Table 1 Clinical criteria for streptococcal toxic shock syndrome based on CDC definitions [13]

Clinical criteria: An illness with the following clinical manifestations^a

 Hypotension defined by a systolic blood pressure less than or equal to 90 mmHg for adults or less than the fifth percentile by age for children aged less than 16 years

 Multiple organ involvement characterized by two or more of the following

  Renal impairment: Creatinin ≥ 2 mg/dL (≥ 177 µmol/L) for adults or ≥ twice the upper limit of normal for age. In patients with preexisting renal disease, > twofold elevation baseline creatinine levels

  Coagulopathy: Platelets ≤ 100,000/mm³ (≤ 100 × 10⁶/L) and/or disseminated intravascular coagulation, defined by prolonged clotting times, low fibrinogen level, and the presence of fibrin degradation products

  Liver involvement: Alanine aminotransferase, aspartate aminotransferase, or total bilirubin levels ≥ twice the upper limit of normal for the patient’s age. In patients with preexisting liver disease, a > twofold increase over baseline levels

  Acute respiratory distress syndrome: defined by acute onset of diffuse pulmonary infiltrates and hypoxemia in the absence of cardiac failure or by evidence of diffuse capillary leak manifested by acute onset of generalized edema, or pleural or peritoneal effusions with hypoalbuminemia

  A generalized erythematous macular rash that may desquamate

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

Laboratory criteria for diagnosis

 Isolation of group A streptococcus