existing renal disease, elevation over baseline by a factor of at least 2; Coagulopathy: platelet count of ≤100x109/L or disseminated intravascular coagulation, defined by prolonged clotting times, low fibrinogen level, and the presence of fibrin degradation products; involvement: alanine aminotransferase (ALT), aspartate aminotransferase (AST), or total bilirubin level at least twice the upper limit of normal for age; in patients with existing liver disease, elevation over baseline by a factor of 2; Adult respiratory distress syndrome, defined by acute onset of diffuse pulmonary infiltrates and hypoxaemia in the absence of cardiac failure; or evidence of diffuse capillary leak manifested by acute onset or generalised oedema; or pleural or peritoneal effusions with hypoalbuminaemia; Generalised erythematous macular rash that may desquamate; the presence of fibrin degradation products Liver involvement: alanine aminotransferase, or total bilirubin level at least twice the upper limit of normal for age; in patients with existing liver disease, elevation over baseline by a factor of two respiratory distress syndrome: defined by acute onset of diffuse pulmonary infiltrates and hypoxaemia in the absence of cardiac failure; or evidence of diffuse capillary leak manifested by acute onset or generalised oedema; or pleural or peritoneal effusions with hypoalbuminaemia Generalised erythematous macular rash that may desquamate Soft tissue necrosis, including necrotising fasciitis or myositis; or gangrene. A definite case is an illness fulfilling criteria IA and II (A and B). A probable case is an illness fulfilling criteria IB and II (A and B) where no other aetiology is identified. (Working Group on Severe Streptococcal Infections 1993).
Soft tissue necrosis, including necrotising fasciitis or myositis; or gangrene. A definite case is an illness fulfilling criteria IA and II (A and B). A probable case is an illness fulfilling criteria IB and II (A and B) where no other aetiology is identified. (Working Group on Severe Streptococcal Infections 1993). Staphylococcal TSS is defined by: Fever: temperature ≥38.9°C; Hypotension: systolic blood pressure ≤90 mmHg in adults or in the 5th percentile for age in children; Diffuse macular rash with subsequent desquamation one to two weeks after onset (including palms and soles); Multisystem involvement (three or more of the following): Hepatic: bilirubin or aminotransferase ≥2 times normal; Staphylococcal TSS is defined by : Fever: temperature ≥38.9C Hypotension: systolic blood pressure ≤90 mmHg Diffuse macular rash with subsequent desquamation one or two weeks after onset (including palms and soles) Multisystem involvement (three or more of the following): Hepatic: bilirubin or aminotransferase ≥2 times normal Haematologic: platelet count ≤100 x 109/L Renal: blood urea nitrogen or serum creatinine level ≥2 times normal Mucous membranes: vaginal, oropharyngeal or conjunctival hyperaemia Gastrointestinal: vomiting or diarrhoea at illness Muscular: severe myalgia or serum creatinine phosphokinase level ≥2 times upper limit Central nervous system: disorientation or alteration in consciousness without focal neurological signs and in the absence of fever or hypotension.
Qualifying Criteria Diagnosis of streptococcal or staphylococcal TSS in accordance with criteria listed above, preferably with isolation of organism; AND Failure to achieve rapid improvement with fluid resuscitation, inotropes, surgery, antibiotic therapy and other supportive measures. Early use in streptococcal TSS. Probable or confirmed diagnosis of streptococcal TSS. AND Failure to achieve rapid improvement with supportive measures. Staphylococcal TSS where rapid improvement is not obtained with fluid resuscitation, inotropes, surgery, antibiotic therapy and other supportive measures. Probable or confirmed diagnosis of staphylococcal TSS. AND Failure to achieve rapid improvement with supportive measures. Qualifying criteria have been defined in line with existing criteria - requiring confirmed or suspected diagnosis and failure to achieve rapid improvement with supportive measures. Review Criteria N/A Early use in streptococcal TSS. Review is not mandated for this indication however the following criteria may be useful in assessing the effectiveness of therapy. Outcome data to be measured One month survival Documented clinical response to Ig therapy. Staphylococcal TSS where rapid improvement is not obtained with fluid resuscitation, inotropes Given that TSS requires one-off treatment, there is no review with automatic patient outcome data collection. Outcome measures have been developed including: One month survival Patient and recovered Patient still in ICU Patient rehabilitating Patient deceased