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| Clinical criteria |
|
| (1) Fever ≥38.9°C (102°F) |
| (2) Rash: diffuse macular erythroderma |
| (3) Desquamation: 1 to 2 weeks after onset of rash |
| (4) Hypotension: for adults, systolic blood pressure ≤90 mmHg; for children <16 years of age, systolic blood pressure less than 5th percentile by age |
| (5) Multisystem involvement (3 or more of the following organ systems) |
| Gastrointestinal: vomiting or diarrhea at the onset of illness |
| Muscular: severe myalgia or creatinine phosphokinase elevation >2 times the upper limit of normal |
| Mucous membrane: 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/micro-L |
| Central nervous system: disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent |
| 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 that meets the laboratory criteria and four of the five clinical criteria |
| Confirmed case: a case that meets the laboratory criteria and all five of the clinical criteria, including desquamation (unless the patient dies before desquamation occurs) |
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