Clinical criteria |
Fever – Temperature ≥38.9°C (102.0°F) |
Rash – Diffuse macular erythroderma |
Desquamation – 1 to 2 weeks after onset of rash |
Hypotension: - For adults – Systolic blood pressure ≤90 mmHg
- For children <16 years of age – Systolic blood pressure less than 5th percentile by age
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Multisystem involvement (3 or more of the following organ systems): - Gastrointestinal – Vomiting or diarrhea at onset of illness
- Muscular – Severe myalgia or creatine phosphokinase elevation >2 times the upper limit of normal
- Mucous membranes – Vaginal, oropharyngeal, or conjunctival hyperemia
- Renal – Blood urea nitrogen or serum creatinine >2 times the upper limit of normal or pyuria (>5 leukocytes/high-power field) in the absence of urinary tract infection
- Hepatic – Bilirubin or transaminases >2 times the upper limit of normal
- Hematologic – Platelets <100,000/microL
- Central nervous system – Disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent
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Laboratory criteria |
Cultures (blood or cerebrospinal fluid) negative for alternative pathogens (blood cultures may be positive for Staphylococcus aureus) |
Serologic tests negative (if obtained) for Rocky Mountain spotted fever, leptospirosis, or measles |
Case classification |
Probable case – A case which meets the laboratory criteria and 4 of the 5 clinical criteria |
Confirmed case – A case which meets the laboratory criteria and all 5 of the clinical criteria, including desquamation (unless the patient dies before desquamation occurs) |