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

From: Streptococcal toxic shock syndrome in the intensive care unit

Clinical criteria: An illness with the following clinical manifestationsa  
 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  
  1. aClinical manifestations do not need to be detected within the first 48 h of hospitalization or illness, as specified in the 1996 case definition [24]. The specification of the 48-h time constraint was for the purpose of assessing whether the case was considered nosocomial, not whether it was a case or not