CLINICAL DESCRIPTION

An illness with the following clinical manifestations:

• Fever: temperature greater than or equal to 102.0 F (38.9 C)
• Rash: diffuse macular erythroderma
• Desquamation: 1 to 2 weeks after onset of illness, particularly on the palms and soles
• Hypotension: systolic blood pressure less than or equal to 90 mm Hg for adults or less than fifth percentile by age for children less than 16 years of age; orthostatic drop in diastolic blood pressure greater than or equal to 15 mm Hg from lying to sitting, orthostatic syncope, or orthostatic dizziness
• Multisystem involvement (three or more of the following):
  • 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 per cubic mm
  • 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, throat, or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus)
  • Rise in titer to Rocky Mountain spotted fever, leptospirosis, or measles

CASE CLASSIFICATION

1. CONFIRMED

   A case in which all six of the clinical findings described above are present, including desquamation, unless the patient dies before desquamation occurs.
   

   
   

2. PROBABLE

   A case in which five of the six clinical findings described above are present.

   
   

3. POSSIBLE
   
   Not used.