|
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) |
|