![]() Additionally, death certificates assigned the ICD-10 code for TSS (A48.3) and cases from the Minnesota Unexplained Critical Illness and Death of Possible Infectious Etiology project (UNEX) ( 9) during 2000–2003 were reviewed. Each medical record was reviewed for TSS case criteria and pertinent epidemiologic and clinical information. Medical records from all hospitalizations receiving the TSS-specific code (040.82 or 040.89) were reviewed ( Figure), and a 20% random sample of medical records from hospitalizations that received >1 nonspecific TSS study code ( Table 2) from within each hospital was reviewed. Requests were sent to medical record departments of these hospitals for data on inpatients discharged from hospitals from January 1, 2000, through December 31, 2003, whose medical records indicated >1 of the select ICD-9 study codes. The MSP area is composed of 7 counties with a population of 2,642,056 (2000 US Census) and 24 acute-care hospitals. Meets laboratory criteria and in which all 5 of the clinical findings described above are present, including desquamation, unless the patient dies before desquamation occurs Meets laboratory criteria and in which 4 of 5 clinical findings described above are present If obtained, no increase in titer for Rocky Mountain spotted fever, leptospirosis, or measles ![]() If obtained, negative results on blood, throat, or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus) Total bilirubin, alanine aminotransferase, or aspartate aminotransferase levels at least twice the upper limit of normalĭisorientation or alterations in consciousness with focal neurologic signs when fever and hypotension are absent Vaginal, oropharyngeal, or conjunctival hyperemiaīlood urea nitrogen or creatinine at least twice the upper limit of normal for laboratory or urinary sediment with pyuria ( >5 leukocytes by high-power field) in the absence of urinary tract infection Severe myalgia or creatine phosphokinase level at least twice the upper limit of normal Systolic blood pressure 5 mm Hg from lying to sitting, orthostatic syncope, or orthostatic dizziness Given the complexity of the case definition, we suspected that TSS underreporting was likely.ġ–2 weeks after onset of illness, particularly on the palms and soles MDH uses the 1997 case definition of the Centers for Disease Control and Prevention (CDC) (Atlanta, GA, USA) to determine case criteria for any probable TSS case ( >4 clinical criteria and laboratory criteria) considered reportable ( Table 1) ( 5). In subsequent years, surveillance methods in Minnesota were changed to a solely passive surveillance system that relied on clinicians to report cases. The national incidence of TSS decreased during 1980–1996 ( 3, 4) after removal of high-absorbency tampons from the market and public awareness campaigns. In January 1980, the Minnesota Department of Health (MDH) initiated surveillance for TSS with active and passive components. ![]() First named in 1978, TSS has been associated with tampon use, intravaginal contraceptive devices, and skin infections, particularly after surgical procedures ( 1, 2). Staphylococcal toxic shock syndrome (TSS) is a severe illness associated with toxin-producing Staphylococcus aureus.
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