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 mmHg).
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.
