An illness with the following clinical manifestations:
fever: temperature greater than or equal to 102.0°F (greater than or
equal to 38.9°C)
rash: diffuse macular erythroderma
desquamation: 1–2 weeks after onset of rash
hypotension: systolic blood pressure less than or equal to 90 mm Hg for
adults or less than fifth percentile by age for children aged less than 16
years
multisystem involvement (three or more of the following organ systems):
gastrointestinal: vomiting or diarrhea at onset of illness
muscular: severe myalgia or creatine phosphokinase level at least twice
the upper limit of normal
mucous membrane: vaginal, oropharyngeal, or conjunctival hyperemia
renal: blood urea nitrogen or creatinine at least twice the upper limit
of normal for laboratory or urinary sediment with pyuria (greater than or
equal to 5 leukocytes per high-power field) in the absence of urinary tract
infection
hepatic: total bilirubin, alanine aminotransferase enzyme, or asparate
aminotransferase enzyme levels at least twice the upper limit of normal for
laboratory
hematologic: platelets less than 100,000/mm3
central nervous system: disorientation or alterations in consciousness
without focal neurologic signs when fever and hypotension are absent
Laboratory Criteria
Negative results on the following tests, if obtained:
blood or cerebrospinal fluid cultures (blood culture may be positive for
Staphylococcus aureus)
negative serologies for spotted fever rickettsiosis, leptospirosis, or
measles
Case Classifications
Probable: a case which meets the laboratory criteria and in which
four of the five clinical findings described above are present
Confirmed: a case which meets the laboratory criteria and in which
all five of the clinical findings described above are present, including
desquamation, unless the patient dies before desquamation occurs
Case Classification Table
N = All “N” criteria in the same column are required to report
or confirm a case.
O* = Four of the five clinical criteria are required to meet the criteria
for reporting and for the illness to be classified as a probable case.
† This criterion is
not necessary if the patient died before sufficient time elapsed for
desquamation to occur.
Criterion
Confirmed
Probable
Clinical Evidence
Fever (temperature ≥ 38.9°C [102.0°F])
N
O*
Diffuse macular erythrodermal rash
N
O*
Desquamation 1-2 weeks after onset of rash†
N
O*
Hypotension (systolic blood pressure ≤ 90 mm Hg for adults or less than
fifth percentile by age for children aged less than 16 years)
N
O*
Multisystem involvement, signified by three or more of the following
findings:
gastrointestinal: vomiting or diarrhea at onset of illness
muscular: severe myalgia or creatine phosphokinase level at least
twice the upper limit of normal
mucous membrane: vaginal, oropharyngeal, or conjunctival
hyperemia
renal: blood urea nitrogen or creatinine at least twice the upper
limit of normal for laboratory or urinary sediment with pyuria ( ≥ 5
leukocytes per high-power field) in the absence of urinary tract
infection
hepatic: total bilirubin, alanine aminotransferase enzyme, or
asparate aminotransferase enzyme levels at least twice the upper limit of
normal for laboratory
hematologic: platelets < 100,000/mm3
central nervous system: disorientation or alterations in
consciousness without focal neurologic signs when fever
and hypotension are absent
N
O*
Laboratory Evidence
Negative blood culture for organisms other than
Staphylococcus aureus (if obtained)