Case of the Month #33 Toxic Shock Syndrome

Published 12/08/2022

Case Definition for the Streptococcal Toxic Shock Syndrome

I. Isolation of group A streptococci (Streptococcus pyogenes) 

II. Clinical signs of severity 

A. Hypotension: systolic blood pressure ≤ 90 mm Hg in adults or below fifth percentile for age in children 


B. Two or more of the following signs: 

1. Renal impairment: creatinine ≥ 177 μmol/L (≥2 mg/dL) for adults or ≥2× the upper limit of normal  

2. Coagulopathy: platelets ≤ 100 × 109/L or evidence of DIC 

3. Liver involvement: serum AST, ALT, or Bilirubin levels ≥2× the upper limit of normal  

4. Adult respiratory distress syndrome  

5. A generalised erythematous macular rash that may desquamate 

6. Soft tissue necrosis, including necrotizing fasciitis or myositis, or gangrene