| Case definitions |
| Confirmed case | A case that meets the clinical criteria and with isolation of group A Streptococcus from a normally sterile site (eg, blood or cerebrospinal fluid or, less commonly, joint, pleural, or pericardial fluid). |
| Probable case | A case that meets the clinical criteria in the absence of another identified etiology for the illness and with isolation of group A Streptococcus from a nonsterile site (eg, throat, skin, vaginal culture). |
| Clinical criteria |
- Hypotension (defined as SBP ≤90 mmHg for adults or <5th percentile for age for children <16 years).
- Multi-organ involvement characterized by two or more of the following:
- Kidney impairment (defined as serum Cr ≥2 mg/dL [177 µmol/L] in adults or ≥2 × ULN for age in children; the definition in patients with pre-existing kidney disease is a >2-fold elevation over the baseline level).
- Coagulopathy (defined as platelet count ≤100,000/microL [100 × 106/L] or DIC [ie, prolonged clotting times, low fibrinogen level, and the presence of fibrin degradation products]).
- Liver involvement (ie, ALT, AST, or total bilirubin levels ≥2 × ULN for the patient's age. In patients with pre-existing liver disease, a >2-fold increase over the baseline level).
- ARDS (ie, acute onset of diffuse pulmonary infiltrates and hypoxemia in the absence of cardiac failure).
- A generalized erythematous macular rash that may desquamate.
- Soft-tissue necrosis, including necrotizing fasciitis or myositis, or gangrene.
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| Laboratory criteria |
- Isolation of group A Streptococcus
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