings described above are present
Confirmed Meets laboratory criteria and in which all 5 of the clinical findings described above are present, including desquamation, unless the patient dies before desquamation occurs

*From the US Centers for Disease Control and Prevention (5).
†Involving >3 organ systems.

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References
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