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 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
aged less than16 years; 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/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, 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
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